An Overview of the Non- Pharmacological and Non-surgical Management of Chronic Obstructive Pulmonary Disease

Main Article Content

Akwe Joyce, MD, MPH Nadene Fair, MD Tatah Fongeh, MD


Over the years, the management of chronic obstructive pulmonary disease has evolved, but given the high mortality and morbidity of COPD, much work still needs to be done. To date, none of the existing pharmacological therapies for COPD has been shown conclusively to modify the long-term decline in lung function. Several trials have been completed to evaluate options that can improve patient symptoms and quality of life.

Optimal management for patients with COPD requires both pharmacological and non-pharmacological managements. Some of the non-pharmacological options for the management of COPD like Oxygen therapy have proven reduction in mortality and mortality, and an improvement in the quality of life. Lung transplant is the only treatment that can stop the decline in lung function. Smoking cessation is the non-pharmacological intervention with the greatest capacity to influence the natural course of COPD. Pulmonary rehabilitation programs are evidence based, multidisciplinary and comprehensive interventions for patients with COPD. These programs involve patient assessment, exercise training, education, nutrition and psychosocial support. Pulmonary rehabilitation programs are designed to reduce symptoms, optimize functional status, increase participation and reduce health care cost through stabilizing or reversing systemic manifestations of the disease.

This article discusses the most used non pharmacological management of COPD and their usefulness in relieving symptoms and improving the quality of life for patients with severe COPD. These treatment options are used in addition to optimal pharmacological therapy.

Article Details

How to Cite
JOYCE, Akwe; FAIR, Nadene; FONGEH, Tatah. An Overview of the Non- Pharmacological and Non-surgical Management of Chronic Obstructive Pulmonary Disease. Medical Research Archives, [S.l.], v. 8, n. 6, june 2020. ISSN 2375-1924. Available at: <>. Date accessed: 15 july 2020. doi:
Research Articles


1. Akwe, Joyce and Fair, Nadene, Chronic Obstructive Pulmonary Disease: An Overview of Epidemiology, Pathophysiology, Diagnosis, Staging and Management (March 31, 2016). International Journal of Clinical and Experimental Medical Sciences, 2016; 2(2): 13-25. Available at SSRN: 2(2): 13-25. Available at SSRN: In: Fair, ed2016.
2. Gold Reports 2020 - Global Initiative for Chronic Obstructive Pulmonary Disease PDF. The GOLD 2020 report is a revision of the GOLD 2019 report. ... What is (and what is not) a COPD exacerbation: thoughts from the new GOLD guidelines. › 2019/11 › GOLD-2020-REPORT-ver1.0wms.pdf Published 2019/11.
3. Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350(10):1005-1012.
4. Friedman M, Hilleman DE. Economic burden of chronic obstructive pulmonary disease. Impact of new treatment options. Pharmacoeconomics. 2001;19(3):245-254.
5. Miratvilles M, Murio C,Guerrero T, Gisbert R, on behalf of the DAFNE Study Group. Cost of chronic bronchitis and COPD. A 1-year follow-up study. Chest.2003; 123:784–791. 2003.
6. Faulkner MA, Hilleman DE. The economic impact of chronic obstructive pulmonary disease. Expert Opin Pharmacother. 2002;3(3):219-228.
7. Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532-555.
8. Calverley PM. Reducing the frequency and severity of exacerbations of chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2004;1(2):121-124.
9. Kanner RE, Connett JE, Williams DE, Buist AS. Effects of randomized assignment to a smoking cessation intervention and changes in smoking habits on respiratory symptoms in smokers with early chronic obstructive pulmonary disease: the Lung Health Study. Am J Med. 1999;106(4):410-416.
10. Anthonisen NR, Skeans MA, Wise RA, Manfreda J, Kanner RE, Connett JE. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med. 2005;142(4):233-239.
11. Faulkner MA, Lenz TL, Stading JA. Cost-effectiveness of smoking cessation and the implications for COPD. Int J Chron Obstruct Pulmon Dis. 2006;1(3):279-287.
12. Hoogendoorn M, Welsing P, Rutten-van Molken MP. Cost-effectiveness of varenicline compared with bupropion, NRT, and nortriptyline for smoking cessation in the Netherlands. Curr Med Res Opin. 2008;24(1):51-61.
13. 1. Johansson PM TP, Guldbrandsson KA,, LA. L. 1. Johansson PM, Tillgren PE, Guldbrandsson KA, Lindholm LA. A model for cost-effectiveness analyses of smoking cessation interventions applied to a Quit-and-Win contest for mothers of small children. Scand J Public Health. 2005;33:343–52. 2005.
14. J. T. Tsevat J. Impact and cost-effectiveness of smoking interventions. Am J Med. 1992;93:43S–7S. 1992.
15. Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev. 2016;3:Cd008286.
16. USPSTF. U.S. Preventive Services Task Force. Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions. September 2015. Published 2015. Accessed.
17. Hajek P, Etter JF, Benowitz N, Eissenberg T, McRobbie H. Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction. 2014;109(11):1801-1810.
18. Bullen C, Howe C, Laugesen M, et al. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet. 2013;382(9905):1629-1637.
19. Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev. 2013(5):Cd009329.
20. Hays JT, McFadden DD, Ebbert JO. Pharmacologic agents for tobacco dependence treatment: 2011 update. Curr Atheroscler Rep. 2012;14(1):85-92.
21. Waschki B, Kirsten A, Holz O, et al. Physical activity is the strongest predictor of all-cause mortality in patients with COPD: a prospective cohort study. Chest. 2011;140(2):331-342.
22. Alison JA, McKeough ZJ, Johnston K, et al. Australian and New Zealand Pulmonary Rehabilitation Guidelines. Respirology. 2017;22(4):800-819.
23. Nici L, Raskin J, Rochester CL, et al. Pulmonary rehabilitation: WHAT WE KNOW AND WHAT WE NEED TO KNOW. J Cardiopulm Rehabil Prev. 2009;29(3):141-151.
24. McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015(2):Cd003793.
25. Mulhall P, Criner G. Non-pharmacological treatments for COPD. Respirology. 2016;21(5):791-809.
26. Incorvaia C, Russo A, Foresi A, et al. Effects of pulmonary rehabilitation on lung function in chronic obstructive pulmonary disease: the FIRST study. Eur J Phys Rehabil Med. 2014;50(4):419-426.
27. Spruit MA. Pulmonary rehabilitation. Eur Respir Rev. 2014;23(131):55-63.
28. Holland AE, Mahal A, Hill CJ, et al. Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial. Thorax. 2017;72(1):57-65.
29. Holland AE, Cox NS. Telerehabilitation for COPD: Could pulmonary rehabilitation deliver on its promise? Respirology. 2017;22(4):626-627.
30. Maltais F, Bourbeau J, Shapiro S, et al. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2008;149(12):869-878.
31. Bourne S, DeVos R, North M, et al. Online versus face-to-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial. BMJ Open. 2017;7(7):e014580.
32. Horton EJ, Mitchell KE, Johnson-Warrington V, et al. Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: a randomised non-inferiority trial. Thorax. 2018;73(1):29-36.
33. Gordon CS, Waller JW, Cook RM, Cavalera SL, Lim WT, Osadnik CR. Effect of Pulmonary Rehabilitation on Symptoms of Anxiety and Depression in COPD: A Systematic Review and Meta-Analysis. Chest. 2019;156(1):80-91.
34. Gimenez M, Servera E, Vergara P, Bach JR, Polu JM. Endurance training in patients with chronic obstructive pulmonary disease: a comparison of high versus moderate intensity. Arch Phys Med Rehabil. 2000;81(1):102-109.
35. Lotters F, van Tol B, Kwakkel G, Gosselink R. Effects of controlled inspiratory muscle training in patients with COPD: a meta-analysis. Eur Respir J. 2002;20(3):570-576.
36. Roberts CM, Lowe D, Bucknall CE, Ryland I, Kelly Y, Pearson MG. Clinical audit indicators of outcome following admission to hospital with acute exacerbation of chronic obstructive pulmonary disease. Thorax. 2002;57(2):137-141.
37. Seemungal TA, Donaldson GC, Bhowmik A, Jeffries DJ, Wedzicha JA. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000;161(5):1608-1613.
38. Agusti A. Systemic effects of chronic obstructive pulmonary disease: what we know and what we don't know (but should). Proc Am Thorac Soc. 2007;4(7):522-525.
39. Swallow EB, Reyes D, Hopkinson NS, et al. Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease. Thorax. 2007;62(2):115-120.
40. Soler X, Gaio E, Powell FL, et al. High Prevalence of Obstructive Sleep Apnea in Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc. 2015;12(8):1219-1225.
41. Desveaux L, Janaudis-Ferreira T, Goldstein R, Brooks D. An international comparison of pulmonary rehabilitation: a systematic review. Copd. 2015;12(2):144-153.
42. Garvey C, Bayles MP, Hamm LF, et al. Pulmonary Rehabilitation Exercise Prescription in Chronic Obstructive Pulmonary Disease: Review of Selected Guidelines: AN OFFICIAL STATEMENT FROM THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION. J Cardiopulm Rehabil Prev. 2016;36(2):75-83.
43. Coquart JB, Grosbois JM, Olivier C, Bart F, Castres I, Wallaert B. Home-based neuromuscular electrical stimulation improves exercise tolerance and health-related quality of life in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2016;11:1189-1197.
44. Stoller JK, Panos RJ, Krachman S, Doherty DE, Make B. Oxygen therapy for patients with COPD: current evidence and the long-term oxygen treatment trial. Chest. 2010;138(1):179-187.
45. Austin MA, Wills KE, Blizzard L, Walters EH, Wood-Baker R. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. Bmj. 2010;341:c5462.
46. Tarpy SP, Celli BR. Long-term oxygen therapy. N Engl J Med. 1995;333(11):710-714.
47. Eaton T, Lewis C, Young P, Kennedy Y, Garrett JE, Kolbe J. Long-term oxygen therapy improves health-related quality of life. Respir Med. 2004;98(4):285-293.
48. Okubadejo AA, Paul EA, Jones PW, Wedzicha JA. Does long-term oxygen therapy affect quality of life in patients with chronic obstructive pulmonary disease and severe hypoxaemia? Eur Respir J. 1996;9(11):2335-2339.
49. Ringbaek TJ, Viskum K, Lange P. Does long-term oxygen therapy reduce hospitalisation in hypoxaemic chronic obstructive pulmonary disease? Eur Respir J. 2002;20(1):38-42.
50. Haidl P, Clement C, Wiese C, Dellweg D, Kohler D. Long-term oxygen therapy stops the natural decline of endurance in COPD patients with reversible hypercapnia. Respiration. 2004;71(4):342-347.
51. Tanni SE, Vale SA, Lopes PS, Guiotoko MM, Godoy I. Influence of the oxygen delivery system on the quality of life of patients with chronic hypoxemia. J Bras Pneumol. 2007;33(2):161-167.
52. Yamamoto H, Teramoto S, Yamaguchi Y, et al. Long-term oxygen administration reduces plasma adrenomedullin levels in patients with obstructive sleep apnea syndrome. Sleep Med. 2007;9(1):80-87.
53. Snider GL. Enhancement of exercise performance in COPD patients by hyperoxia: a call for research. Chest. 2002;122(5):1830-1836.
54. Somfay A, Porszasz J, Lee SM, Casaburi R. Dose-response effect of oxygen on hyperinflation and exercise endurance in nonhypoxaemic COPD patients. Eur Respir J. 2001;18(1):77-84.
55. Emtner M, Porszasz J, Burns M, Somfay A, Casaburi R. Benefits of supplemental oxygen in exercise training in nonhypoxemic chronic obstructive pulmonary disease patients. Am J Respir Crit Care Med. 2003;168(9):1034-1042.
56. O'Donnell DE, D'Arsigny C, Webb KA. Effects of hyperoxia on ventilatory limitation during exercise in advanced chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;163(4):892-898.
57. Lacasse Y, Lecours R, Pelletier C, Begin R, Maltais F. Randomised trial of ambulatory oxygen in oxygen-dependent COPD. Eur Respir J. 2005;25(6):1032-1038.
58. Ram FS, Wedzicha JA. Ambulatory oxygen for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2002(2):Cd000238.
59. Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med. 2015;11(3):259-270.
60. Croxton TL, Bailey WC. Long-term oxygen treatment in chronic obstructive pulmonary disease: recommendations for future research: an NHLBI workshop report. Am J Respir Crit Care Med. 2006;174(4):373-378.
61. Amani H, Lozano DD, Blome-Eberwein S. Brother, have you got a light? Assessing the need for intubation in patients sustaining burn injury secondary to home oxygen therapy. J Burn Care Res. 2012;33(6):e280-285.
62. Murabit A, Tredget EE. Review of burn injuries secondary to home oxygen. J Burn Care Res. 2012;33(2):212-217.
63. Sharma G, Meena R, Goodwin JS, Zhang W, Kuo YF, Duarte AG. Burn injury associated with home oxygen use in patients with chronic obstructive pulmonary disease. Mayo Clin Proc. 2015;90(4):492-499.
64. Carlos WG, Baker MS, McPherson KA, Bosslet GT, Sood R, Torke AM. Smoking-Related Home Oxygen Burn Injuries: Continued Cause for Alarm. Respiration. 2016;91(2):151-155.
65. Roca O, Hernandez G, Diaz-Lobato S, Carratala JM, Gutierrez RM, Masclans JR. Current evidence for the effectiveness of heated and humidified high flow nasal cannula supportive therapy in adult patients with respiratory failure. Crit Care. 2016;20(1):109.
66. Mauri T, Turrini C, Eronia N, et al. Physiologic Effects of High-Flow Nasal Cannula in Acute Hypoxemic Respiratory Failure. Am J Respir Crit Care Med. 2017;195(9):1207-1215.
67. Frat JP, Coudroy R, Marjanovic N, Thille AW. High-flow nasal oxygen therapy and noninvasive ventilation in the management of acute hypoxemic respiratory failure. Ann Transl Med. 2017;5(14):297.
68. Nagata K, Kikuchi T, Horie T, et al. Domiciliary High-Flow Nasal Cannula Oxygen Therapy for Patients with Stable Hypercapnic Chronic Obstructive Pulmonary Disease. A Multicenter Randomized Crossover Trial. Ann Am Thorac Soc. 2018;15(4):432-439.
69. Braunlich J, Dellweg D, Bastian A, et al. Nasal high-flow versus noninvasive ventilation in patients with chronic hypercapnic COPD. Int J Chron Obstruct Pulmon Dis. 2019;14:1411-1421.
70. Bruni A, Garofalo E, Cammarota G, et al. High Flow Through Nasal Cannula in Stable and Exacerbated Chronic Obstructive Pulmonary Disease Patients. Rev Recent Clin Trials. 2019;14(4):247-260.
71. Sjoberg F, Singer M. The medical use of oxygen: a time for critical reappraisal. J Intern Med. 2013;274(6):505-528.
72. Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995;333(13):817-822.
73. Ram FS, Picot J, Lightowler J, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2004(1):Cd004104.
74. Keenan SP, Sinuff T, Cook DJ, Hill NS. Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure ventilation? A systematic review of the literature. Ann Intern Med. 2003;138(11):861-870.
75. Williams JW, Jr., Cox CE, Hargett CW, et al. AHRQ Comparative Effectiveness Reviews. In: Noninvasive Positive-Pressure Ventilation (NPPV) for Acute Respiratory Failure. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012.
76. Lindenauer PK, Stefan MS, Shieh MS, Pekow PS, Rothberg MB, Hill NS. Outcomes associated with invasive and noninvasive ventilation among patients hospitalized with exacerbations of chronic obstructive pulmonary disease. JAMA Intern Med. 2014;174(12):1982-1993.
77. Keenan SP, Powers CE, McCormack DG. Noninvasive positive-pressure ventilation in patients with milder chronic obstructive pulmonary disease exacerbations: a randomized controlled trial. Respir Care. 2005;50(5):610-616.
78. Martin TJ, Hovis JD, Costantino JP, et al. A randomized, prospective evaluation of noninvasive ventilation for acute respiratory failure. Am J Respir Crit Care Med. 2000;161(3 Pt 1):807-813.
79. Plant PK, Owen JL, Elliott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet. 2000;355(9219):1931-1935.
80. Conti G, Antonelli M, Navalesi P, et al. Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med. 2002;28(12):1701-1707.
81. Kwok H, McCormack J, Cece R, Houtchens J, Hill NS. Controlled trial of oronasal versus nasal mask ventilation in the treatment of acute respiratory failure. Crit Care Med. 2003;31(2):468-473.
82. Safka KA, McIvor RA. Non-pharmacological management of chronic obstructive pulmonary disease. Ulster Med J. 2015;84(1):13-21.
83. Schettino G, Altobelli N, Kacmarek RM. Noninvasive positive pressure ventilation reverses acute respiratory failure in select "do-not-intubate" patients. Crit Care Med. 2005;33(9):1976-1982.
84. Diaz O, Iglesia R, Ferrer M, et al. Effects of noninvasive ventilation on pulmonary gas exchange and hemodynamics during acute hypercapnic exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1997;156(6):1840-1845.
85. Struik FM, Sprooten RT, Kerstjens HA, et al. Nocturnal non-invasive ventilation in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure: a randomised, controlled, parallel-group study. Thorax. 2014;69(9):826-834.
86. Marin JM, Soriano JB, Carrizo SJ, Boldova A, Celli BR. Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome. Am J Respir Crit Care Med. 2010;182(3):325-331.
87. Ambrosino N, Strambi S. New strategies to improve exercise tolerance in chronic obstructive pulmonary disease. Eur Respir J. 2004;24(2):313-322.
88. Ambrosino N. Assisted ventilation as an aid to exercise training: a mechanical doping? In: Eur Respir J. Vol 27. England2006:3-5.
89. Maltais F, Reissmann H, Gottfried SB. Pressure support reduces inspiratory effort and dyspnea during exercise in chronic airflow obstruction. Am J Respir Crit Care Med. 1995;151(4):1027-1033.
90. Polkey MI, Kyroussis D, Mills GH, et al. Inspiratory pressure support reduces slowing of inspiratory muscle relaxation rate during exhaustive treadmill walking in severe COPD. Am J Respir Crit Care Med. 1996;154(4 Pt 1):1146-1150.
91. Kyroussis D, Polkey MI, Hamnegard CH, Mills GH, Green M, Moxham J. Respiratory muscle activity in patients with COPD walking to exhaustion with and without pressure support. Eur Respir J. 2000;15(4):649-655.
92. Polkey MI, Hawkins P, Kyroussis D, Ellum SG, Sherwood R, Moxham J. Inspiratory pressure support prolongs exercise induced lactataemia in severe COPD. Thorax. 2000;55(7):547-549.
93. Keilty SE, Ponte J, Fleming TA, Moxham J. Effect of inspiratory pressure support on exercise tolerance and breathlessness in patients with severe stable chronic obstructive pulmonary disease. Thorax. 1994;49(10):990-994.
94. Bianchi L, Foglio K, Pagani M, Vitacca M, Rossi A, Ambrosino N. Effects of proportional assist ventilation on exercise tolerance in COPD patients with chronic hypercapnia. Eur Respir J. 1998;11(2):422-427.
95. Johnson JE, Gavin DJ, Adams-Dramiga S. Effects of training with heliox and noninvasive positive pressure ventilation on exercise ability in patients with severe COPD. Chest. 2002;122(2):464-472.
96. van 't Hul A, Kwakkel G, Gosselink R. The acute effects of noninvasive ventilatory support during exercise on exercise endurance and dyspnea in patients with chronic obstructive pulmonary disease: a systematic review. J Cardiopulm Rehabil. 2002;22(4):290-297.
97. Costes F, Agresti A, Court-Fortune I, Roche F, Vergnon JM, Barthelemy JC. Noninvasive ventilation during exercise training improves exercise tolerance in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2003;23(4):307-313.
98. van 't Hul A, Gosselink R, Hollander P, Postmus P, Kwakkel G. Training with inspiratory pressure support in patients with severe COPD. Eur Respir J. 2006;27(1):65-72.
99. van 't Hul A, Gosselink R, Hollander P, Postmus P, Kwakkel G. Acute effects of inspiratory pressure support during exercise in patients with COPD. Eur Respir J. 2004;23(1):34-40.
100. Levy M, Tanios MA, Nelson D, et al. Outcomes of patients with do-not-intubate orders treated with noninvasive ventilation. Crit Care Med. 2004;32(10):2002-2007.
101. Chu CM, Chan VL, Wong IW, Leung WS, Lin AW, Cheung KF. Noninvasive ventilation in patients with acute hypercapnic exacerbation of chronic obstructive pulmonary disease who refused endotracheal intubation. Crit Care Med. 2004;32(2):372-377.
102. Nava S, Sturani C, Harti S, et al. End-of-life decision-making in respiratory intermediate units: A european survey. Rev Port Pneumol. 2007;13(6):883-887.
103. Curtis JR, Cook DJ, Sinuff T, et al. Noninvasive positive pressure ventilation in critical and palliative care settings: understanding the goals of therapy. Crit Care Med. 2007;35(3):932-939.
104. Schols AM, Soeters PB, Mostert R, Pluymers RJ, Wouters EF. Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease. A placebo-controlled randomized trial. Am J Respir Crit Care Med. 1995;152(4 Pt 1):1268-1274.
105. Creutzberg EC, Wouters EF, Mostert R, Weling-Scheepers CA, Schols AM. Efficacy of nutritional supplementation therapy in depleted patients with chronic obstructive pulmonary disease. Nutrition. 2003;19(2):120-127.
106. Schols AM, Creutzberg EC, Buurman WA, Campfield LA, Saris WH, Wouters EF. Plasma leptin is related to proinflammatory status and dietary intake in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;160(4):1220-1226.
107. Engelen MP, Schols AM, Baken WC, Wesseling GJ, Wouters EF. Nutritional depletion in relation to respiratory and peripheral skeletal muscle function in out-patients with COPD. Eur Respir J. 1994;7(10):1793-1797.
108. Wouters EF. Nutrition and metabolism in COPD. Chest. 2000;117(5 Suppl 1):274s-280s.
109. Pouw EM, Ten Velde GP, Croonen BH, Kester AD, Schols AM, Wouters EF. Early non-elective readmission for chronic obstructive pulmonary disease is associated with weight loss. Clin Nutr. 2000;19(2):95-99.
110. Landbo C, Prescott E, Lange P, Vestbo J, Almdal TP. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;160(6):1856-1861.
111. Schols AM, Slangen J, Volovics L, Wouters EF. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157(6 Pt 1):1791-1797.
112. Guo Y, Zhang T, Wang Z, et al. Body mass index and mortality in chronic obstructive pulmonary disease: A dose-response meta-analysis. Medicine (Baltimore). 2016;95(28):e4225.
113. Gray-Donald K, Gibbons L, Shapiro SH, Macklem PT, Martin JG. Nutritional status and mortality in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1996;153(3):961-966.
114. Agusti AG, Noguera A, Sauleda J, Sala E, Pons J, Busquets X. Systemic effects of chronic obstructive pulmonary disease. Eur Respir J. 2003;21(2):347-360.
115. Engelen MP, Schols AM, Lamers RJ, Wouters EF. Different patterns of chronic tissue wasting among patients with chronic obstructive pulmonary disease. Clin Nutr. 1999;18(5):275-280.
116. Nicklas BJ, Tomoyasu N, Muir J, Goldberg AP. Effects of cigarette smoking and its cessation on body weight and plasma leptin levels. Metabolism. 1999;48(6):804-808.
117. Palange P, Forte S, Felli A, Galassetti P, Serra P, Carlone S. Nutritional state and exercise tolerance in patients with COPD. Chest. 1995;107(5):1206-1212.
118. MacNee W. Oxidative stress and lung inflammation in airways disease. Eur J Pharmacol. 2001;429(1-3):195-207.
119. Ferreira RM, de Souza ESNA, Salis LHA, et al. Troponin I elevation and all-cause mortality after elective percutaneous coronary interventions. Cardiovasc Revasc Med. 2017;18(4):255-260.
120. Ferreira IM, Brooks D, White J, Goldstein R. Nutritional supplementation for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012;12:Cd000998.
121. Gouzi F, Maury J, Heraud N, et al. Additional Effects of Nutritional Antioxidant Supplementation on Peripheral Muscle during Pulmonary Rehabilitation in COPD Patients: A Randomized Controlled Trial. Oxid Med Cell Longev. 2019;2019:5496346.
122. Rutschmann OT, Janssens JP, Vermeulen B, Sarasin FP. Knowledge of guidelines for the management of COPD: a survey of primary care physicians. Respir Med. 2004;98(10):932-937.
123. Kim DK, Bridges CB, Harriman KH. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older: United States, 2016. Ann Intern Med. 2016;164(3):184-194.
124. Cimen P, Unlu M, Kirakli C, et al. Should Patients With COPD Be Vaccinated? Respir Care. 2015;60(2):239-243.
125. Bekkat-Berkani R, Wilkinson T, Buchy P, et al. Seasonal influenza vaccination in patients with COPD: a systematic literature review. BMC Pulm Med. 2017;17(1):79.
126. Benzo R, McEvoy C. Effect of Health Coaching Delivered by a Respiratory Therapist or Nurse on Self-Management Abilities in Severe COPD: Analysis of a Large Randomized Study. Respir Care. 2019;64(9):1065-1072.
127. Corhay JL, Moermans C, Henket M, Nguyen Dang D, Duysinx B, Louis R. Increased of exhaled breath condensate neutrophil chemotaxis in acute exacerbation of COPD. Respir Res. 2014;15:115.
128. Lilly EJ, Senderovich H. Palliative care in chronic obstructive pulmonary disease. J Crit Care. 2016;35:150-154.
129. Pinnock H, Kendall M, Murray SA, et al. Living and dying with severe chronic obstructive pulmonary disease: multi-perspective longitudinal qualitative study. Bmj. 2011;342:d142.
130. Dajczman E, Wardini R, Kasymjanova G, Prefontaine D, Baltzan MA, Wolkove N. Six minute walk distance is a predictor of survival in patients with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation. Can Respir J. 2015;22(4):225-229.
131. Reticker AL, Nici L, ZuWallack R. Pulmonary rehabilitation and palliative care in COPD: Two sides of the same coin? Chron Respir Dis. 2012;9(2):107-116.
132. Gore JM, Brophy CJ, Greenstone MA. How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer. Thorax. 2000;55(12):1000-1006.
133. Carlucci A, Guerrieri A, Nava S. Palliative care in COPD patients: is it only an end-of-life issue? Eur Respir Rev. 2012;21(126):347-354.

Most read articles by the same author(s)

Obs.: This plugin requires at least one statistics/report plugin to be enabled. If your statistics plugins provide more than one metric then please also select a main metric on the admin's site settings page and/or on the journal manager's settings pages.