As well as medication, various other treatments can help people with COPD. Special rehabilitation programs (pulmonary rehabilitation) and physical exercise are the most effective.
Non-drug treatments for COPD include exercise that takes into account the physical limitations caused by the disease, breathing exercises, and special rehabilitation and patient education programs. These treatments can help you maintain physical fitness, improve your breathing and make it easier to deal with acute symptoms. Many of them can be integrated into your daily life.
If you have severe COPD, oxygen therapy can help make it easier to breathe and compensate for the lack of oxygen.
Sports and exercise can improve your physical performance and quality of life. Regular exercise improves your stamina so you don’t get out of breath so quickly.
Types of exercise often recommended for people with COPD include things like brisk walking, jogging, cycling, physical exercises, swimming, breathing exercises, dancing, tai chi and qigong.
It is not clear whether one type of exercise is better than others – that will depend on the severity of the COPD, your individual level of physical fitness and your personal preferences. It is important to have a medical check-up before starting a program. Some activities may be too risky if you have, for instance, severe breathing difficulties or a heart condition.
Regular breathing exercises can increase your lung volume, strengthen your breathing muscles, and prevent shortness of breath. This improves your stamina during physical exercise. The exercises can also make it easier to cough up phlegm. And they can help you to manage acute shortness of breath.
The exercises are part of respiratory (breathing) therapy. This therapy also includes practicing using respirators, usually under the instruction of a physiotherapist.
What can you do if you have acute breathing difficulties?
If you have an acute episode of shortness of breath (called a flare-up or exacerbation), "pursed-lip breathing" and a special sitting posture known as the “tripod position” are recommended. Both of these make breathing easier and keep the airways from narrowing even more. In pursed lip-breathing, you calmly breathe in through your nose, then press your lips together and slowly breathe out through your mouth. The tripod position involves sitting with your legs apart on a chair, leaning forward, and resting your forearms on your upper thighs. Alternatively you can rest your arms on a table and lay your head on them.
In Germany and other countries, people with COPD can apply for pulmonary rehabilitation (PR). This program lasts several weeks and includes physical training, patient education, respiratory therapy, dietary advice, and strategies to help you quit smoking. Pulmonary rehabilitation is offered in specialized clinics or as outpatient therapy. The aim is to help you cope better with your COPD and to live as normal a life as possible despite the limitations the disease causes.
Studies have shown that pulmonary rehabilitation can improve quality of life and make it easier to cope with COPD. People who used to have frequent flare-ups need to go to the hospital less often in the first few years following rehabilitation.
Rehabilitation can increase physical fitness and make it possible to walk longer distances again without getting out of breath. The risk of having to go to the hospital because of acute shortness of breath may be lower in the first few years after participating in the program. Pulmonary rehabilitation can help both people whose symptoms stay the same over long periods of time and people who have frequent flare-ups.
Because improvements through rehabilitation alone don't last for long, it's important to continue doing things like breathing exercises and physical exercises on your own in everyday life. Another option is to take part in regular exercise or breathing programs for people with COPD. Your doctor can help you assess whether further rehabilitation is a good idea.
Smoking is the main cause of COPD, so quitting smoking is one of the most effective measures to keep the condition from getting worse. On top of that, quitting smoking can lower your risk of developing other diseases. There are a number of strategies that can help you quit. The main ones are behavioral therapy and medication. Both are effective, either on their own or in combination with each other.
Various medications and types of nicotine replacement therapy are available to help you quit smoking. The side effects vary depending on the type of treatment.
Some people with COPD lose a lot of weight over time. Their muscles become weaker and they become less fit. If you lose a lot of weight, dietary advice or nutritional therapy can be a good idea. It is then important to weigh yourself regularly. Taking high-calorie supplements is sometimes helpful. Studies show that underweight people with COPD can gain weight and muscle strength by eating a high-calorie diet. But it is not clear whether this can also help improve other COPD symptoms.
On the other hand, being severely overweight can also reduce your fitness. One thing you can then do to help you lose weight is make changes to your diet.
Oxygen therapy and breathing support masks
In later stages of COPD, breathing on your own may be too exhausting because it tires out your breathing muscles. Oxygen therapy is often needed at this stage of COPD. There are different types of oxygen devices:
- Oxygen concentrators: These devices are set up in a room to be used for oxygen therapy. They draw in oxygen from the air and then increase the oxygen concentration. The enriched oxygen is breathed in through a thin tube (nasal cannula) in your nose.
- Oxygen tank: Oxygen tanks are usually portable and also release oxygen through a nasal cannula. Their advantage is that you can move about quite freely and even leave the house. But the oxygen has to be replaced or refilled regularly.
Oxygen therapy is often needed at least 15 hours a day, and might also be used while sleeping. Some people only need it occasionally in specific situations, like before or during physical activity.
Special masks that support your breathing are another option. They cover your mouth and nose, and blow pressurized oxygen into your lungs. This takes some of the burden off exhausted breathing muscles. The mask takes some getting used to at first. It needs to be worn for 8 to 14 hours per day, depending on the severity of the COPD.
Education programs can help you learn things like how to take medication properly and use oxygen devices correctly. They can also teach you special inhalation techniques and offer advice on preventing and dealing with acute breathing difficulties. The general aim of patient education is to help you cope with COPD as best you can. Patient education programs are a part of disease management programs (DMPs).
Beauchamp MK, Evans R, Janaudis-Ferreira T, Goldstein RS, Brooks D. Systematic review of supervised exercise programs after pulmonary rehabilitation in individuals with COPD. Chest 2013; 144(4): 1124-1133.
Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Deutsche Atemwegsliga, Österreichische Gesellschaft für Pneumologie (ÖGP). S2k-Leitlinie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD). AWMF-Registernr.: 020-006. January 24, 2018.
Ding M, Zhang W, Li K, Chen X. Effectiveness of t'ai chi and qigong on chronic obstructive pulmonary disease: a systematic review and meta-analysis. J Altern Complement Med 2014; 20(2): 79-86.
Ferreira IM, Brooks D, White J, Goldstein R. Nutritional supplementation for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2012; (12): CD000998.
Global initiative for Chronic Obstrunctive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstrunctive pulmonary disease - 2019 Report. 2019.
Holland AE, Hill CJ, Jones AY, McDonald CF. Breathing exercises for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2012; (10): CD008250.
Howcroft M, Walters EH, Wood-Baker R, Walters JA. Action plans with brief patient education for exacerbations in chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2016; (12): CD005074.
Lenferink A, Brusse-Keizer M, van der Valk PD, Frith PA, Zwerink M, Monninkhof EM et al. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017; (8): CD011682.
McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2015; (2): CD003793.
McNamara RJ, McKeough ZJ, McKenzie DK, Alison JA. Water-based exercise training for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2013; (12): CD008290.
Ngai SP, Jones AY, Tam WW. Tai Chi for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2016; (6): CD009953.
Puhan MA, Gimeno-Santos E, Cates CJ, Troosters T. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2016; (12): CD005305.
Thomas MJ, Simpson J, Riley R, Grant E. The impact of home-based physiotherapy interventions on breathlessness during activities of daily living in severe COPD: a systematic review. Physiotherapy 2010; 96(2): 108-119.
Van Eerd EA, van der Meer RM, van Schayck OC, Kotz D. Smoking cessation for people with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2016; (8): CD010744.
IQWiG health information is written with the aim of helping
people understand the advantages and disadvantages of the main treatment options and health
Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.
Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.