Treatments without medication

Smoking is the main cause of COPD, so quitting smoking is the most effective thing you can do to slow down the progression of the disease. On top of that, quitting smoking can lower your risk of developing other diseases. Various things can help you quit. The main ones are behavioral training approaches 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.

Sports and exercise can improve your physical performance and your breathing. Regular exercise improves your stamina, making it easier to breathe.

Types of exercise often recommended for people with COPD 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 more suitable 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 an exercise program. Some activities may be too risky if you have severe breathing difficulties or a heart condition, for instance.

Regularly doing breathing exercises can increase your lung volume, strengthen your breathing muscles and prevent shortness of breath. This improves your stamina during physical activities. 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 breathing devices, usually under the instruction of a physiotherapist.

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 stop 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.

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 symptoms and dealing with acute breathing difficulties. The general aim of patient education is to help you cope with COPD as best you can.

These patient education programs are a part of the disease management program (DMP) for COPD. Public health insurers in Germany offer DMPs for people with chronic diseases.

People with COPD can apply for pulmonary rehabilitation. This program lasts several weeks and includes physical exercise, patient education, respiratory physiotherapy, dietary advice, and strategies to help you quit smoking. Pulmonary rehabilitation is offered in specialized clinics or an outpatient setting. 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 people whose COPD symptoms stay the same over long periods of time as well as 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 it's a good idea to apply for another pulmonary rehabilitation program after some time.

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

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.

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.