Pneumology
Thanks to our interdisciplinary team and the joint definition of your rehabilitation goals, we are demonstrably able to extend your lifespan, minimize the burden of your illness and thus improve your quality of life. They should be able to participate in all areas of life again. Our aim is to make you an expert on your illness. If you know what to look out for, you will also know what you can be confident about.
Team
We are here for you
- COPD
- Chronic bronchitis
- Bronchial carcinomas
- Bronchial asthma
- Follow-up rehabilitation after lung operations, lung transplant
- Interstitial lung diseases
- Convalescence after severe pneumonia with sepsis
- respiratory insufficiency
- Pulmonary hypertension
- Pulmonary artery embolism
- Post-COVID after Sars-Cov-2 infection
Disease patterns and therapy
The disease
In COPD, the airways are constantly inflamed (chronic bronchitis) and constricted (obstructive). In healthy lungs, the vital oxygen enters the bloodstream via so-called alveoli. In COPD, however, these are partially destroyed and overinflated like small balloons. The technical term for an over-inflated lung is emphysema. Due to the narrowed airways and localized hyperinflation, not enough oxygen reaches the body. The consequences are complaints such as shortness of breath. It is characteristic of COPD that the constrictions do not disappear completely even after inhalation of appropriate medication. COPD usually progresses in different stages (GOLD 1 = initial stage to GOLD 4 = severe COPD).
The disease cannot be cured, but can be alleviated by various medical measures. In addition to therapeutic interventions, rehabilitation is the most important option for alleviating symptoms and making everyday life easier .
The incidence of COPD has risen sharply in recent decades. Around 15% of the German population over the age of 40 suffer from the disease, with the figure rising to 27% for those over 70. It is assumed that there is also a high number of undiagnosed illnesses. It is estimated that around 600 million people worldwide are affected. COPD is the third most common cause of death worldwide.
Smoking as a risk factor
The main cause of COPD is smoking
Tobacco smoke is responsible for COPD in around 9 out of 10 patients. Smoking also exacerbates the symptoms and causes COPD to progress more quickly.
Other risks include passive smoking, air pollution in occupational activities and frequent respiratory infections in childhood.
Difference between COPD and asthma
COPD | Asthma | |
Shortness of breath | under load or permanently | paroxysmal |
Cough | clear or discolored sputum | Mostly dry cough |
Narrowing of the airways | Drug treatment can have a soothing effect | Drug treatment |
Age | usually from the age of 40 | mostly in childhood or adolescence |
Complaints
Typical symptoms of COPD are
- Shortness of breath on exertion, later often also at rest
- Cough
- Ejection
The diagnosis of COPD is classified according to the four degrees of severity according to the GOLD division. The classification determines the therapeutic measures and the associated rehabilitation.
COPD can always worsen suddenly. If a deterioration goes beyond the usual level and lasts for at least 2 days, experts speak of an exacerbation.
In severe forms, water retention in the legs and clouding of consciousness can occur.
The main causes of exacerbations are viruses and bacteria, which is why they occur particularly frequently during the cold and wet season. Inhaling cigarette smoke, exhaust fumes or smoke can also trigger the sudden deterioration
In rare cases, an inpatient stay in hospital is even necessary. There, patients are supported by non-invasive ventilation (NIV). Only if NIV fails or for other serious reasons are patients given invasive ventilation (using a breathing tube in the trachea).
In around 20 percent of patients with chronic bronchitis, the disease develops into chronic obstructive bronchitis(COB). This is characterized by a narrowing of the airways (obstructive = constricted), which is accompanied by an increased susceptibility to infection.
In the advanced course of the disease, a “cor pulmonale” (pulmonary heart) can occur. In cor pulmonale, a right heart failure develops, triggered by an enlarged and therefore weakened right side of the heart. This can lead to water retention in the legs and abdomen, heart failure and respiratory muscle failure.
Diagnostics
What technical investigations are necessary?
Lung function:
Special devices measure the narrowing of the airways and the total air content of the lungs. It is also tested whether the inhalation of a medication available for COPD has a positive effect on the impaired respiratory function. Lung function measurement is used to classify the severity of the disease and is essential for assessing the course of the disease and determining the therapy.
Blood gas analysis:
Oxygen and carbon dioxide levels in the blood are determined under resting and exercise conditions (e.g. climbing stairs, 6-minute walk test). The data is crucial for assessing the prognosis of the disease and for any long-term oxygen therapy that may become necessary.
Imaging procedures:
These include X-rays of the chest organs, computer tomography and ultrasound examinations of the chest, including echocardiography. Imaging procedures are necessary and indispensable for the detection of other possible diseases (lung cancer!) and for the detection of complications of COPD (pneumonia, pulmonary embolism, heart changes).
Treatment
What treatment options are available?
The treatment of COPD is usually a lifelong therapy, it must be carried out consistently and requires repeated review by the doctor. Therapy is graduated according to the degree of severity. Drug treatment is based on respiratory dilators and anti-inflammatory agents, which are best administered by inhalation (metered dose inhalers, powder inhalers). Antibiotics are only necessary in the case of complicating infections. If other organs (heart!) are involved in the further course of the disease, they will be included in the treatment. In severe cases, long-term oxygen administration and mask ventilation are used.
What can those affected do?
Avoid inhaled pollutants:
Abstaining from inhalation smoking is the single most effective measure for preventing the risk of disease and reducing the progression of the disease. If possible and necessary, occupational and domestic pollutants should also be avoided.
Prevent infections:
Respiratory tract infections worsen the overall outlook for COPD. A regular lifestyle, a healthy diet and sufficient sleep strengthen the immune system. The flu vaccination (influenza) is recommended annually, as is the vaccination against pneumonia (pneumococcus, only required every 5 years), especially for older patients.
Rehabilitation and AHB
People with COPD are entitled to rehabilitation every four years if:
- they feel restricted in their everyday life by the disease,
- employment is threatened,
- the symptoms have worsened significantly,
- the disease causes severe psychological suffering.
Prerequisite for AHB:
- Significant functional limitations
- Complex training requirements
Benefits of rehab
In summary, rehabilitation for COPD has been proven to be very effective in numerous studies.
The rehabilitation measures for COPD consist of a structured program lasting three weeks. They primarily serve
- training the respiratory muscles,
- the development of strength and endurance,
- stabilization of the immune system and
- comprehensive patient training.
Typical rehabilitation goals
In addition to the limitations of pulmonary function, the focus of pneumological rehabilitation is on reconditioning physical resilience, overcoming social isolation, treating psychological disorders, in particular depression, muscle atrophy and weight loss.
- Increase walking distance on flat ground with / without rollator
- Increase in walking distance on flat ground with / without O2
- Improvement when climbing stairs with / without O2
- Reduce cough
- Reduce sputum
- Reduce O2 demand
- Handling inhalation aids and their dosage
- Smoking cessation / “What are the benefits of not smoking?”
- Dealing with shortness of breath
- Dealing with oxygen therapy
- Learning relaxation methods
Treatment at the GZO
- Diagnostics (6-minute walk test, lung function test, blood gas analysis, blood count, diffusion measurement, ECG)
- Optimization of pharmacotherapy
- Physical training (MTT, ergometer, group gymnastics, Nordic walking)
- Knowledge transfer about the disease (living nicotine-free, dealing with anxiety and depression, dealing with oxygen therapy, self-help for shortness of breath, oxygen and mask therapy, COPD, asthma and other lung diseases – what is behind it?)
- Respiratory physiotherapy Respiratory physiotherapy is used in COPD patients to reduce the work of breathing, to use the respiratory muscles more effectively, to improve secretion elimination and thoracic mobility and thus also to improve gas exchange. (if required, also reflective breathing therapy)
- Nutritional advice (depending on the variant, COPD patients tend to be overweight or underweight; both represent a risk factor; if required, nutritional advice is available in the form of individual advice, group advice, healthy cooking)
- Social care and provision of aids (what happens at home?, O2 supply)
- Psychosocial counseling and therapy (individual and group sessions, learning relaxation methods PMR, imagination, Qi Gong)
What happens at home?
- Continuation of muscle building and endurance training
- Vaccination recommendations for chronically ill patients according to the STIKO recommendation
- Participation in outpatient pulmonary sports groups
Further links
The disease (anatomy, frequency)
Asthma is a chronic respiratory disease characterized by seizure-like constrictions of the airways alternating with periods in which there are no symptoms at all. This narrowing of the airways, which often changes during the course of the day, is typical of asthma.
Asthma can be divided into “early-onset” asthma (approx. 10 % of children) and “late-onset” asthma (approx. 5 % of adults), depending on whether it occurs in childhood/adolescence or only in (later) adulthood. Asthma can be present with or without allergies. The symptoms caused by allergies are varied and can affect other organ systems in addition to the lungs, such as the skin, nose and eyes, gastrointestinal tract and others.
In bronchial asthma, the airways are inflamed and also hypersensitive to stimuli. This leads to a sudden narrowing of the airways, sometimes even at rest. This makes breathing difficult. Shortness of breath and shortness of breath – the asthma attack.
Difference between COPD and asthma
COPD | Asthma | |
Shortness of breath | under load or permanently | paroxysmal |
Cough | clear or discolored sputum | Mostly dry cough |
Narrowing of the airways | Drug treatment can have a soothing effect | Drug treatment |
Age | usually from the age of 40 | mostly in childhood or adolescence |
Complaints
Symptoms of bronchial asthma occur in the form of attacks of breathlessness at night and also during the day. Coughing, wheezing and a tight feeling in the chest often occur during the day.
Diagnostics
Asthma and possible triggers are determined by various examinations:
- Interview and physical examination
- Spirometry (measurement of lung function)
- Reversibility test (comparative measurement of lung function before and after administration of medication)
- Allergy tests
Treatment
What treatment options are available?
The treatment depends on your symptoms, including possible asthma attacks.
The most important thing with allergic asthma is to avoid the allergy trigger as far as possible. If this alone does not help, medication is used. As the side effects are less severe, inhalable agents are preferred. It is important that the patient learns how to use the inhaler correctly.
In order to quickly alleviate sudden symptoms, there are on-demand medications that immediately widen the airways in the lungs. The most important long-term medication is inhalable cortisone in spray or powder form. It suppresses the inflammation and thus alleviates the cause of the symptoms. It is important to inhale the cortisone regularly so that the inflammation does not return. People who use it permanently are less likely to have an asthma attack and are less likely to be hospitalized. Cortisone can also prevent deaths from asthma. If cortisone alone is not enough, other medications are added.
Supplementary measures improve the success of the treatment. These include: not smoking, taking part in asthma training courses, learning self-help techniques for breathlessness and regular physical exercise.
What can those affected do?
- Physical exercise is good for you. It is important to warm up and slowly reduce the load at the end.
- Try to stop smoking.
- An asthma diary creates transparency about the course of the disease
- Training courses support self-management and help to deal with the chronic illness. Topics include, for example
- Breathing techniques such as the lip brake
- Dosage of the medication to the symptoms
- Instruction in the inhalation system
Anyone who receives a new inhalation system requires instruction. Patients practise and demonstrate the correct handling in the doctor’s surgery. Pharmacies can also provide support here. - Regular peak flow measurements
Rehab and AHB (requirements, benefits)
The prerequisite for rehabilitation exists if, despite outpatient therapy, there are physical, social or psychological consequences of the illness that restrict the possibility of normal activities or participation in normal professional and private life. These include, for example
- Lack of asthma control despite optimal therapy (shortness of breath, coughing),
- frequent infections,
- impending need for care and assistance,
- Necessity of non-drug therapy methods (if these cannot be provided to a sufficient extent on an outpatient basis),
- Concomitant diseases that have a lasting impact on quality of life (including mental health),
- Restrictions in professional and private life.
You should also talk to your doctor about rehabilitation / follow-up treatment (AHB) after respiratory treatment in hospital, if you are at risk of becoming unable to work, or if you have problems at school, university or in training due to illness. The same applies if your asthma has psychological consequences and has led to anxiety, social withdrawal or depression.
Rehabilitation includes measures designed to enable asthmatics to lead as normal a life as possible again. The inpatient rehabilitation program usually lasts 3 weeks.
A rehabilitation program enables patients to be monitored more closely. Adherence (coordination of treatment plan) and hurdles in the implementation of the therapy can thus be determined together with the patients*.
*lt. National Care Guideline Asthma 2020
Typical rehabilitation goals
- Improvement when climbing stairs
- Increase physical resilience
- Reduce asthma attacks / medication on demand
- Learn how to use inhalation aids and their dosage
- Smoking cessation / “What are the benefits of not smoking?”
- Dealing with shortness of breath
- Learning relaxation methods
Therapy at the GZO
- Diagnostics (specialist visits, resting ECG, BGA, blood count, spriometry, 6-minute walk test, diffusion measurement)
- Optimization of pharmacotherapy in particular. Inhalation
- Physical training
- Individual physiotherapy incl. Respiratory therapy, coughing technique (also reflective respiratory therapy if required)
- Group gymnastics with breathing exercises
- Ergometer Circulation training
- Nordic Walking
- Medical training therapy
- Knowledge transfer about the disease
Living nicotine-free, self-help for breathlessness, oxygen and mask therapy, asthma and other lung diseases – what’s behind it all? - Nutritional advice
Asthma causes frequent or chronic inflammation of the bronchial tubes. A healthy diet is very important and excess weight should be reduced. Nutritional counseling is available in the form of individual counseling and group counseling. You can also learn “healthy cooking” in our training kitchen. - Social care and prescription of medical aids
- Psychological counseling and therapy
Learning relaxation methods PMR, imagination, Qi Gong; individual and group discussions if required.
What happens at home?
- Participation in outpatient pulmonary sports groups
- Regular asthma training
- Regular specialist check-ups.
- Continuation of regular exercise therapy and endurance training
- Vaccination recommendations for chronically ill patients according to the STIKO recommendation
The disease (anatomy, frequency)
The lung disease COVID-19 is caused by a coronavirus, the pathogen SARS-CoV-2.
Coronaviruses belong to a large family of viruses that can cause various diseases. Depending on their severity, these range from a normal cold to serious infections that can lead to pneumonia, among other things.
Complaints
Symptoms of COVID-19 are individual to each person and the severity of the disease can vary greatly. Not every infected person has symptoms that can be traced back to the disease. The spectrum of the disease ranges from an asymptomatic course to lung failure. It is assumed that 81% of infected persons show a mild, approx. 14% a severe and approx. 5% a critical course of the disease.
The most common signs of a corona infection are
- Cold symptoms such as fever, cough, runny nose, sore throat
- Pain in the head, limbs, chest and abdomen
- Odor and taste disorders or loss
- Tiredness and general weakness
- Swelling of lymph nodes, skin changes
- Disturbance of concentration and memory
- Diarrhea
Diagnostics
The infection is detected by means of pathogen detection. Various options are used, such as the PCR test or rapid antigen test detection. The advantage of rapid antigen tests is that the results are detected much more quickly, although the reliability of the result is higher with a PCR test.
Treatment
What treatment options are available?
The treatment depends on your symptoms. Depending on the severity of the disease:
- Oxygen administration
- Medication for the prevention of thrombosis
- Respiratory therapy
- Antibiotics for pneumonia
- Cortisone therapy
- Antibodies against the virus
- There are also repeated cases in which the SARS-CoV-2 vaccination has helped patients to improve and even become symptom-free.
- The Robert Koch Institute and the STIKO regularly publish up-to-date information on vaccination recommendations.
What can those affected do?
- Physical exercise – in moderation – is good for you. It is important to warm up and slowly reduce the load at the end.
- Use breathing therapy, perform exercises regularly and independently to achieve success.
- Memory training
Rehab and AHB (requirements, benefits)
- The acute symptoms should have subsided for at least 2 days
- Patients should not have a lack of oxygen in their blood.
- Patients should have a stable circulation
- Have no signs of severe heart failure
Typical rehabilitation goals
- Increase in walking distance on flat ground
- Increase in walking distance on flat ground with / without O2
- Improvement when climbing stairs with / without O2
- Learning relaxation methods
- Improvement of existing functional limitations and performance
- Psychological: support in coping with the illness
- Restoration of performance for work and everyday social life
Therapy at the GZO
Diagnostics
- Pneumological functional diagnostics, lung function, diffusion, oxygen saturation and blood gases
- A cardiological examination is carried out if necessary to assess cardiac performance and cardiac involvement due to the disease
- The 6-minute walk test is also relevant for monitoring success, with measurement of oxygen saturation, pulse and breathlessness according to the Borg scale at the beginning and end of the measure
- If possible, spiroergometry should also be arranged.
- Psychological support
Optimization of pharmacotherapy
Physical training
- Individual physiotherapy incl. Respiratory therapy, coughing technique
- Group gymnastics with breathing exercises
- Ergometer Circulation training
- Nordic Walking
- Medical training therapy
- Walks
Knowledge transfer about the disease
Dealing with oxygen therapy, lectures
Nutritional advice: if required, nutritional advice is available in the form of individual advice, group advice and healthy cooking in the teaching kitchen
Social care and prescription of medical aids
If required, O2 supply, lung sports, referral to self-help groups, further treatment in COVID-19 outpatient clinics
Psychological counseling and therapy
- Learning relaxation methods such as PMR, imagination, Qi Gong; individual and group sessions if required
- Physical training with measurement of oxygen saturation at rest and after exercise
- Respiratory physiotherapy
- Psychological support, individual discussions and in small groups
What happens at home?
- e.g. participation in outpatient pulmonary sports groups
- https://www.lungensport.org/lungensport-register.html
- Coronavirus: News | FAQs | Info – Federal Ministry of Health
- https://www.sauerstoffliga.de/
- https://www.lungenaerzte-im-netz.de
- https://www.nakos.de
- Regular specialist check-ups.
- Continuation of regular exercise therapy and endurance training
- Psychological support, if required
- Vaccination recommendations for chronically ill patients according to the STIKO recommendation
Aftercare
As aftercare, you will be given home exercise programs and put in touch with social services.
Follow-up appointments will be organized for you during your stay. Our doctors and exercise therapists evaluate the physical fitness of each individual patient and, if indicated and supported by the patient, arrange contact with a suitable local lung sports group.
Whether a prescription for medical aids is required, and if so which ones, is evaluated during the course of the treatment procedure with the aid of objective examination results and these are prescribed if necessary. Our social services will be happy to help you with the procurement.
Our discharge management team and social services will be happy to answer any further questions you may have.
Benefits of pneumological rehabilitation
The primary aim of rehabilitation measures is to enable people to participate (again) in those situations or areas of life that are important to them, despite their continuing impairments.
At the beginning of the rehabilitation program, (realistic) rehabilitation goals are agreed with you. Both physical-functional, educational and socially-active goals are set.
Examples of this are “being able to climb 2 flights of stairs again”, “being able to play with the grandchildren again”, “optimization of risk factors such as 2 kg weight reduction”. Goals connect therapist and patient and thus improve the therapy outcome. Goals strengthen self-efficacy and lead to higher overall patient satisfaction.
To achieve all these goals, we work in an interdisciplinary team. This consists of physiotherapists, sports and occupational therapists, doctors and nursing staff, nutritionists, psychologists and social services.
Another focus is on the treatment of risk factors and concomitant diseases.
The patient is guided into an active role through training. He becomes a kind of expert in his own right. The rehabilitation measure lays the foundation for sustainable prevention.