Non-drug treatments

Photo of an elderly man on a walk

If you have , the most important thing you can do is to stop smoking completely. Exercise and special rehabilitation programs (pulmonary rehabilitation) can help you maintain your physical fitness as much as possible, and to better manage the disease.

Non-drug treatments for include quitting smoking, 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 , oxygen therapy can help make it easier to breathe and compensate for the lack of oxygen.

Why is quitting smoking so important?

Smoking is the main cause of , so quitting smoking is the most effective thing you can do 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.

Good to know

There’s not a big difference between smoking 5 cigarettes a day and smoking 30 cigarettes a day in terms of how your lungs function. For that reason, experts strongly recommend quitting completely.

What can physical exercise do?

Sports and exercise can improve your physical performance and quality of life. Regular exercise improves your stamina to make it easier to breathe.

Types of exercise often recommended for people with include things like brisk walking, jogging, cycling, physical exercises, swimming, breathing exercises, dancing, tai chi, qigong and pilates.

It is not clear whether one type of exercise is better than others – that will depend on the severity of the , 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.

Can respiratory physiotherapy help?

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) physiotherapy. This type of therapy also includes practicing using respirators, usually under the instruction of a .

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.

What does patient education involve?

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 as best you can.

These patient education programs are a part of the disease management program (DMP) for . In Germany and other countries, the statutory health insurers offer DMPs for people with chronic diseases.

What is pulmonary rehabilitation?

People with can apply for pulmonary rehabilitation (PR). This program lasts several weeks and includes physical training, patient education, respiratory physiotherapy, 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 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 . 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 . Your doctor can help you assess whether further rehabilitation is a good idea.

Pulmonary rehabilitation is also an important part of the disease management program (DMP).

When is it a good idea to get dietary advice?

Some people with 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 can gain weight and muscle strength by eating a high-calorie diet. But it is not clear whether this can also help improve other 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.

How do oxygen therapy and breathing support masks work?

In later stages of , breathing on your own may be too exhausting because it tires out your breathing muscles. Oxygen therapy is often needed at this stage of . 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 .

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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. 2018.

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Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2022 Report. 2022.

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IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

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. 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.

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Updated on December 28, 2022

Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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