COPD is an abbreviation for Chronic Obstructive Pulmonary Disease. In this context, COPD includes several similar disease patterns that have similar symptomatology and symptoms. In particular, severe shortness of breath, coughing and sputum (coughing mucus) are typical. The main cause of COPD is smoking.
What is COPD?
Infographic on the different lung diseases and their characteristics, anatomy and location. Click to enlarge. Chronic obstructive pulmonary disease (COPD) is damage to the lungs that cannot be reversed (irreversible). The COPD almost in principle the chronic bronchitis (“smoker’s cough“), chronic bronchiolitis and emphysema (destruction of the alveoli and thus significantly reduced exchange surface for the gases) together. A typical symptom is a breathing disorder during expiration. During expiration, the bronchi collapse or become obstructed by viscous mucus. This is medically referred to as obstruction. At the beginning of the disease, shortness of breath occurs only intermittently during exertion, and later it is sometimes permanent at rest. Other symptoms include white to brownish sputum, especially in the morning, and an agonizing cough. Chronic obstructive pulmonary disease is one of the common diseases in Germany, and the incidence continues to rise.
Causes
By far the most common cause of COPD (chronic obstructive pulmonary disease) is active, but also passive, cigarette smoking. Even former smokers can still develop chronic obstructive pulmonary disease. However, the risk is much lower. The physical stimulus and toxins directly damage the cells in the airways, but also cause and bfavor chronic inflammation. In this process, the defense cells not only clear toxic particles, but additionally damage the lung framework through self-digestion. Similarly, general environmental pollution (for example, by particulate matter or biofuel degradation products) is a relevant cause of chronic obstructive disease. Some authors even concede it a similar importance as for smoking. Less common causes are occupational contact with hazardous substances (e.g. cotton or chemical substances), infections and dietary habits (food containing nitrite seems to favor COPD). Alpha1-antitrypsin deficiency also leads to emphysema. This is a hereditary condition in which an enzyme is missing or reduced that can limit self-digesting enzymes.
Symptoms, complaints, and signs
Due to the gradual progression of COPD, typical symptoms of the disease are often recognized late and the diagnosis is made at a late stage of the disease. Typical symptoms of COPD include sputum, cough, and shortness of breath, also summarized as “AHA” symptoms. The productive cough with viscous mucus is typically chronic for several months. It occurs mainly in the morning after getting up and is difficult to cough up. The narrowing of the airways also causes shortness of breath. The problems manifest themselves primarily during exhalation. Patients have problems breathing out the air completely and a dry, whistling breathing sound may occur during exhalation. Initially, the shortness of breath occurs primarily during exertion, so-called exertional dyspnea, but in the course of time, shortness of breath also occurs more frequently at rest. Patients suffer from an increasing reduction in their physical capacity. As a result of the decreasing lung capacity, there is an increasing lack of oxygen supply to the body. This manifests itself as a blue coloration of the lips, tongue, and the tips of the fingers or toes. Doctors refer to this as cyanosis. Frequent viral infections and cigarette smoke worsen the symptoms of COPD (exacerbation) and thus promote the progression of the disease.
Course
The sooner COPD (chronic obstructive pulmonary disease) is diagnosed and treated by a physician, the fewer complications will occur and the disease may have a relatively good prognosis. Furthermore, the disease also depends on whether the affected person stops smoking and actively carries out various rehabilitation measures. Typical complications that can occur in the course of the disease are pneumonia or even lung cancer caused by smoking.In this context, and with inadequate treatment, heart failure or complete respiratory failure may even occur, resulting in death.
Complications
The progressive weakening of the lungs due to COPD can lead to increased colonization of bacteria and other pathogens. Further respiratory infections may increase as a result. In this case, the mucous membranes (especially those of the bronchial tubes) no longer have the opportunity to counteract the infections. An acute worsening of the leading symptoms of COPD is also possible at any time. The increased shortness of breath and lack of oxygen cause cramping and, consequently, higher blood pressure and increased strain on the heart muscles. Both increase the risk of heart attack and stroke considerably. In addition, an acute exacerbation not infrequently requires treatment because the affected person can no longer breathe at all. The purely structural damage to the airways caused by chronic obstructive pulmonary disease can lead to collapse of the lungs. A pneumothorax can vary greatly in severity and can also pose an acute threat to life. Nocturnal breathing cessations, which may be associated with advanced COPD, can lead to heart failure. Reduced blood flow can cause permanent damage to organs. In addition, the heart can swell and eventually fail completely as a result of poor oxygenation.
When should you see a doctor?
Considering that COPD is one of the leading causes of death, a quick trip to the doctor is in order. So if the typical symptoms – coughing and shortness of breath – occur, no sufferer should shy away from going to the doctor. It makes sense to clarify the symptoms. Although it is possible that it is a harmless infection, it is chronic symptoms, long-term smoking or frequent exposure to pollutants that indicate chronic damage to the lungs. The earlier COPD is detected, the better it can be prevented from progressing. Correspondingly, the risks for the sequelae of smoker’s lung can be well reduced, leading to an almost normal life expectancy with fewer limitations if the lung is treated consistently. Treating physicians are in the first instance the family doctor (for clarification of infections and for the purpose of a first examination) and for the further treatment of the COPD a lung specialist. If COPD has already been diagnosed, regular monitoring by the treating physician is recommended in order to change the therapy if necessary. In case of an occurring deterioration of the condition, a physician should be consulted in any case.
Treatment and therapy
Therapy is given according to the degree (stage) of chronic obstructive pulmonary disease (COPD). The goal is only to improve symptoms. Efforts are also made to prevent or slow progression of the disease. The lung changes themselves are irreversible. First and foremost are drugs that dilate the bronchial tubes. These are usually inhaled when shortness of breath occurs and are rapidly effective. Typical representatives of this group are the short-acting beta-2-sympathomimetics (e.g. salbutamol), anticholinergics (e.g. ipratropium bromide) and the methylxanthines (theophylline, reserve drug). A combination of drugs from different drug groups is possible. If the medication is not sufficient when needed, long-acting beta-2 sympathomimetics (e.g., salmeterol) are added. Glucocorticoids (e.g., budesonide) are used from stage three or in the event of a – usually infection-triggered – worsening of the condition (exacerbation). These can be given inhalatively, and in acute cases also systemically as tablets or intravenously. Long-term systemic cortisone therapy is not useful in chronic obstructive pulmonary disease. In addition, antibiotics should be used in the case of infections, since inflammations in the sense of an exacerbation can massively worsen the symptoms. The effectiveness of expectorants (e.g. acetylcysteine (ACC)) has not been proven. Physical measures are also helpful, e.g. use of the respiratory support muscles in the so-called coach seat or breathing exercises for more breath control (lip brake when exhaling). If these measures are not sufficient (stage four), the patient is supplied with oxygen. Portable oxygen devices can be easily integrated into everyday life. A distinction is made between continuous treatment and interval treatment.If the disease progresses further, the respiratory muscles can no longer cope with the increased work and become exhausted. The affected person must then be ventilated completely as part of home ventilation. Interval therapy is also possible in this case. However, weaning from ventilation is usually only realistic if there has been an exacerbation. Surgical procedures (lung volume resection for emphysema, lung transplantation) are the last line of therapy.
Outlook and prognosis
The prognosis of COPD is usually considered unfavorable. It depends largely on whether and to what extent the course of the disease can be influenced. If the progression of the disease can be significantly slowed, the prospects of improvement increase. Nevertheless, on average, the life expectancy of a COPD patient decreases by up to 5-7 years in direct comparison to healthy people. For the improvement of health, the patient’s cooperation is essential. The consumption of harmful substances must be completely avoided. This includes cessation of smoking as well as consumption of other toxic substances. If the patient is exposed to nicotine, exhaust fumes or other pollutants from the trades or construction industry, his chances of recovery decrease considerably. At the same time, the course of the disease progresses more rapidly. As soon as the lung tissue of the COPD patient has been only minimally damaged, the prospect of alleviating the symptoms or the chance of recovery increases. However, this is only possible in a few patients. In most cases, the tissue damage to the lungs of COPD patients is already far advanced and can no longer be repaired. Often, the only way to improve health is then to obtain a donor lung and thus a transplant. Nevertheless, further progression of COPD can be prevented with drug therapy and avoidance of harmful substances.
Prevention
The best prevention is to quit smoking or not to start smoking in the first place. However, passive smoking must also be consistently avoided. Upper respiratory tract infections should be treated consistently to avoid an outbreak or worsening of chronic obstructive pulmonary disease.
Follow-up
Various methods of follow-up can be considered for chronic obstructive pulmonary disease. These depend on the extent to which the lungs could be relieved and the effects the disease has had and continues to have on the body and psyche of the affected person. For example, those affected by COPD can make use of psychological counseling and self-help groups. This is particularly valuable if the disease is no longer considered treatable or has led to severe limitations. This may be due, for example, to a disturbance in the appearance of the skin as a result of the disease or to an all-round reduction in performance. For all forms of mild and moderate cases of COPD that required inpatient treatment, various forms of physical aftercare can be considered. Light exercise (walking, climbing stairs, etc.) and going to places with clean air are generally recommended. In addition, regular breathing exercises are also part of the aftercare. Keeping the body healthy (especially with regard to excess weight) is also part of aftercare. Patients with chronic obstructive pulmonary disease must also undergo regular follow-up examinations. Here, the lung function and structure are recorded and progress or setbacks are determined. In the case of severely damaged lungs, lifelong follow-up examinations can be assumed.
What you can do yourself
In order to be able to regain strength when diagnosed with COPD and to maintain independence and mobility despite the disease, those affected have many options. For example, in addition to unconditionally giving up cigarettes, the aim should be to lead a daily life that contains hardly any pollutants in the air. This includes avoiding dusty rooms, chemical fumes and busy roads. Regular walks in the fresh air as well as suitable sport – this is to be selected with the attending physician – are advisable. In this way, the lungs are cleansed and breathing capacity can be increased. Applied breathing techniques such as lip-blocking can also improve breathing. Since breathing becomes increasingly strenuous as COPD progresses, it may be necessary to change the diet. For example, the diet should be particularly rich in vitamins and minerals so that cell renewal in the bronchial tubes, mucus production and the immune system can be strengthened.Sufficient amounts of fluid and tea facilitate the coughing up of accumulated sputum. Steam inhalations have proven effective in decongesting the lungs and loosening mucus at the same time. Mint, eucalyptus, thyme and sage are oils often used here. Installing an air filter in frequently used rooms can further protect the lungs from additional particles. If weakness due to shortness of breath increases, everyday aids (grab bars on the bathtub and the like) should be installed.