Early Respiratory Physiotherapy Following Noninvasive Ventilation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Case Report

Patient InformationA 70-year-old woman with a 24-year history of chronic obstructive pulmonary disease (COPD) was admitted with an acute exacerbation requiring inpatient management. Medical History• COPD for 24 years.• Hypertension.• Type 2 Diabetes Mellitus. introDuCtionChronic obstructive pulmonary disease (COPD) is characterized by persistent airflow obstruction and repeated episodes of symptom worsening, impairing daily functioning and quality of life.Acute exacerbations of COPD (AECOPD) cause worsening respiratory symptoms and functional impairment. 1 According to the World Health Organization, COPD is the third leading cause of death worldwide and a major cause of disability. 2 Acute exacerbations result from respiratory infections, environmental pollutants, or disease progression and are associated with increased dyspnea, coughing, sputum production, reduced exercise tolerance, and poor gas exchange.Recurrent exacerbations worsen quality of life and hasten the deterioration of lung function.3 Acute COPD exacerbations are frequently treated with noninvasive ventilation (NIV), especially bi-level positive airway pressure (BiPAP).BiPAP enhances alveolar ventilation, reduces respiratory muscle strain, facilitates carbon dioxide removal, and lessens the need for invasive mechanical ventilation.4 Respiratory physiotherapy is an important supportive component of COPD management.Following clinical stabilization of an acute exacerbation, it helps address respiratory symptoms, physical deconditioning, and functional limitations through breathing exercises, airway clearance techniques, thoracic mobility exercises, and limb mobilization.5 This case report describes the clinical course and outcomes of early structured respiratory physiotherapy following clinical stabilization in a patient with AECOPD, with sessions performed during NIV-free periods.