Chronic Obstructive Pulmonary Disease (COPD): Therapy

General measures

  • Aim to maintain normal weight!Determine BMI (body mass index, body mass index) or body composition using electrical impedance analysis and, if necessary, participate in a medically supervised program for the underweight.
  • Lip brake (also dosed lip brake) – breathing technique that contributes to the relaxation of the respiratory muscles. This allows increased mucus removal and can also be used as an emergency measure in case of shortness of breath, in addition to medication.Procedure: The lips are pursed as if whistling, and the upper lip should be slightly protruded. It should be exhaled as long as possible against the only a gap wide open lips or loose on each other, lips. This causes the cheeks to inflate slightly. The air should escape slowly and evenly. The air should not be squeezed out. When performed correctly, the exhale lasts longer than the inhale.
  • Nicotine restriction! (refrain from tobacco use) incl. passive smoking → smoking cessation.
  • Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
  • Regular exercise (at least 3 km on at least three days a week)!This leads even in patients in COPD stage III or IV to reduce exacerbations (“disease relapses”) and hospital admissions.
  • Physical training in all stages of COPD (see below sports medicine).
  • Travel recommendations:
    • Airworthiness: patients on home oxygen therapy are fit to fly if they require less than 4 l/min.
    • Cardiac conditions (e.g., chronic heart failure (CHF), pulmonary hypertension (PH)/pulmonary hypertension) are the greater risk from an aeromedical perspective (see above conditions for details)
  • Avoidance of environmental pollution (workplace hygiene):
    • General air pollution
    • Occupational dusts – quartz-containing dusts, cotton dusts, grain dusts, welding fumes, mineral fibers, irritant gases such as ozone, nitrogen dioxide or chlorine gas.
    • Wood fire

Conventional non-surgical therapy methods

  • Long-term oxygen therapy (LTOT; 16-24 h/d): In patients whose COPD has been classified as severity III and is associated with chronic hypoxia/oxygen deficiency (chronic hypoxemia at rest: arterial partial pressure of oxygen (pO2) < 55 mmHg), long-term oxygen therapy is indicated. Enough oxygen should be given to raise the pO2 to about 60-70 mmHg.Humidifiers can be used at flow rates of 2 liters/minute and above.The minimum duration of use for long-term oxygen therapy should be 15 hours daily.Effect:Therapy provides adequate oxygen to tissues and relieves respiratory muscles.Other beneficial effects include.

    Patients receiving LTOT should be followed up regularly. Note: Long-term oxygen treatment was without survival benefit in patients with moderate hypoxemia at rest. Inclusion criterion was an oxygen saturation (SpO2) between 89-93% measured by pulse oximetry.Note: Pulse oximetry is a medical device used for continuous noninvasive measurement of arterial blood oxygen saturation (SpO2) and pulse rate.

  • Respiratory distress and therapy with morphine: Low-dose morphine (2 times 10 mg of sustained-release morphine daily) relieves respiratory symptoms in COPD patients with moderate to severe dyspnea without causing respiratory depression. I.e. No noticeable increase in partial pressure of CO2 with this therapy.
  • Noninvasive Positive Pressure Ventilation (NIPPV): helps COPD patients with hypercapnia (elevated blood carbon dioxide; partial pressure of carbon dioxide: pCO2 > 45 mmHg). BPAP (bilevel positive airway pressure) devices with two levels of positive pressures – higher on inspiration (inhalation), lower on expiration (exhalation) – are optimal.Results: significantly lower risk of death in hypercapnic COPD patients with BPAP compared with patients without the device; less often admitted for hospitalization (38.7 vs. 75.0%) and less often intubated (5.3 vs. 14.7%).

Vaccinations

The following vaccinations are advised, as infection can often lead to worsening of the present disease:

  • Flu vaccination
  • Pneumococcal vaccination Note: In patients with immunosuppression, the STIKO advises sequential vaccination, with PCV13 (conjugate vaccine) first and PSV23 (23-valent polysaccharide vaccine) 6-12 months later. This strategy has significantly higher protective efficacy than when vaccinated with PSV23 alone.

Regular checkups

  • Regular medical check-ups to verify the success of treatment.

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Observance of the following nutritional medical recommendations:
    • In malnourished patients, an energy intake of 45 kcal/kg bw/d is considered recommended – caloric intake above this level may cause malaise and respiratory distress
    • Patients with acute respiratory failure should be fed a hypercaloric fat-based diet characterized by low carbohydrate content, high fat content – 45-55% of total energy intake – and moderately high nitrogen intake – about 300 mg/kg bw/d
  • Selection of appropriate foods based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement or a fully balanced diet for the dietary treatment of patients with catabolic metabolic state.
  • Detailed information on nutritional medicine can be obtained from us.

Sports Medicine

  • Endurance training (cardio training) and strength training (muscle training) – for therapy (“pulmonary sports”).
  • Suitable sports disciplines are endurance sports such as walking, Nordic walking or swimming. If the patient lacks the strength for endurance sports, strength training as a single measure is an alternative.
  • Also suitable is ergometer training. This improves not only the muscle strength of patients with COPD but also the 6-minute walk distance and dyspnea (shortness of breath).
  • Physical training causes an improvement in exercise capacity and quality of life, furthermore a decrease in dyspnea (shortness of breath), reduction of exacerbations (significant worsening of the disease), COPD-associated anxiety, depression and mortality (death rate).An exercise program can be started during an acute phase of the disease. This helps to keep the loss of function low and accelerate recovery.
  • Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.

Physical therapy (including physiotherapy)

  • As part of physical therapy, a procedure called respiratory therapy is performed. The aim is to learn breathing techniques and breathing-easing body positions to relieve the symptoms of COPD such as shortness of breath.

Training

  • Patient education serves first to educate the patient about the nature and individual severity of the disease.Patients in the at-risk group learn to reduce or avoid risk factors and are educated about smoking cessation.
  • If severity I or II are present, great attention is paid to self-medication as well as to the management of acute exacerbations (disease episodes).
  • In the case of severity III, additional education is given about possible complications as well as the possibility of long-term oxygen therapy.
  • Training in the correct use of inhalers and medication!

Rehabilitation

  • Pulmonary rehabilitation (pneumological rehabilitation) is the name given to a rehabilitation program that can be performed on an inpatient or outpatient basis. It is suitable for COPD patients with severity levels I to III or groups B to D according to GOLD. The rehabilitation program includes patient education and physiotherapy in addition to physical training and nutritional counseling.