Non-pharmacologic treatments post-COPD exacerbation

In the short term it is essential to give oxygen. It may be difficult to keep a mask on her and nasal prongs might be better. Be aware that similar to patients with respiratory failure and elevated pCO2, she may not be able to tolerate a high concentration of oxygen. Consider a Venturi mask with controlled low oxygen flow.
Physiotherapy is also very helpful in assisting expulsion of sputum and improving volume of inspired and expired air.
In the longer term multidisciplinary pulmonary rehabilitation programs are a substantial benefit for patients with COPD. The main components of these programs are graduated increments in exercise to train skeletal and accessory respiratory muscles to their maximal level of performance. This increase in muscle performance translates to increased exercise tolerance and improvements in health related quality of life. There is increasing evidence that pulmonary rehabilitation reduces frequency of admissions and length of hospital stay. A pulmonary rehabilitation program can be initiated immediately following an acute exacerbation and has shown to be safe.
Support for smoking cessation is critical because her COPD is due to cigarette smoking. She has probably been told this fact several times so your advice will not be new. You need to tell her in an understanding way that continued smoking will further aggravate her lung condition. You should initiate discussions about smoking cessation programs and the use of nicotine replacement to deal with aspects of nicotine withdrawal.
Although vaccines are not strictly a non-drug therapy, this is an important consideration. You should make a note to have Mrs Umaga immunised against influenza annually, ideally before the influenza season begins. Pneumococcal vaccination is also recommended.


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