When one considers prevention, smoking is well-recognised as the principle cause of COPD, however this is being managed (NICE, 2018). That is not to say that air pollution should be dismissed, as globally this remains a significant cause of COPD, along with the burning of bio-mass fuels (Rice and Malhotra, 2015), with Bernstein and Rice (2013) highlighting climate change as a significant factor. It should be considered therefore that focussing on sustainable energy production, specifically in terms of clean-air policies would have a major impact on the incidence of COPD (Duić, Urbaniec and Huisingh, 2014; Peacock et al., 2011).
The management of those diagnosed with COPD requires a subtler approach, as the disease carries a multi-faceted social burden (Britton, 2003), with patients suffering from progressive physical decline, depression and social withdrawal (Fishwick et al., 2015; Zhang et al., 2011; Johnson et al., 2007). In terms of sustainability, non-pharmacological solutions should be considered along with medication, with studies by Goldstein et al. (2012) and Birnbaum (2011) highlighting the beneficial effects of pulmonary rehabilitation on quality of life and impact on resources, though Guo and Bruce (2014) note that it is underutilised and there are adherence problems to be overcome. Weight loss due to cachexia is a common factor in COPD, causing reduction in health status and greater dependency on health services, and there is evidence that nutritional support would have a positive effect (Khan, Kumar and Daga, 2016; Gupta et al., 2010). However, Sanders et al., (2010) point out that managing cachexia is still poorly implemented, recommending that nutritional support should be part of a multi-part structured plan. Approaches like this increase quality of life for sufferers and reduce the use of health resources, which carry a burden in both production and disposal, with its consequent impact on climate.