Can morphine relieve the symptoms?
Morphine belongs to the group of opiates. Nowadays the drug is called morphine. It is not an everyday drug in the treatment concept of COPD. Nowadays, however, it is used as the drug’s ultima ratio, sometimes during inpatient hospital stays, when the acute shortness of breath cannot be controlled in any other way. The relief of shortness of breath with morphine is mainly due to the fact that opiates reduce restlessness and anxiety and lead to a decrease in work of breathing.
What level of care is provided with end-stage COPD?
The level of care (or the degree of care) depends on six different criteria. In particular, mobility and self-sufficiency are impaired in COPD due to the severe shortage of air in the final stage. Social contacts and everyday life also suffer from the disease. In the final stage of COPD, a classification into the highest level of care (level 5) should be made. However, this classification often depends on minor details, so that if the classification is lower, professional help should be sought for the application for care.
What are the complications of end-stage COPD?
Since COPD is a severe lung disease, lung-associated complications are the most common. These include exacerbation of respiratory tract infections at all stages. Mild colds make it impossible to breathe properly, resulting in increasing shortness of breath.
In addition, the pathogens settle much faster than in lung-healthy individuals, so that pneumonia frequently occurs. In the final stage, it is essential to treat these inpatients as they lead to a rapid deterioration in lung function and can therefore be life-threatening. The chronically progressive deterioration of work of breathing also plays a major role in end-stage COPD.
In addition, the over-inflation of the lungs can lead to a congestion of blood in the pulmonary vessels and thus to an overload of the right side of the heart. Pneumonia is a typical complication of many diseases of the lungs and respiratory tract. In end-stage COPD, the respiratory tract is very susceptible to pathogens, so respiratory infections occur quickly.
These spread particularly well to the lungs, where they lead to pneumonia. The most common pathogens are the bacteria Streptococcus pneumoniae and Haemophilus influenzae, but viruses can also cause pneumonia. As a result, breathing becomes more difficult, adding to the already existing shortness of breath in end-stage COPD.
This results in a so-called respiratory insufficiency (inability to take in sufficient oxygen and release sufficient carbon dioxide). Therefore, pneumonia in end-stage COPD is a life-threatening emergency that requires intensive care. The therapy is initially carried out using inhaled substances that dilate the airways.
In addition, the pathogens (if the pneumonia was caused by bacteria) should be treated with antibiotics. If there is increasing respiratory insufficiency, supportive, non-invasive ventilation is initially performed. In an emergency, invasive ventilation is also possible.
Other complications, such as the presence of severe cardiac stress, must also be taken into account during therapy. In the case of end-stage COPD, the first step is so-called “air-trapping”. Here, the inhaled air cannot be fully exhaled due to the narrowing of the airways, so that the air is trapped in the lungs.
If this (or other mechanisms such as airway collapse or infection in the lungs) causes damage to the lung tissue, the body starts an immune response. This is accompanied by the release of inflammatory cells and fluid. This fluid collects in the lungs in the form of water. COPD also causes a narrowing of the blood vessels in the lungs. This increases the pressure, especially in the right half of the heart, and can worsen the accumulation of water in the lungs.
