Non-Pharmacological Management

In addition to pharmacological therapies, several non-drug strategies play an important role in the management of COPD exacerbations.

Oxygen Therapy

• Titrated to maintain oxygen saturation >90% with a target PaO2 >60 mmHg.
• Caution in COPD patients with chronic hypercapnia, as oxygen therapy can worsen hypercapnia and respiratory acidosis.
• Continuous pulse oximetry monitoring is recommended to titrate oxygen and detect acute hypercapnia.
• Devices include nasal cannula, simple face mask, non-rebreather mask. High-flow nasal cannula may be used in respiratory failure.

Ventilatory Support

• Noninvasive ventilation (NIV) indicated for acute hypercapnic respiratory failure. Continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) delivered via face or nasal mask.
• Improves gas exchange, reduces intubation risk and mortality. Contraindicated in severe acidosis, hemodynamic instability, inability to protect airway.
• Invasive mechanical ventilation is indicated if NIV fails or is contraindicated.

Pulmonary Rehabilitation

• Exercise training, self-management education, and psychosocial support after hospital discharge.
• Reduces hospital readmissions and mortality and improves quality of life and exercise capacity.

Lifestyle Modifications

• Smoking cessation to prevent future exacerbations. Counseling and pharmacotherapy significantly improve quit rates.
• Avoidance of outdoor air pollution and secondhand smoke. Air filtration systems may be beneficial.
• Treatment of comorbid conditions like heart failure, obesity, and anxiety/depression.
• Flu and pneumococcal vaccination to reduce infection risk.

Non-pharmacological therapies complement medical management to maximize recovery, preserve lung function, and prevent future exacerbations.