Secondary diseases of a COPD
The pulmonary emphysema describes a progressive conversion and degradation of the lung tissue with a decrease in the gas-exchange surface. The reason for this is the narrowing (= obstruction) of the airways. This leads to more difficult exhalation with only slightly impaired inhalation.
This leads to over-inflation of the lungs and damage to the tissue forming the alveoli. Their number and surface area then decreases continuously as the disease progresses. In addition, inhaled toxins (e.g. cigarette smoke) lead to direct changes in the lung tissue and further remodelling of the lung occurs. Due to the reduced gas exchange surface, less oxygen can be absorbed and less carbon dioxide can be released from the blood, resulting in chronic oxygen deficiency in the blood. In return, harmful carbon dioxide accumulates.
Therapy of a COPD
The most important therapy for COPD is to quit smoking or avoid other triggers such as toxic fumes. Physical training and activity are also important. This promotes physical performance and can at least slow down the progression of the disease.
(however, in this case, consultation with the treating physician is necessary, since in the case of advanced heart failure, sporting overexertion can be harmful again!) In training courses the affected persons learn how to deal with their illness and measures are taught which help the affected persons to cope with the shortness of breath, e.g. – Posture in case of shortness of breath (coach seat)
- Use of the so-called lip brake (breathing technique that prevents the alveoli from collapsing)
- Training of the respiratory auxiliary muscles (not used during normal breathing, can be activated if necessary and additionally support the respiratory movements of the thorax)
The treatment options with drugs are now very diverse. The administration of different drugs can be arranged according to the stage and concomitant disease in order to create an optimal therapy plan for each patient.
However, these drugs are not able to cure the disease. So far, it is only possible to slow down the progression of COPD. Basically, the therapy usually includes basic medication, which is taken daily and is usually effective for a long time (basic medication).
In addition, there are medications that only have to be taken when needed (on-demand medication). These are particularly suitable for short-term attacks of shortness of breath and are usually only effective for a short time. The drugs attack different mechanisms that lead to COPD.
Most important are drugs that dilate the muscles of the airways, so-called bronchodilators. These drugs relax the muscles of the respiratory tract, making them wider and allowing more air to flow through. So-called sympathomimetics and parasympatholytics are used for this purpose.
Most of these drugs are administered by inhalation because they reach the lungs directly and are ideally distributed there. Both groups of drugs are available in both short-acting and long-acting forms. In most cases, therapy is started with one of the drugs.
These include salbutamol, fenoterol, ipratropium bromide, salmeterol, formoterol and tiotropium bromide. Depending on the severity of the disease, medications from other classes of medication can also be prescribed. A basic combination therapy with these drugs is also possible.
To counteract the chronic inflammation associated with COPD, steroids and anti-inflammatory drugs are also prescribed. Inhaled steroids include budesonide, fluticasone and beclometasone. Roflumilast is prescribed for repeated derailments, but it has many side effects.
By inhibiting a certain enzyme called phosphodiesterase, the inflammation is reduced and the vessels in the lungs are dilated. Very rarely theophylline is still used. However, this drug has the most side effects and should only be used in exceptional cases.
Oxygen therapy in COPD can take on different forms depending on the symptoms of the affected person. In COPD, the body is no longer able to absorb sufficient oxygen from the air. Reference values for determining the oxygen content in the blood are the partial pressure of oxygen and the oxygen saturation.
The partial pressure of oxygen is a measure of the amount of dissolved oxygen in the blood. It is given in the unit mmHg (historical unit: a mercury column was previously used for measurement). The critical value at which oxygen therapy would be initiated would be <60 mmHg.
Oxygen saturation is given in percent and indicates the percentage of red blood cells that are saturated with oxygen. The reference range here is 92-99%. The critical value here is a saturation below 90%.
Therefore, persons with an oxygen pressure < 60 mmHg in their blood should be supplied with an oxygen device. In a late stage of COPD, long-term oxygen therapy of at least 16 hours per day is usually necessary. However, it is often advisable to start oxygen therapy before this time.
For example, many people lose oxygen saturation in their blood while sleeping and therefore need oxygen therapy at night. Even during physical exertion and sport, it is often advisable to get oxygen early on. As the disease progresses, the effectiveness of breathing decreases.
If too little oxygen is absorbed into the blood in the lungs and too little CO2 is released into the air we breathe, this process must be supported by oxygen therapy. The oxygen is then usually administered for at least 16 hours a day. For this purpose, patients are given a mobile oxygen device as well as a nasal cannula or mask, which continuously delivers the oxygen to the patient.
If the drops in saturation occur mainly at night and during sleep, there are various forms of therapy for the night. These can also be helpful during the day in the case of acute deterioration. Masks that keep the airways open are now widely used to support the patient’s own breathing and facilitate exhalation.
(so-called non-invasive ventilation). A stay in a sleep laboratory is necessary to initiate this therapy. This topic might also be of interest to you: Breathing exercises in COPD.
Surgery is not a common therapeutic measure in COPD. In this disease, the primary problem lies in the airways. It is not possible to operate on these so that they are less constricted.
A problem associated with COPD is the reduced breathing of air from the lungs. This traps a lot of oxygen-poor air in the lungs, the organ over-inflates. In such cases a system of so-called lung valves can help.
As a last resort in COPD, lung transplantation may be considered for some patients. For a small group of patients, surgical measures may also be considered. Bronchoscopy (endoscopy of the lung) is a procedure that can be used.
A tube with a camera at its tip is inserted into the trachea and the doctor can assess the airways on a monitor. This method is very well suited for the insertion of valves that can reopen narrowed airways. These valves allow air to escape from over-inflated sections of the lung.
Thus, formerly over-inflated sections become smaller and healthy lung sections can expand better again. A lung transplantation can also be performed in cases of highly advanced COPD. The transplantation of a lung can significantly improve the quality of life, but is also associated with many risks and a lifelong intake of strong medication with correspondingly many side effects.
