Richtlijn over niet-medicamenteuze behandeling bij COPD

- The non-pharmacological treatment of patients with chronic obstructive pulmonary disease (COPD) comprises a large number of related components.

- Active case-finding is advocated in (ex-)smokers above the age of 40 who either cough or have 2 respiratory-tract infections per year.

- Structured self-management programmes may have positive effects; follow-up is of importance to prevent relapse of unhealthy behaviour.

- Patients with COPD must not smoke.

- Exercise training is essential in all stages of COPD; an exercise test should be done first, especially in severe COPD.

- Exercise training should preferably be incorporated in a pulmonary-rehabilitation programme if other components of such a programme are also indicated.

- Certain breathing exercises may be considered in patients that feel anxious or tense.

- Nutritional support combined with exercise training should be considered in patients with severe COPD and underweight, involuntary weight loss or a deficiency of fat-free mass.

- There are limited indications that psychosocial interventions may have a positive effect on the well-being and psychosocial function of patients with COPD.

- An exercise test to assess the maximum tolerated energy expenditure is indicated in COPD patients that experience limitations on their physical capabilities during work.

- Maintenance therapy with supplemental oxygen should be considered in case of hypoxia (P_ao2 < 7.3 kPa) and if the P_ao2 = 7.3-8.0 kPa combined with indications of pulmonary hypertension, peripheral oedema or a haematocrit > 0.55.

- A yearly influenza vaccination is indicated.

Ned Tijdschr Geneeskd. 2006;150:1233-7