Download PDF
Semin Respir Crit Care Med
DOI: 10.1055/a-2818-1471
Invited Review Article

Non-pharmacological treatment of AECOPD

Authors

  • Giulia Panzuti

    1   Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy., Università di Bologna, Bologna, Italy (Ringgold ID: RIN9296)
    2   Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico di Sant'Orsola, Bologna, Italy (Ringgold ID: RIN18508)

  • Tommaso Zanaboni

    3   Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy., University of Bologna, Bologna, Italy (Ringgold ID: RIN9296)
    4   Respiratory and Critical Care Unit, IRCCS University Hospital of Bologna Sant Orsola Polyclinic, Bologna, Italy (Ringgold ID: RIN18508)

  • Lara Pisani

    5   Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy., University of Bologna, Bologna, Italy (Ringgold ID: RIN9296)
    4   Respiratory and Critical Care Unit, IRCCS University Hospital of Bologna Sant Orsola Polyclinic, Bologna, Italy (Ringgold ID: RIN18508)
Further Information
 PDF Download

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, non-pharmacological interventions play a crucial role in stabilizing patients, reducing complications, and promoting functional recovery. Respiratory strategies—including conventional oxygen therapy (COT), high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), and invasive mechanical ventilation (IMV)—is 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 tele-rehabilitation, 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, though 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 non-pharmacological 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.



Publication History

Received: 15 January 2026

Accepted: 19 February 2026

Accepted Manuscript online:
24 February 2026

© . Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA