Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a condition where the lung is permanently damaged and the airways of the lungs (bronchial tubes) are narrowed. People with advanced COPD find it very difficult to breathe. They get out of breath during the most basic everyday activities, such as climbing the stairs, going for a walk or working in the garden.

Rather than occurring suddenly, COPD develops gradually over several years. Many people initially mistake symptoms, particularly the persistent cough, for “normal” smoker’s cough, bronchitis or asthma. They often only realize it is something else when the symptoms become more severe. Many of them are over 60 by then.

The amount of air absorbed by the lungs differs depending on levels of physical exertion. People at rest need less than a tenth of the air they need during intense exercise.

Since many people do not fully utilize their lungs’ potential in everyday life, it can take them years to notice that their lung function has declined. Once a large proportion of their reserves are lost, chronic obstructive pulmonary disease presents as dyspnea (shortage of breath).

Typical symptoms are:

• shortage of breath (dyspnea) initially only during physical exercise, but also at rest in the advanced stages of COPD
• daily coughing over a long period
• sputum
• wheezing or humming noises when breathing
• more severe symptoms during a common cold or flu

Acute exacerbations typically occur as the disease progresses. These materialize as a sudden, severe deterioration in the condition, mostly in the form of attacks of dyspnea and increased coughing with sputum.

Persistent inflammation of the bronchial tubes is one of the causes of COPD. Pulmonary emphysema, where the air sacs (alveoli) in the lung are overinflated, may also be a contributory cause of the disease.

If the airways are frequently exposed to harmful substances such as tobacco smoke, dust or gas, a chronic cough (bronchitis) can develop. Whilst the inside of healthy bronchial tubes is lined with hair-like cilia, these are destroyed by inflammation in COPD.

People who smoke are at an increased risk of developing chronic obstructive pulmonary disease. Not all smokers contract the disease. However, most people with COPD smoke or have smoked in the past.

Persistent, long-term pulmonary irritation can also favor COPD. This includes significant exposure to certain types of dust at the workplace.

It is estimated that around 5 to 10 out of every 100 people over 40 have COPD. That makes the disease more common than asthma. Men are much more commonly affected than women by COPD.

Not smoking, or giving up smoking, is the most effective way to prevent COPD. However, most smokers find it difficult to quit. 

It is also important to avoid exposure to harmful substances in the environment or at the workplace as far as possible. Protective measures in the workplace can help.

Exacerbations are often caused by respiratory tract infections. In the common cold and flu season in particular, people with COPD should protect themselves against infection, which further weakens the body.

Many people with COPD approach their family doctor for an initial examination. They need to attend a specialist lung disease (pneumology) practice for more specialized tests.

The doctor will usually start by examining the body and taking a blood sample as well as asking about other conditions. This is followed by special lung function tests (“spirometry”). If COPD is suspected, additional tests may be required in some circumstances to exclude other conditions such as asthma, cardiac insufficiency or lung cancer. The doctor will also ask about psychological symptoms, such as feelings of anxiety or despondency.

Treatment aims to

• alleviate symptoms
• make everyday life easier
• improve quality of life
• slow the progression of COPD
• prevent exacerbations

The most effective measure is to quit smoking completely. This is often easier said than done. However, there are many support options that may help with quitting – from advisory services to group courses and medication. Strategies that may help with quitting smoking include a combination of a withdrawal program and nicotine replacement therapy.

Other helpful measures include exercise and sport, breathing exercises, inhalation and dietary changes. Health insurance providers also offer disease management programs (DMPs) for people with COPD. These aim to reduce the number of severe attacks of dyspnea (breathlessness) and slow the progression of COPD through consistent treatment and support.

If non-pharmaceutical interventions fail to relieve symptoms to a sufficient degree, medication becomes an important component of daily COPD treatment. These are mostly inhaled but may also be taken in tablet form. Depending on the stage of the disease, different types of medication may be combined either permanently or for temporary relief of symptoms. The following types of medication are available:

• Bronchodilators are mostly inhaled in powder form and can make breathing easier. These include beta-2 agonists and anticholinergics. 
•  Phosphodiesterase-4 (PDE-4) inhibitors inhibit inflammation of the airways.
• Medication containing cortisone similarly have an anti-inflammatory effect but are normally only used to treat severe symptoms.
• In rare cases, antibiotics are used temporarily on a precautionary basis.

Oxygen treatment is often used at advanced stages of COPD. The form depends on the severity of the condition. Surgery is also considered in the case of severe pulmonary emphysema where all other treatment options have been exhausted. A lung transplant is also an option under certain circumstances.

More detailed information about COPD treatment options can be found at gesundheitsinformation.de.

In-depth information about the treatment of COPD is available in the COPD patient guideline published by the German Agency for Quality in Medicine (Ärztliches Zentrum für Qualität in der Medizin).

Pulmonary rehabilitation (also called pneumological rehabilitation in Germany) is an important part of the COPD disease management program. People with the disease are eligible for outpatient or inpatient rehab. 

Rehabilitation is intended to help people with COPD cope better with the disease and improve their quality of life. They are given their own personal treatment plan to do this. This combines physical training, training in how to cope with the disease, therapy and social as well as psychological support. 

The effects of COPD vary significantly, depending on how advanced the disease is. Restrictions on everyday life may be minimal for many years. However, symptoms increase with time. Most cases of severe COPD require a high level of support and care from other people and normal everyday life is no longer possible.

People deal with the disease in different ways. Many find it helpful to adapt their lifestyle and their daily routine around their body’s needs and responses. Some people find it helpful to concentrate on a small number of things that are particularly important to them. Others do specific breathing and relaxation exercises or a little sport, depending on their physical fitness.

Daily practical support and emotional support from family and friends become increasingly important as COPD progresses.

Many people with the disease initially experience a cough with sputum, which they often do not realize is a sign of COPD. Since their airways are only slightly narrowed at first, they barely notice the gradual decline in lung function. Over time, however, the coughing and sputum production become more severe and respiratory problems during physical exercise also increase.

As the disease progresses their quality of life is increasingly impaired. At this stage they find even simple everyday activities such as washing or dressing difficult. Many people experience shortage of breath (dyspnea) even when their body is at rest.