Pneumology

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

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

• https://www.lungensport.org/lungensport-register.html
• https://lungenstiftung.de/publikationen
• https://www.copd-deutschland.de/
• https://www.copd-deutschland.de/rehakliniken
• https://www.sauerstoffliga.de/
• https://www.lungenaerzte-im-netz.de/
• https://www.nakos.de