COPD is a generic term for chronic bronchitis and emphysema – permanent, progressive diseases of the respiratory tract (Engl. : chronic obstructive pulmonary disease), which are characterized by the fact that exhalation is hindered by a narrowing of the bronchi. In the course of the disease, the lung tissue is destroyed. As a result, gas exchange is increasingly impaired and insufficient oxygen reaches the organism.
Causes of COPD
COPD is a consequence of cigarette smoking in about 9 out of 10 cases – hence the colloquial term smoker’s lung. Other causes, such as infections or air pollution, as well as occupational risk factors (dust, chemicals), can promote COPD. The severity and course of the disease also depend on genetic factors. In rare cases, a congenital disease is the underlying cause: AAT deficiency. In this case, an important enzyme, alpha-1-antitrypsin (also: alpha-1-proteinase inhibitor), which protects the sensitive alveoli from harmful substances, is missing. If this substance is missing or functions inadequately, the alveoli and airways are constantly attacked by inhaled substances and gradually destroyed. In those affected, however, the symptoms usually become apparent at a younger age (25 to 30 years).
Symptoms of COPD
The main characteristics of the disease are chronic cough, especially in the morning, sputum and increasing shortness of breath, especially during exertion – in advanced stages, even short distances become impossible. As the disease progresses, the airways become increasingly narrowed and breathing becomes obstructed. Especially when exhaling, the airflow is restricted. Over the years, a feeling of “overinflation” of the lungs develops in addition to shortness of breath. The affected person then has the oppressive feeling of constantly breathing on the last reserves of his lungs.
COPD or asthma?
Unlike asthma, COPD comes on silent soles – the disease develops over years or decades. In contrast, a typical sign of asthma is a sudden onset of shortness of breath. Although asthma and COPD are both associated with a narrowing of the airways, they are nevertheless two different clinical pictures that are also treated differently.
Diagnosis of chronic obstructive pulmonary disease.
Any cough that lasts longer than eight weeks may indicate COPD, especially if the affected person smokes: high-risk groups are longtime smokers over 40 years of age who suffer from shortness of breath on exertion, cough, and sputum (AHA symptoms). The suspected diagnosis of COPD is usually made by the physician on the basis of the symptoms described and the patient’s medical history; it is confirmed primarily by spirometry. This examination allows the function of the lungs to be assessed by measuring the volume of breath that can be exhaled after a maximum deep inhalation in one second with the greatest effort. Even if therapy cannot eliminate the cause, early diagnosis and thus timely treatment of COPD is important to prevent the disease from progressing further. Another argument in favor of early treatment is the fact that COPD sometimes leads to considerable physical and social limitations for those affected and not infrequently to an increased mortality rate. The risk of cardiac disease is also greatly increased.
Treatment of COPD
To date, there is no causal therapy for COPD. This means that the disease cannot be cured, although it is possible to slow its progression and positively influence acute exacerbations. The goal of any treatment is to improve lung function, reduce shortness of breath, and increase exercise capacity. Therapy for COPD is composed of the following:
- The most important measure to stop the gradual deterioration of lung function is to stop smoking.
- Physical exercise or rehabilitative training also represent basic measures.
- It is still essential that those affected learn under guidance how they can positively influence their breathing in daily life. This includes breath-easing techniques (lip brake, certain postures, coughing techniques) at rest, but also under the stresses.
- For drug therapy, mainly bronchodilators (dilate the airways) and cortisone preparations (against inflammation) are used for inhalation.
Often affected people find the transition difficult
Many affected people have difficulty implementing these measures. The following factors play a role:
- The complaints often seem “trivial.” The typical symptoms of cough and sputum are gladly downplayed by patients.
- Airway obstruction does not develop overnight, but over a long period of time. An asthma patient adjusts his lifestyle very quickly after an attack, in contrast, COPD patients adapt to the symptoms without giving up the causal evil, smoking.
- Because of the shortness of breath, so-called avoidance strategies are developed. Although physical exercise would be important, the affected limit their scope more and more and everyday life then plays out mainly sitting.
- COPD patients have often already had many attempts to quit smoking and are partially discouraged. Therefore, there is a lack of insight and a genuine effort to change lifestyle and quit smoking.
COPD: self-help information
Sufferers therefore need information to successfully implement the therapy measures themselves:
- Knowledge about the disease as well as effects of air or environmental pollution.
- Self-monitoring for example peak flowmetry, keeping a COPD diary (available from the German Respiratory League).
- Information in dealing with hazardous situations (for example, stays at high altitude, air travel, certain sports).
- Sports and exercise therapy, because appropriate physical training leads to an increase in performance.
- A structured patient education to improve self-management skills.
