In chronic obstructive pulmonary disease (COPD), the lungs are permanently damaged and the airways (bronchi) are narrowed. This makes it difficult to breathe in advanced COPD. Even everyday activities can be enough to get out of breath – such as climbing stairs, gardening or taking a walk.
COPD does not arise suddenly, but develops slowly over years. Complaints such as a persistent cough are often mistaken for a "normal" cough in the beginning Smoker's cough, a bronchitis or asthma held. The fact that another illness is behind it is often only recognized when more severe complaints are already noticeable. Many affected persons are then older than 60 years of age. Treatment of COPD aims to halt or at least slow down the progression of the disease. The most important thing is to give up smoking . Medications can relieve symptoms and prevent respiratory distress attacks. Patient training helps to cope with the disease.
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The lungs have very large reserves. At rest, usually only less than one tenth of the amount of air is needed that respiration can handle during heavy exertion. This enormous margin is the reason why the function of the lungs can slowly deteriorate over years without much being noticed in everyday life. Only when a large part of the reserves has already been lost does chronic obstructive pulmonary disease become noticeable in the form of shortness of breath. Typical symptoms of COPD are:
– Shortness of breath during physical exertion; in advanced COPD already at rest – daily cough over a longer period of time – expectoration – sounds when breathing such as whistling and humming – increased discomfort during colds or flu illnesses
Exacerbations, sudden and marked worsening of the disease, are also typical. Usually manifested by attacks of shortness of breath and increased coughing with expectoration.
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Several factors play a role in the development of COPD: On the one hand, the bronchial tubes are permanently inflamed. On the other hand, the alveoli of the lungs may be overinflated, which is called pulmonary emphysema.
A chronic cough ( bronchitis ) can develop when the respiratory tract is frequently exposed to pollutants such as tobacco smoke, dust or gases. Inflammation destroys the cilia that line the inner wall of the bronchial tubes like a carpet.
Normally, the cilia are mobile and covered by a thin layer of mucus. Dust and disease germs from the air we breathe usually get stuck somewhere in this mucus film and then don't reach the lungs. The cilia then transport the mucus out of the bronchi. This self-cleaning process is very important for the health of the lungs. If the cilia are destroyed, the mucus can no longer be removed properly and the bronchial tubes become clogged.
Destroyed alveoli (air sacs in the lungs)
In emphysema, the walls of the alveoli are destroyed. Instead of many small blisters, larger blisters form, which reduces the overall surface area of the lungs. This results in less oxygen entering the bloodstream. In COPD, inflamed, narrowed bronchial tubes and emphysema come together so that the consequences are mutually reinforcing.
Narrowed airway (bronchus)
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There is a strong link between smoking and chronic obstructive pulmonary disease: not every smoker gets the disease, but most people with COPD smoke or have smoked in the past.
Other prolonged irritations of the lungs also promote the disease. This includes, for example, heavy exposure to certain types of dust at the workplace.
There is also evidence that certain congenital characteristics are partly responsible for the fact that some people develop COPD more easily than others. Examples of this are disorders of lung development in the womb and the rare "alpha-1-antitrypsin deficiency". It affects about 1 to 2 out of every 100 people with the disease.
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It is estimated that about 5 to 10 out of 100 people over the age of 40 have COPD . It is thus more common than asthma . Men are significantly more likely to develop the disease than women.
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Symptoms are not clear at first, but most often people with mild COPD also have a more frequent cough with sputum. Their airways are initially only slightly narrowed, so they hardly notice the gradual loss of lung function. Over time, however, physical exertion causes more and more respiratory problems. Also the discomfort caused by coughing. Sputum becomes stronger.
In advanced stages, the disease greatly limits the quality of life. People with severe COPD have such narrowed airways that they experience shortness of breath even during everyday activities such as washing and dressing, or even at rest.
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In the advanced stages of the disease, the lungs can no longer supply the body with sufficient oxygen. This also results in changes in other organs. So the heart has to pump more blood through the lungs. Due to the increased stress, the responsible right part of the heart muscle thickens, physicians speak of a "cor pulmonale". As a result, the heart loses its beating power. This can lead to water retention in the legs and body, for example.
Because physical exertion causes discomfort in people with chronic obstructive pulmonary disease, they exercise less. The result is a loss of muscle mass, which reduces physical performance even further.
In people with COPD, normally harmless respiratory infections can cause lung function to suddenly deteriorate and symptoms to increase sharply. These attacks are medically called exacerbations. Often, treatment in the hospital is then necessary. However, exacerbations can also be triggered by smoke, exhaust fumes and certain weather conditions such as heat, cold and high humidity. Typical warning signs of such acute deterioration are:
– more sputum – discolored sputum, purulent sputum, sputum is more viscous than usual – more shortness of breath than usual – more cough than usual – greater need for medication – fever , decreased performance, greater fatigue, or other nonspecific complaints
An increase in shortness of breath triggers anxiety in most people, which in turn can increase the shortness of breath. It is therefore good to know what to do in such situations. There are so-called contingency plans for this . They list typical symptoms and describe, among other things, when it is convenient to change the intake or dosage of medication and go to the doctor or hospital.
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The disease is often not recognized at the beginning. People who smoke, in particular, often mistake their symptoms for a supposedly harmless "smoker's cough" for a long time. However, symptoms such as a persistent cough and frequent shortness of breath can indicate COPD.
First examinations are often possible in the family doctor's office. A visit to a specialist in pulmonary medicine (pneumology) is needed for specific tests.
The doctor first examines the body, asks about other diseases and takes blood samples. Examinations of the lungs ( pulmonary function tests , spirometry ) follow. Depending on the results, further examinations may be necessary to rule out other diseases such as asthma, heart failure or lung cancer.
The aim of the examinations is also to find out how far COPD has progressed and what the risk of complications is. Knowledge is important for treatment planning.
Prevention information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_ELSE$$CMS_VALUE(tt_textCategory.dataset.formData.tt_name.convert2)$$CMS_END_IF$
The most effective way to prevent COPD is not to smoke or to stop smoking. This is often easier said than done. Strategies that can help with smoking cessation include, for example, a combination of a cessation program and nicotine replacement therapy.
Since pollutants in the environment or at the workplace can also promote COPD, it makes sense to avoid them as much as possible. Protective measures at the workplace can ensure that people are not permanently exposed to such substances.
A common trigger of exacerbations is respiratory infections. Sore throat, sweating and fever further debilitate with COPD. During cold and flu season, it is therefore important to protect yourself from infection . This includes avoiding contact with people with colds or large crowds of people. It may also be useful to get vaccinated against influenza or pneumococcus.
Treatment Information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_ELSE$$CMS_VALUE(tt_textCategory.dataset.formData.tt_name.convert2)$$CMS_END_IF$
The treatment of chronic obstructive pulmonary disease aims to relieve symptoms and discomfort, to make everyday life easier and to improve the quality of life. Second, it is designed to slow the progression of COPD and prevent exacerbations.
An essential part of daily COPD treatment is medication – either to inhale or to take as a tablet. Combinations of different medications are common, depending on the stage of the disease. The following medications are available:
Airway dilators (bronchodilators): These are usually inhaled as a powder and can make it easier to breathe. These include beta-2 mimetics , anticholinergics and methylxanthines. Cortisone-containing drugs: Cortisone spray or tablets inhibit airway inflammation. PDE-4 inhibitors: These tablets also have an anti-inflammatory effect.
In very advanced COPD, additional treatment with oxygen is often necessary. The form of treatment depends on the severity of the disease.
If all treatment options have been exhausted for severe emphysema, surgery is also an option. For example, lung volume reduction and bullectomy (bulla: Latin for bladder) reduce the overinflated parts of the lungs to make breathing easier. Under certain conditions, a lung transplant is also conceivable.
Supportive measures include physical activity, breathing training, inhalations, or dietary changes. In addition, health insurers offer so-called disease management programs (DMPs) for people with COPD. Its aim is to reduce the number of severe attacks of breathlessness and slow down the progression of COPD through consistent and well-monitored treatment.
More knowledge
Rehabilitation Information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_ELSE$$CMS_VALUE(tt_textCategory.dataset.formData.tt_name.convert2)$$CMS_END_IF$
Pneumological rehabilitation (pulmonary rehabilitation) helps people with chronic obstructive pulmonary disease (COPD) to better manage their disease and lead as normal a life as possible. A treatment plan is put together for this, tailored to personal needs. The treatment plan is a combination of physical training, education in managing the disease and therapy, and social and psychological support.
Pneumological rehabilitation is an important component of the COPD disease management program . It can be used on an outpatient or inpatient basis.
Life and everyday life information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_ELSE$$CMS_VALUE(tt_textCategory.dataset.formData.tt_name.convert2)$$CMS_END_IF$
How COPD is affected depends very much on the stage of the disease. COPD may be associated with only minor life restrictions for many years. Over time, however, the symptoms increase. In the case of severe COPD, normal everyday life is no longer possible, and comprehensive support and care by others is then usually necessary.
For many people, it helps to adjust their lifestyle and daily routine to meet their body's needs and responses. Some focus more on the things that are most important to them. Others use certain breathing and relaxation techniques, allow themselves to rest or do a little sport, depending on the shape of the day.
As COPD progresses, the practical and emotional support of family and friends becomes more important.
In addition to the possibility of participating in a disease management program (DMP), there is a wide range of personal counseling and support services for patients with COPD . However, many of these services are organized differently locally and are not always directly available. A list of contact points helps to find and use offers in the vicinity.
Decramer M, Janssens W, Miravitlles M. Chronic obstructive pulmonary disease . Lancet 2012; 379(9823): 1341-1351.
German Society of Pneumology and Respiratory Medicine (DGP), German Respiratory League, Austrian Society of Pneumology (oGP). S2k guideline on the diagnosis and treatment of patients with chronic obstructive bronchitis and emphysema (COPD) . AWMF Register No.: 020-006. 24.01.2018.
Institute for Quality and Efficiency in Health Care (IQWIG). Lung volume reduction procedure for severe emphysema : final report; order N14-04. 07.02.2017. (IQWiG Reports; Vol. 487).
Kopsaftis Z, Wood-Baker R, Poole P. Influenza vaccine for chronic obstructive pulmonary disease (COPD) . Cochrane Database Syst Rev 2018; (6): CD002733.
Walters JA, Tang JN, Poole P, Wood-Baker R. Pneumococcal vaccines for preventing pneumonia in chronic obstructive pulmonary disease . Cochrane Database Syst Rev 2017; (1): CD001390.
Updated on 27. February 2019 Next planned update: 2022