[Guideline for the non-pharmacological treatment of COPD]

The non-pharmacological treatment of patients with chronic obstructive pulmonary disease (COPD) comprises a large number of related components. Active case-finding is advocated in (ex-)smokers above the age of 40 who either cough or have 2 respiratory-tract infections per year. Structured self-management programmes may have positive effects; follow-up is of importance to prevent relapse of unhealthy behaviour. Patients with COPD must not smoke. Exercise training is essential in all stages of COPD; an exercise test should be done first, especially in severe COPD. Exercise training should preferably be incorporated in a pulmonary-rehabilitation programme if other components of such a programme are also indicated. Certain breathing exercises may be considered in patients that feel anxious or tense. Nutritional support combined with exercise training should be considered in patients with severe COPD and underweight, involuntary weight loss or a deficiency of fat-free mass. There are limited indications that psychosocial interventions may have a positive effect on the well-being and psychosocial function of patients with COPD. An exercise test to assess the maximum tolerated energy expenditure is indicated in COPD patients that experience limitations on their physical capabilities during work. Maintenance therapy with supplemental oxygen should be considered in case of hypoxia (PaO2 < 7.3 kPa) and if the PaO2 = 7.3-8.0 kPa combined with indications of pulmonary hypertension, peripheral oedema or a haematocrit > 0.55. A yearly influenza vaccination is indicated.