COPD:
symptoms, causes and treatment
COPD is a chronic lung disease characterised by chronic bronchitis (chronic inflammation of the alveoli) and emphysema (hyperinflation of the lungs), which leads to breathing difficulties. The lower airways are permanently constricted (obstructed). Productive cough and shortness of breath are symptoms that may indicate chronic obstructive pulmonary disease. COPD cannot be cured, but with the right treatment, its progress can be slowed. Find out more about the symptoms, causes and treatment of COPD.
In Switzerland, around 400,000 people suffer from chronic obstructive pulmonary disease, or COPD for short.
Because the lower respiratory tract is permanently constricted in COPD sufferers, the air flow is blocked, especially when exhaling.
There are two types of COPD, although mixed forms are also common:
- In addition to narrowed airways, inflammation of the bronchi or bronchioles (bronchitis, bronchiolitis) is also present.
- As well as narrowed airways, patients suffer from hyperinflated lungs (pulmonary emphysema). This destroys lung tissue and makes gas exchange more difficult, resulting in a lack of oxygen in the blood.
The main symptoms of COPD are:
- Expectoration (phlegm production)
- Cough (“smoker’s cough”)
- Shortness of breath
At first, shortness of breath only becomes noticeable when exercising. In later stages, it also occurs at rest.
As the disease progresses, the skin on the lips, hands and feet may turn blue due to a lack of oxygen (cyanosis). Among other things, patients can develop anaemia, muscle loss, chronic fatigue, loss of appetite and weight loss. In addition, COPD patients often suffer from anxiety disorders and depression, e.g. due to frightening shortness of breath and increasing physical limitations. The risk of cardiovascular and metabolic diseases is also increased.
If symptoms worsen suddenly (exacerbation), sufferers should consult a doctor. In severe cases, there is a risk of lung failure.
Further possible causes include harmful airborne particles (such as air pollution or dust pollution at work) or an inherited alpha-1 antitrypsin deficiency (which leads to respiratory damage).
If you suspect that you have COPD, contact your GP first. If necessary, they may refer you to a pulmonary specialist.
Investigations
After your medical history is documented, including your symptoms and risk factors (e.g. smoking), a physical examination will be carried out. The doctor will use a stethoscope to listen to your lungs. Blue skin on the lips or nails may indicate advanced COPD disease.
Spirometry is essential for detecting COPD. This lung function test determines the FEV1 value (one-second capacity measurement of the lung, in which you exhale as quickly as possible), which indicates the extent to which the airways are narrowed.
Further examinations can confirm the diagnosis and rule out other causes of the symptoms, such as asthma:
- Specific lung function tests (e.g. body plethysmography, diffusing capacity measurement)
- Exercise tests
- Imaging procedures (X-ray, CT, bronchoscopy)
- Blood tests (e.g. blood gas analysis, test for alpha-1 antitrypsin deficiency and inflammation markers such as CRP)
Different COPD stages
If the diagnosis of COPD is confirmed, the next step is to determine its severity. The severity levels of COPD are stated in grades (GOLD 1 (mild) to GOLD 4 (very severe)) and groups (A to D). The GOLD levels are based on the FEV1 value, while the groups are based on the number of exacerbations in a year and the severity of symptoms. The scale therefore ranges from GOLD 1 A to GOLD 4 D.
The most important therapy component is quitting smoking. Passive smoking should also be avoided at all costs. Other treatment methods are also used:
Medicines
The basic treatment for COPD patients includes bronchodilators (e.g. anticholinergics, beta-2 sympathomimetics). These medicines are inhaled in order to dilate the bronchi.
If bronchodilators alone do not achieve the desired results, anti-inflammatory corticosteroids (cortisone) can be used.
Other medications, such as mucolytics or antibiotics, are often useful as required.
Operations
Surgery is an option for people whose symptoms are not sufficiently improved by medication. Where lung volume is reduced, for example, the lung that is hyperinflated by emphysema can be reduced in size.
In extreme cases, a lung transplant is required. In order to prevent the foreign organ from being rejected, patients are then reliant on drugs that suppress the immune system (immunosuppressants) throughout their lives.
Other treatments
COPD patients benefit from a variety of treatments:
- Physical activity
- Respiratory therapy
- Physiotherapy
- Lung training
- Long-term oxygen therapy in the advanced stages of the disease
- Dietary supplements for underweight patients
Because COPD increases the risk of infection, patients should have all recommended vaccinations.
Research: new drugs for COPD?
Scientists do a lot of research into COPD in order to better understand the disease and improve treatment. Approaches for new drugs include, for example, the inhibition of pro-inflammatory messenger substances. The focus is currently on p38-MAPK inhibitors and monoclonal antibodies, among other things.
Bronchial dilating and anti-inflammatory PDE4 inhibitors (such as roflumilast and cilomilast), which are relatively new to the European market, are thought to improve lung function and prevent exacerbations. However, in a data analysis carried out by the international research network Cochrane, these medications, which are also approved in Switzerland, showed only a small benefit.
COPD is a chronic disease that progresses inexorably. The progression can be slowed with good treatment, but it cannot be stopped or reversed.
On average, patients with COPD live five to seven years fewer than those without this lung disease. However, life expectancy varies greatly from person to person. In addition to the GOLD stage, the decisive factors are nicotine consumption, exacerbations, age and concomitant diseases. Patients usually die of respiratory failure or cardiovascular disease.
Psychotherapy can help to deal with psychological problems. Relaxation techniques help to reduce stress. COPD patients sometimes benefit from travelling to places with a suitable climate. It is important for them to be able to breathe clean air with a high oxygen content, e.g. at the seaside.
For more information and support services, please visit:
- Guideline der mediX Schweiz: COPD (Stand: Mai 2022), unter www.medix.ch (Abrufdatum 03.11.22)
- Leitlinie der Deutschen Atemwegsliga und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin unter Beteiligung der Österreichischen Gesellschaft für Pneumologie: Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD) (Stand: Januar 2018), unter: www.awmf.org (Abrufdatum: 03.11.2022)
- Bundesärztekammer (BÄK) et al.: Nationale Versorgungsleitlinie COPD (Stand: Juni 2021), unter: www.awmf.org (Abrufdatum: 03.11.2022)
- Lungeninformationsdienst: COPD: Chronisch obstruktive Lungenkrankheit, unter: www.lungeninformationsdienst.de (Abrufdatum: 03.11.2022)
- Lungenliga: COPD nachweisen – Diagnose, unter www.lungenliga.ch/de/ (Abrufdatum: 03.11.2022)
- Lungenärzte im Netz: Habe ich COPD?, unter: www.lungenaerzte-im-netz.de (Abrufdatum: 03.11.2022)
- Lungenärzte im Netz: Krankheitsbild, unter: www.lungenaerzte-im-netz.de (Abrufdatum: 03.11.2022)
- Lungenärzte im Netz: Prognose & Selbstmanagement, unter: www.lungenaerzte-im-netz.de (Abrufdatum: 03.11.2022)
- Cochrane: Phosphodiesterase-4-Hemmer für Menschen mit chronisch obstruktiver Lungenerkrankung (COPD), unter www.cochrane.org/de/ (Abrufdatum: 04.11.2022)
- https://www.bag.admin.ch/bag/de/home/krankheiten/krankheiten-im-ueberblick/chronische-atemwegserkrankungen.html
- Bundesamt für Gesundheit BAG: Chronische Atemwegserkrankungen, unter www.bag.admin.ch (Abrufdatum: 04.11.2022)