Non-pharmacologic Prevention of AECOPD.

Chronic obstructive pulmonary disease (COPD) is a major global health issue, with acute exacerbations (AECOPD) significantly worsening outcomes and increasing healthcare burden. This review explores non-pharmacologic strategies aimed at preventing AECOPD. Pulmonary rehabilitation consistently demonstrates its effectiveness in reducing exacerbations and mortality while improving exercise capacity and quality of life. Lung volume reduction, through both surgical and bronchoscopic methods, has shown promise in select patient groups, leading to improved lung function and reduced exacerbation risk. Smoking cessation remains a critical intervention, while the role of electronic cigarettes is still debated; some evidence suggests they may help patients unable to quit tobacco smoking. Vitamin D supplementation has shown potential in reducing exacerbations, particularly in patients with severe deficiency, though conflicting results warrant further research. Furthermore, shielding measures, such as mask-wearing and social distancing, have gained attention during the COVID-19 pandemic for their role in reducing exacerbation risk. Lastly, vaccination, diet and nutrition, and non-invasive ventilation (NIV) may have important role in the prevention of AECOPD. These non-pharmacologic approaches should be integrated into comprehensive COPD management to improve outcomes and prevent AECOPD.