Pulmonary rehabilitation has become a cornerstone in the management of moderate to severe COPD. Pulmonary rehabilitation is a program of education regarding lung function and dysfunction, proper breathing techniques (diaphragmatic breathing, pursed lip breathing), and proper use of respiratory equipment and medications. An essential ingredient in this program is the use of increasing physical exercise to overcome the reduced physical capacity that usually has developed over time. In addition, occupational and physical therapy are used to teach optimal and efficient body mechanics.

Lung volume reduction surgery (LVRS) has received much fanfare in the lay press. LVRS is a surgical procedure used to treat some patients with COPD. The premise behind this surgery is that the over-inflated, poorly-functioning upper parts of the lung compress and impair function of the better-functioning lung elsewhere. Thus, if the over-inflated portions of lung are removed surgically, the compressed lung may expand and function better. In addition, the diaphragm and the chest cavity achieve more optimal positioning following the surgery, and this improves breathing further. The best criteria for choosing patients for LVRS are still uncertain. A national study was completed in 2003. Patients primarily with emphysema at the top of their lungs, whose exercise tolerance was low even after pulmonary rehabilitation, seemed to do the best with this procedure. On average, lung function and exercise capacity among surviving surgical patients improved significantly following LVRS, but after two years returned to about the same levels as before the procedure. Patients with forced expiratory volume in FEVI of less than 20% of predicted and either diffuse disease on the CAT scan or lower than 20% diffusing capacity or elevated carbon dioxide levels had higher mortality. The role of LVRS is at present is very limited.