COPD: symptoms, stages and therapyCOPD is a progressive lung disease that is divided into four stages and is associated with reduced life expectancy – especially without therapy. Read more about symptoms, what can stop the disease and what the risk factors are.
© iStock. COPD is the abbreviation for Chronic Obstructive Pulmonary Disease. Means chronic obstructive pulmonary disease. It is a progressive disease of the lungs in which there is permanent (chronic) inflammation and narrowing (obstruction) of the airways. Pulmonary emphysema is also classified as COPD. Unlike asthma, the obstruction in COPD cannot be reversed, or not completely, even with the administration of medications.
The incidence of COPD increases with age. It is estimated that about one percent of the total population is affected, and as many as ten percent over the age of 40. Especially if left untreated, symptoms of COPD worsen over time. Due to the permanent inflammation, there are remodeling processes in the alveoli and a reduced gas exchange. Increasingly impaired lung function can lead to damage to the heart, bone system, and metabolic organs, and even death of the patient. COPD is associated with a reduction in life expectancy by an average of five to seven years. The disease is the third leading cause of death in Europe.
How COPD develops? The causes
The most common cause of COPD is smoking. Smokers should therefore regard chronic morning cough with sputum as an urgent warning signal to stop smoking. In addition, occupational exposure to respiratory irritant gases and vapors or working in a dust-laden environment and general air pollution can cause COPD. Frequent respiratory infections in childhood and certain rare childhood diseases can also result in COPD. However, these causes are much rarer compared to smoking. Genetic predisposition and lung growth disorders are also considered risk factors for the development of COPD.
If chronic cough, sputum and shortness of breath are ignored in the long term, the disease is likely to progress rapidly. Remodeling processes in the airways of the lungs, reduced gas exchange, oxygen deficiency in the blood and other, sometimes life-threatening secondary diseases of COPD can massively impair the quality of life and lead to death. Only a smoking cessation and a therapy tailored to the disease state can stop this development.
How COPD manifests itself: Symptoms
The main symptoms of COPD are shortness of breath, which initially occurs only under exertion, later also at rest, as well as cough and sputum. It is also referred to as AHA symptomatology. Other signs may include noises when exhaling or an occasional tightness in the chest.
COPD is classified into stages based on severity and symptoms, which is based on the global initiative for COPD called GOLD. The GOLD stages are:
COPD stage 0 (risk group)Chronic cough and sputum with normal lung function (no narrowing of the airways)
COPD stage GOLD 1: mildly impaired lung function with or without chronic symptoms (cough, sputum, shortness of breath on vigorous exercise)
COPD stage GOLD 2Moderately impaired lung function with or without chronic symptoms (cough, sputum, shortness of breath)
COPD stage GOLD 3: severely impaired lung function with or without chronic symptoms (cough, sputum, shortness of breath)
COPD stage GOLD 4: very severely impaired lung function
In advanced stages, a decrease in performance and feelings of weakness or cachexia (severe emaciation and loss of muscle mass) may occur. Furthermore, the skin sometimes takes on a blue-red color (cyanosis) due to the decrease in the oxygen content of the blood. Consequential diseases affecting the heart, musculature, bone system, metabolism and psyche can also occur. An acute worsening is called an exacerbation.
COPD exacerbation is most commonly seen in stages 2 to 4. It is accompanied by a sudden increase in cough, sputum and shortness of breath, sometimes a yellow-green discoloration of the sputum or a tightness in the chest, and occasionally fever. Bronchial infections are the main cause of exacerbations. If such a sudden deterioration occurs, a doctor should be consulted immediately, who will initiate the necessary treatment. Hospitalization is necessary if the following symptoms occur during the exacerbation:
– swelling (edema) – new or increasing blue-red discoloration of the skin – clouding of consciousness, comatose states – increased heart rate (tachycardia) – irregular heartbeat and cardiac arrhythmia – accelerated breathing (tachypnea) – severely impaired lung function with acute respiratory distress
Diagnosis of COPD
The physician first conducts a thorough questioning of the affected person (anamnesis) and asks, among other things:
the symptoms present (cough, sputum, dyspnea, disordered breathing)
their course and intensity
the circumstances of their occurrence (during exertion or at rest?)
The presence of risk factors for COPD (for example, tobacco use, occupational exposure to triggering agents, use of medications)
Likewise, the physician inquires about possible respiratory diseases in the family and about diseases that are also present. Some, such as heart disease, are typical concomitant diseases (comorbidities) of COPD. On the other hand, the history may also provide important information about the presence of another respiratory disease or a disease outside the respiratory tract. It is therefore the starting point for further differential diagnostic procedures.
As with the medical history, the physical examination that follows provides information about the presence and severity of COPD. An important component is the assessment of lung and heart sounds and respiration. In people with early-stage COPD, the findings of the physical examination may also be normal.
Moderate COPD is characterized by changes in breathing sounds (wheezing, whistling or humming) and prolonged exhalation, while severe COPD is characterized by changes in skin color or swelling due to water retention in the limbs (peripheral edema).
Pulmonary function test
Spirometry is the most important examination in the pulmonary function test. It is done in all suspected cases and severities of COPD, as well as to rule out other lung diseases such as asthma. Spirometry is used to determine the degree of airway narrowing (obstruction). Also of importance in this regard is whole-body plethysmography. Reversibility tests with bronchodilators (bronchodilator medications) or corticosteroids (cortisone-containing medications) are particularly relevant for distinguishing between asthma and COPD.
Spirometry: These values reveal the presence of COPD
The most important values for the diagnosis of COPD in spirometry are the one-second capacity (FEV1) and the vital capacity (VC). The FEV1 value is the amount of air exhaled after maximum deep inspiration in the first second of exhalation during maximum effort. The inspiratory vital capacity represents the amount of air that can be taken in after maximum deep exhalation during maximum deep inspiration.
The ratio of one second to vital capacity (FEV1/VK) is considered the safest parameter for assessing COPD; a normal value excludes the presence of COPD.
In a reversibility test, two measurements of the FEV1 value are taken:
Once before taking a rapid-acting bronchodilator (such as a beta-2 sympathomimetic or anticholinergic)
once a short time after taking the drug
If the patient responds to the medication and there is a decrease in airway obstruction (indicated by an increase in FEV1), this is indicative of asthma. Conversely, if the patient does not respond to the medication, the diagnosis of COPD is obvious. A reversibility test can also be performed with the help of a cortisone-containing medication, but the second measurement is then only taken after two to four weeks of use.
In patients with stage 3 to 4 COPD who are unable to perform forced breathing maneuvers as required by spirometry, the measures of raw (airway resistance) and intrathoracic gas volume (ITGV) are used to demonstrate obstruction or overinflation of the airways and lungs, respectively.
Other diagnostic procedures
Other important diagnostic procedures for diagnosing COPD include:
– Laboratory tests such as determination of blood count and C-reactive protein – X-ray and computer tomographic images of the lungs or chest (especially to exclude other lung diseases) – Blood gas analysis to measure the oxygen and carbon dioxide content in the arterial blood and the determination of the CO diffusion capacity – Exercise tests in case of shortness of breath during exercise (exertional dyspnea)
Therapy: What medications help with COPD? For the treatment of COPD, there are a number of medications available. Non-drug methods available. Their use depends on the severity of the COPD. The presenting symptoms as well as the individual response to each medication.
Medications for COPD
The following medications may be considered for COPD, depending on symptoms and comorbidities:
airway dilating drugs (beta-2 sympathomimetics, anticholinergics and theophylline)
Expectorant medications (mucopharmaceuticals)
Antibiotics for the treatment of acute exacerbations
Non-drug COPD therapy
Non-drug therapy plays a major role in the treatment of COPD. The main goals are to improve the quality of life and physical resilience of those affected. Non-drug therapy includes the following:
Long-term treatment with oxygen and home ventilation
Disease management programs (DMPs) are treatment programs that provide people with chronic diseases with more targeted and effective treatment than is feasible with the usual care provided by general practitioners and specialists. The aim is to provide better care and training in the management of the disease to prevent progression of COPD and complications.
Knowledge about COPD and how to deal with it properly are important, which is why it can be helpful to join a support group. The exchange with other affected persons can help and motivate to stop the disease. Regionally, a self-help group for COPD can be searched for here.
Although COPD is a respiratory disease that cannot be cured, it can be treated effectively. Only therapy tailored to the condition, regular medical check-ups and avoidance of triggers and risk factors, first and foremost smoking, can halt rapid progression. The therapy also helps to increase physical resilience and alleviate existing symptoms. It can significantly improve the patient's quality of life.
The Standing Committee on Vaccination (STIKO) also recommends that COPD patients be vaccinated against seasonal influenza and pneumococcus to reduce the risk of acute exacerbations. Bacterial and viral pathogens are considered the most common triggers of dangerous exacerbations.
Preventing COPD: Avoiding risk factors
The primary goal of preventive measures is to prevent progressive damage to the lungs. Accordingly, known risk factors for COPD should be avoided. These include harmful influences at the workplace (gases, fumes, dust exposure) and especially smoking. Smoking cessation does not reverse existing lung damage, but it does slow down the deterioration of lung function to a normal level for the age of the patient.