What can be done about the feeling of suffocation?
In the final stage, COPD (chronic obstructive pulmonary disease) is often accompanied by the subjective feeling of suffocation. This can initially be compensated by a supply of oxygen in higher flow rates. Later, certain body positions in particular help to improve breathing.
For example, resting the hands on the legs can enable the breathing muscles to work better. The lip-brake can cause a widening of the airways and thus ensure a better situation when breathing out. In addition, nightly sleep should no longer take place lying down completely but with the upper body elevated. In the absolute final stage a so-called palliative therapy can be carried out. Among other things, medication is used here that has an anxiety-relieving effect.
What does the therapy look like in the final stage?
The therapy of COPD is based on the stages of the disease. In stage 4 after GOLD the maximum therapy is used. This includes inhaled glucocorticoids (steroids) in combination with a long-acting anticholinergic or a long-acting beta-2 sympathomimetic.
Roflumilast, a relatively new active substance from the group of PDE-4 inhibitors, can also be used. Theophylline is also used in some patients. Inhaled glucocorticoids are available in the form of combination preparations with long-acting beta-2 mimetics.
Not all COPD patients benefit from glucocorticoid therapy, so that the success of the therapy should be evaluated regularly. If the symptoms do not improve, the therapy should be changed. Among the frequently used glucocorticoids are budesenoside and fluticasone.
Frequently used beta-2 mimetics are formoterol and salmeterol. From the group of long-acting anticholinergics, ipatropium bromide and tiatropium bromide are frequently used. In case of acute exacerbation, the use of antibiotics may also be necessary.
However, this is not absolutely necessary and should be weighed up critically in each individual case. Especially in patients with end-stage COPD, drug therapy often does not sufficiently alleviate the symptoms. Therefore, long-term oxygen therapy is often necessary in addition.
The oxygen is supplied through nasal cannula. The patients are given a home oxygen device for this purpose. If the indication is sufficient, this is financed by the statutory health insurance companies.
If the CO2 values in the respiratory gases are significantly increased, non-invasive ventilation may also be necessary. This form of ventilation relieves the respiratory muscles and leads to a better gas exchange with sufficient reduction of the CO2 value. This type of ventilation is used both as an acute measure in inpatient everyday life and as home ventilation.
The last resort for end-stage COPD is to use intubation and invasive ventilation in a hospital. In addition, a lung volume resection can be considered. In an endoscopic procedure (bronchoscopy), valves are inserted into the lung to counteract the over-inflation of the lung typical in COPD. This is not a real operation, but the procedure is usually performed under general anaesthesia.
