COPD: Chronic obstructive pulmonary disease
According to the World Health Organisation (WHO) information, COPD is the third-leading cause of death in the world. In Germany, approximately 6 million people are affected. The risk of contracting COPD is thus comparable to that of asthma and diabetes, and higher than that of a heart attack. Based on this background, COPD can certainly be considered a widespread disease in Germany.
Causes of COPD
There are only few diseases, such as COPD, that can generally be so clearly ascribed to a single cause: smoking. Almost all affected persons are smokers, former smokers, or passive smokers. Furthermore, environmental factors such as exhaust fumes, but also genetic factors, favour the development of COPD.
What happens in the respiratory tract of affected persons? Normally, the so-called cilia and a thin layer of mucus in the lungs are responsible for ensuring that infiltrating pollutants are quickly discharged from the lungs. Cigarette smoke, however, disrupts this cleansing mechanism: It damages the cilia and irritates the lungs’ mucous glands so that more mucus is formed. The smoker’s cough phenomenon is a direct consequence of increased mucus formation.
If the natural removal of pollutants is disrupted in this manner, it creates an ideal breeding ground for pathogens. The result is recurring inflammation in the lungs that attack the lung tissue over the long term. When the inflammation processes continue advancing, structures that are irreparable are destroyed – thus, COPD develops.
Symptoms of COPD
The symptoms of COPD are often designated as AHA symptoms, whereby “AHA” stands (in the German language) for mucus, coughing, and shortness of breath.
The typical progression of COPD usually starts with a cough that is most pronounced in the morning. Instances of physical exertion can also result in distressing fits of coughing with mucus secretion. Often, coughing may remain the only symptom of COPD for many years.
COPD causes shortness of breath because the airways become increasingly narrow due to the inflammatory processes. A measurement used for the narrowing of bronchi is the FEV1 forced expiratory volume in one second. If the forced expiratory volume in one second falls below approximately 50% of the target value, shortness of breath will occur – at first only during exertion, but later also at rest as values continue to decrease.
Affected persons often do not take the symptoms seriously at first, due to the very subtle progression of COPD. Most persons can cope well with occasional coughing, and the shortness of breath intensifies only gradually such that it is hardly noticed at first. Among many patients, COPD is therefore diagnosed rather late, when already in an advanced stage.
The following video shows the development in the lungs, when COPD emerges together with pulmonary emphysema:
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Diagnosis
To obtain a reliable diagnosis of COPD, the symptoms and also the results of a lung function test are critical. The forced expiratory volume in one second (FEV1) as well as the forced vital capacity (FVC) or even the forced expiratory volume in six seconds (FEV6) are measured, among other things, with the help of a spirometer.
Because pulmonary patients often suffer from weakening lung function, regular lung function tests provide information on the progression of the disease.
Therefore, tests should be conducted regularly and the measured values should be entered in a patient diary. The diary then offers the treating doctor important information on which therapeutic measures should be considered, and which drugs show the best effect.
Based on the measured values, the COPD is categorised into four severity levels according to the standards of the Global Initiative for Chronic Obstructive Lung Disease (GOLD):
Severity level 1: mild COPD
Severity level 2: moderate COPD
Severity level 3: severe COPD
Severity level 4: very severe COPD
Lung function tests for COPD, such as the RC-Test COPD, are now available especially for at-home use and allow patients regular self-control of different pulmonary function values. These manual devices are a good complement to the doctor’s diagnosis.
Therapy
The first therapy step consists in stopping the cause of the disease, and avoiding the inhalation of harmful substances. Smoking cessation is a prerequisite for successful therapy!
Th aim of COPD therapy is, first and foremost, to improve the quality of life of the patient and to slow down the progression of the disease. Treatment of the existing symptoms includes multiple components, which depend on the patient and characteristics of the COPD.
1. Drug therapy
Drugs for inhalation are intended to halt inflammatory processes, reduce mucosal swelling, and dilate the airways. Drugs containing cortisone are the first-line treatment for advanced COPD; in addition, antibiotics are used in cases of acute bacterial infection.
If the drugs are inhaled using metered-dose inhalers, the use of an inhalation device such as RC-Chamber® is recommended. Drugs containing cortisone, in particular, produce side effects such as fungal growth and irritation of the vocal cords. Inhalation devices minimise the side effects of metered-dose inhalers and optimise the deposition of the active agent in the lungs.
The dilation of the airways can be measured via a peak flow measurement using a peak flow meter. The efficacy of the drug therapy can be verified in this manner.
In addition, inoculations help to prevent flu viruses and pneumococcal infections and exacerbations.
RC-Chamber®
The spacer for inhalation for all ages
2. Physiotherapy
Studies have demonstrated that physical exercise slows down the advancement of COPD.
The findings show that proper exercise improves endurance and physical stamina, relieves symptoms, and reduces the length of hospital stays.
The type of physical activity to be performed depends, once again, on the level of severity of the COPD. In an advanced stage, so-called “lung sports groups” which specialise in training with pulmonary patients, are an option.
Respiratory physiotherapy is also an indispensable component of successful COPD treatment. Here, patients receive instruction on respiratory exercises and specific body positions that facilitate breathing, such as the pursed lips or the cart driver position.
Professional associations additionally recommend therapy with oscillating PEP therapy devices such as the RC-Cornet®, for cases of COPD. The RC-Cornet® – as well as its further development the RC-Cornet® PLUS – generate pressure and flow variations which dilate the bronchi and facilitate the expectoration of stubborn phlegm. Studies have demonstrated that regular training with the RC-Cornet® sustainably improves the well-being of COPD patients, decreases the need for antibiotics, and reduces the length of hospital stays.
RC-Cornet® PLUS
The PLUS for your quality of life
3. Oxygen therapy / ventilation
Oxygen therapy helps with chronic respiratory insufficiency, significantly improves the well-being of COPD patients, and prolongs life expectancy.
Aside from hospital use, there are also portable devices that the patient can use at home or on the road.
Oxygen therapy is required if a blood gas analysis ascertains a steady partial oxygen pressure below 60 mmHg, and the pCO2 values have not increased. The influx of oxygen through a nasal cannula reduces risks such as high pulmonary pressure (pulmonary hypertension) and is comfortable for the patient.
Numerous studies have shown that artificially increasing the air’s oxygen level through long-term oxygen therapy (LOT) increases once again the patient’s stamina in cases of advanced COPD and, furthermore, has a life-prolonging effect.
4. Nutrition therapy
Many patients with severe COPD show significant weight loss, which can be compensated for with a high-fat, high-calorie diet.
5. Surgical interventions
If all therapeutic measures produce no improvement in advanced COPD, lung volume reduction surgery or a lung transplant are considered for certain patients. In the case of a lung volume reduction, lung valves are placed in hyperinflated areas of the lungs in order to release air from them. A lung transplant with a donor lung is only used as a last resort – nevertheless, this delicate operation is possible only in rare cases.
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