Possibilities of therapy
The therapy of COPD consists of the following measures and must be adapted individually. – Avoid triggering noxae
- Drugs
- Oxygen therapy and breathing apparatus
- Night-time breathing apparatuses
- Respiratory gymnastics
- Infection prophylaxis
Avoiding noxious substances
Very important in therapy is to find the triggering factors of COPD and to eliminate them if possible. As a rule, this means that the person affected should stop smoking in order to slow down the progression of COPD. This requires an active willingness to cooperate (compliance) on the part of the affected person.
Drug therapy
Since the diameter of the bronchial tubes is narrowed in COPD (chronic obstructive pulmonary disease), breathing is also more difficult because the resistance in the airways is increased. In order to reduce this resistance, one tries to widen the bronchi with medication. On the one hand, this is done by fast and short-acting inhalable drugs which bind to specific receptors of the autonomic nervous system (ß2-receptors of the sympathetic nervous system) and thus dilate the bronchi.
These drugs include substances such as salbutamol or fenoterol (ß2 sympathomimetics) and are used to suppress acute respiratory distress. Since the autonomic nervous system consists of two parts (sympathetic and parasympathetic nervous system) and plays a major role in breathing, an additional substance can be administered which attacks the second component of the autonomic nervous system, the parasympathetic nervous system. This class of substances includes the ipratropium (parasympatholytic), which is also inhaled and is short-acting.
In order to achieve a longer effect, substances such as tiotropium (belongs to the parasympatholytic class) and salmeterol or formoterol (belongs to the ß2 sympathomimetic class) are used and usually inhaled twice a day. Cortisone is a large group of anti-inflammatory drugs. They inhibit chronic inflammation within the respiratory tract and thus prevent acute attacks of disease (exacerbations).
The cortisones used in COPD therapy are called budesenoside, beclometasone and fluticasone. They do not differ from cortisone in their effect, but have the advantage that their side effect profile is significantly lower, as they act almost exclusively in the airways. They are mainly used in advanced COPD (GOLD stage C/D) and in cases of acute deterioration (exacerbation).
The above mentioned preparations are taken with the help of sprays. By inhaling the sprays deeply, the active substance reaches the airways directly. Cortisone often shows only limited efficacy in COPD (in contrast to bronchial asthma). It is therefore recommended to discontinue the preparation if there is no response or no improvement of the symptoms. Long-term use of cortisone in the airways significantly increases the risk of pneumonia.
Bronchodilators
The airways (trachea, bronchi) are surrounded by smooth muscles. The innervation of these muscles is carried out by the vegetative nervous system (sympathetic, parasympathetic). While the sympathetic nervous system (e.g. during exertion or stress situations) dilates the airways by relaxing the smooth muscles, the sympathetic nervous system causes a narrowing of the airways by contracting the muscles.
This mode of action is exploited in the drug therapy of COPD. In this process, both an activation of the sympathetic nervous system (beta-2 sympathomimetics) and an inhibition of the parasympathetic nervous system (anticholinergics or parasympatholytics) lead to an expansion of the airways (bronchodilatation). For this reason these groups of drugs are also called bronchodilators.
Beta-2 sympathomimetics lead to an expansion of the airways by binding to beta-2 receptors of the sympathetic nervous system. A distinction is made between short- and long-acting preparations. Salbutamol and fenoterol belong to the short-acting (SA = short acting) drugs, while salmeterol, formoterol and indaceterol are attributed to the long-acting (LA = long acting) ones.
The short-acting beta-2 sympathomimetics are used as demand medication in the case of an acute worsening of COPD (exacerbation). The long-acting beta-2 sympathomimetics, on the other hand, are used for long-term therapy of COPD. Depending on the GOLD stage, the therapy consists of one or a combination of several preparations.
Anticholinergics lead to an expansion of the airways by inhibiting the receptors of the parasympathetic nervous system. A distinction is also made between short- and long-acting preparations. The most frequently prescribed short-acting (SA) preparation is ipratropium bromide.
This is used as a demand medication in the case of an acute worsening of COPD (exacerbation). A long-acting (LA) anticholinergic is tiotropium bromide. This is used for long-term COPD therapy.
Depending on the GOLD stage, the therapy consists of one or a combination of several preparations. A frequently used alternative to bronchodilators and cortisone is theophylline. This is used especially when the symptoms do not improve or in cases of advanced COPD.
In addition, it can be used in severe respiratory distress in the context of exacerbated COPD. Theophylline leads to an inhibition of the inflammation within the respiratory tract as well as to a dilatation of the respiratory tract by slackening of the smooth muscles. In addition, theophylline also shows numerous side effects due to its non-specific inhibition of various enzymes and receptors.
Besides an inner restlessness with insomnia and seizures, cardiac rhythm disturbances and complaints in the gastrointestinal tract are also described. Theophylline should therefore never be used for acute heart diseases (e.g. fresh heart attack, cardiac rhythm disturbances). Another alternative to the bronchodilators and cortisone described above is the active substance roflumilast.
In contrast to theophylline, roflumilast specifically inhibits only one enzyme in the body (phosphodiesterase-4). As a result, there is a reduced release of inflammatory messengers within the respiratory tract, which inhibits the immigration of further inflammatory cells. Roflumilast is particularly indicated in the case of recurrent attacks of disease (exacerbations). It is often combined with long-acting beta-2 sympathomimetics. However, since the enzyme (phosphodiesterase-4) is not only present in the respiratory tract, it sometimes causes very serious side effects (nausea, diarrhoea, abdominal pain).
