Nonpharmacologic Therapies in Patients With Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-Analysis

Claudia C. Dobler*, Allison S. Morrow, Magdoleen H. Farah, Bradley Beuschel, Abdul M. Majzoub, Michael E. Wilson, Bashar Hasan, Mohamed O. Seisa, Lubna Daraz, Larry J. Prokop, M. Hassan Murad, Zhen Wang

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

11 Citations (Scopus)
356 Downloads (Pure)



To evaluate the effectiveness and adverse eventsof nonpharmacologic interventions in patients with exacerbation of chronicobstructive pulmonary disease (COPD).

Patients and Methods:

We searched Embase, MEDLINE, Cochrane databases,Scopus, and from database inception to January 2, 2019, forrandomized controlled trials that enrolled adults with exacerbation of COPD andevaluated the effect of nonpharmacologic interventions on clinical outcomesand/or lung function.


We included 30 randomized controlled trials with2643 participants. Improvement in 6-minute walking test distance was associatedwith resistance training (weighted mean difference [WMD], 74.42; 95% CI, 46.85to 101.99), pulmonary rehabilitation (WMD, 20.02; 95% CI, 12.06 to 28.67),whole body vibration (WMD, 89.42; 95% CI, 45.18 to 133.66), and transcutaneouselectrical nerve stimulation (WMD, 64.54; 95% CI, 53.76 to 75.32). Improvementin quality of life was associated with resistance training (WMD, 18.7; 95% CI,5.06 to 32.34), combined breathing technique and range of motion exercises(WMD, 14.89; 95% CI, 5.30 to 24.50), whole body vibration (WMD, -12.02; 95% CI,-21.41 to -2.63), and intramuscular vitamin D (WMD, -4.67; 95% CI, -6.00 to-3.35 at the longest follow-up). Oxygen titration with a target oxygensaturation range of 88% to 92% was associated with reduced mortality comparedwith high flow oxygen (odds ratio, 0.36; 95% CI, 0.14 to 0.88). All findingswere based on low strength of evidence.


In patients hospitalized for exacerbation ofCOPD, exercise interventions and pulmonary rehabilitation programs mayameliorate functional decline. Oxygen should be titrated with a target oxygensaturation of 88% to 92% in these patients.


Trial Registration: PROSPERO Identifier:CRD42018111609

Original languageEnglish
Pages (from-to)1169-1183
Number of pages15
JournalMayo Clinic Proceedings
Issue number6
Publication statusPublished - 1 Jun 2020


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