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 simplest of everyday activities such as climbing the stairs, going for a walk or working in the garden.

COPD does not occur suddenly, but develops gradually over several years. People often 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 common cold or influenza

“Exacerbations” typically occur as the disease progresses. These involve 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 a higher risk of developing chronic obstructive pulmonary disease. Not all smokers contract the disease. However most people with COPD have previously smoked or still smoke.

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 far more often affected than women.

Many people with COPD start with a cough with sputum that they often do not realize is a sign of COPD. Since their airways are only slightly narrowed initially 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.

Not smoking, or giving up smoking, is the most effective way to prevent COPD. But most smokers find it difficult to break the habit. There are a number of strategies that can help them with this such as a combination of a withdrawal program and nicotine replacement therapy.

It is also important to avoid exposure to harmful substances in the environment or at the workplace as far as possible. Preventive actions at 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 as it further weakens the body.

Many people approach their general practitioner for an initial test and 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 treatment goal is to alleviate symptoms, make everyday life easier and increase quality of life. Treatment is also aimed at slowing down the progression of the COPD and preventing exacerbations.

Day-to-day treatment of COPD involves taking medication in the form of tablets or by inhalation. A combination of drugs may also be used depending on the stage of the disease.

The following medication is available:

• Bronchodilators such as beta-2 agonists, anticholinergics and methyl xanthine. These are mostly inhaled in powder form and can make breathing easier.
• Cortisone sprays or cortisone tablets inhibit inflammation of the airways.
• PDE-4 inhibitors in tablet form also have an anti-inflammatory effect.

Oxygen treatment is often used at advanced stages of COPD. The form depends on the severity of the condition.

Surgery is also considered once all other treatment options for severe pulmonary emphysema have been exhausted. A lung transplant is also an option under certain circumstances.

The following can be used to support treatment of chronic obstructive pulmonary disease:

• breathing exercises
• inhalation
• physical activity
• changes to diet

Health insurance providers also offer disease management programs (DMPs) for people with COPD.

More detailed information on COPD and how it is treated can be found at gesundheitsinformation.de.

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 to 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 a great deal depending on how advanced the disease is. Restrictions on everyday life may be minimal for many years. However symptoms increase as time goes on. Most cases of severe COPD require comprehensive 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 constitution.

Day-to-day as well as emotional support from family and friends becomes increasingly important as the COPD progresses.

There are two accounts of personal experiences from people with COPD available on gesundheitsinformation.de.