Several studies have indicated that around 60 per cent of patients with COPD do not adhere to their medicines. You can help by explaining why the medicines have been prescribed and minimising any obstacles that are preventing them from being taken. It's important to consider the following:

• Be aware that drug treatments are given to relieve symptoms and improve quality of life, but they will not reverse the underlying lung damage 
• Check inhaler technique €“ only one in 10 patients with a metered dose inhaler (MDI) performs all essential steps correctly. Studies have indicated that patients make fewer errors with dry powder inhalers (DPI) than with aerosol metered MDIs. The elderly, in particular, may have problems with dexterity, so handling inhalers and timing medicine inhalation may be difficult. Dry powder inhalers require less timing ability
• Give advice on the benefits and use of spacer devices where appropriate
• Oxygen may be used to support patients with severe COPD. Questions about this service, such as holiday arrangements, replacement masks and tubing, should be directed to local service providers 
• Discuss self management plans with patients who have frequent exacerbations. Self management plans should include details of how to recognise an exacerbation, triggers associated with worsening of COPD, when to use 'rescue' courses of antibiotics and steroids and when to contact the GP or other appropriate healthcare professional
• Advise COPD patients to exercise within the limits of their disease, as exercise will improve their quality of life. Patients should be advised to walk more often and further, and be told that being out of breath is not dangerous €“ as long as they are not gasping for breath. Advise them to use bronchodilators 20 minutes before exercise to reduce breathlessness
• Patients on oral steroids or high dose inhaled steroids can be given a steroid warning card 
• Patients who live on their own may need access to the pharmacy delivery service, if it's available, when their exacerbations are bad 
• Recent studies have indicated that COPD patients are at an almost three-fold increased risk of iron deficiency, and that iron-deficient patients are more likely to report COPD exacerbations. Symptoms to watch out for include leg cramps when climbing stairs, increased fatigue and unusual cravings for ice cold food.