Chronic Obstructive Pulmonary Disease

Symptoms

Possible symptoms of chronic obstructive pulmonary disease (COPD) include a chronic cough, mucus production, sputum, shortness of breath, chest tightness, breath sounds, lack of energy, and sleep disturbances. The symptoms often worsen with physical exertion. An acute worsening of chronic symptoms is referred to as an exacerbation. In addition, numerous systemic and extrapulmonary concomitant diseases may also occur, such as loss of muscle mass, weight loss, anemia, cardiovascular disease, osteoporosis, depression, infectious diseases, and diabetes mellitus. Patients with COPD have an increased risk of developing lung cancer. The Lung League estimates that COPD affects up to 400,000 people in many countries.

Causes

Underlying the disease is persistent and progressive airway obstruction. By far the most common cause is tobacco smoking (>80-90%), which causes a prolonged inflammatory response, pathologic changes, and overinflation of the alveoli in the lungs. Other triggers include residential air pollution, chronic respiratory infections, fumes, dust, and chemicals in the workplace.

Diagnosis

Diagnosis is made with medical treatment based on patient history, physical examination, pulmonary function measurement (spirometry), and imaging techniques, among other tests. Possible differential diagnoses include asthma, heart failure, and infectious diseases such as tuberculosis. The CAT score can be used to classify COPD into different clinical severity levels.

Nonpharmacologic treatment

  • Most important and prognostically decisive measure: quit smoking and also avoid passive smoking!
  • Physical activity is considered very important (exercise program, fitness training).
  • Pulmonary rehabilitation: counseling and education, training, nutrition.
  • Avoid triggers of exacerbations such as dust and ozone.
  • Surgical interventions: lung volume resection, lung transplantation.

Drug treatment

In contrast to asthma, bronchodilators rather than inhaled glucocorticoids are the first-line agents for treatment in COPD. For basic therapy, the long-acting agents are preferably used. Long-acting beta2-sympathomimetics are effective between 12 to 24 hours and allow a long-lasting effect. They selectively stimulate the adrenergic β2-receptors of the bronchial muscles and thus have a bronchospasmolytic effect:

  • Formoterol (Foradil, Oxis).
  • Salmeterol (Serevent)
  • Indacaterol (Onbrez)
  • Vilanterol (Relvar Ellipta, Anoro Ellipta)
  • Olodaterol (Striverdi)

Short-acting beta2-sympathomimetics are administered for rapid symptom relief:

Parasympatholytics and LAMAs are muscarinic receptor antagonists that abolish the effects of the neurotransmitter acetylcholine, causing bronchodilatation. They are derived from the tropane alkaloid atropine and are administered by inhalation. The newer agents need only be applied once daily (LAMA):

Combinations of beta2-sympathomimetics with parasympatholytics:

Phosphodiesterase inhibitors are anti-inflammatory and/or bronchodilators. The effects are based on the inhibition of phosphodiesterases in inflammatory cells and the consequent increase in cAMP. This reduces the release of inflammatory mediators and the migration of neutrophils and eosinophils into the airways.Theophylline has a narrow therapeutic range and is toxic in overdose. It is no longer recommended when other bronchodilators are available:

Inhaled glucocorticoids are anti-inflammatory agents used for severe COPD and exacerbations. Their use is controversial. Glucocorticoids have immunosuppressive properties and may cause oral fungus. Therefore, inhalation should be done before eating or the mouth should be rinsed after inhalation. Local application is better tolerated than systemic. Monotherapy is not recommended:

Vaccinations are indicated for the prevention of respiratory infections, which lead to complications and worsening of the disease. Recommended on the one hand the annual flu vaccination and on the other hand pneumococcal vaccination, which must be renewed every 5-6 years. Other medicines:

  • Oxygen for long-term oxygen therapy
  • Mucolytic agents such as acetylcysteine
  • Cortisone tablets: short-term for exacerbation.
  • Antibiotics for acute respiratory infections.
  • Antitussives such as codeine and dextromethorphan are not recommended