Nonpharmacological Treatment of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) are acute events characterized by rapid worsening of dyspnea, cough, and sputum production, often leading to gas exchange impairment, ventilatory failure, and hospitalization. While pharmacological therapy remains central for managing the acute phase, nonpharmacological interventions play a crucial role in stabilizing patients, reducing complications, and promoting functional recovery. Respiratory strategies-including conventional oxygen therapy, high-flow nasal cannula, noninvasive ventilation, and invasive mechanical ventilation-are tailored to disease severity and underlying pathophysiology, aiming to unload respiratory muscles, improve ventilation, and optimize gas exchange. Pulmonary rehabilitation (PR) is essential to counteract skeletal and respiratory muscle dysfunction, sarcopenia, and exercise intolerance, thereby enhancing quality of life (QoL) and physical performance. Nutritional management addresses malnutrition, negative energy balance, and micronutrient deficiencies, supporting muscle preservation, immune function, and overall recovery. Home-based care models, including hospital-at-home programs and telerehabilitation, reduce hospital stays, facilitate early discharge, and improve access to structured PR programs. Structured self-management strategies and individualized exacerbation action plans empower patients, enhance symptom control, and reduce hospital readmissions, although their effectiveness may vary according to patient health literacy. Integrating these interventions into a comprehensive, multidisciplinary care pathway addresses both acute physiological derangements and long-term functional decline. Emerging digital health solutions-including telemonitoring, wearable sensors, and artificial intelligence-based predictive models-offer opportunities for early detection, personalized interventions, and enhanced patient engagement. This review synthesizes current evidence on nonpharmacological management of AECOPD, highlighting practical strategies to optimize respiratory support, rehabilitation, nutritional interventions, and self-management, ultimately aiming to accelerate recovery, prevent relapse, and improve QoL in this high-risk patient population.