Course of COPD

introduction

In contrast to many acute diseases, COPD does not start suddenly, but develops slowly over a longer period of time. The cause of the disease is permanent damage to the lungs and the resulting narrowing of the airways (bronchi).

The first early symptom is usually a persistent cough. However, this is often misinterpreted or ignored as a "smoker's cough" or a slight infection of the respiratory tract. Over the course of the day, the cough increases and slimy secretions are coughed up from the lungs, especially in the morning hours. The shortness of breath (dyspnea), which is initially only perceived during heavy exertion, increases dramatically over the course of the day, so that even everyday activities can cause difficulties with COPD in an advanced stage.

It is therefore often only recognized that it is not an acute illness but a chronically progressive illness when the symptoms are severe and have existed for some time. The disease is therefore often only diagnosed in old age.

The aim of the therapy is to stop the disease from progressing or at least to slow it down.

Read more about this: Stages of COPD

When do you need oxygen?

As the disease progresses, the inflammation of the small airways worsens the gas exchange in the lungs. This leads to so-called diffusion disorders. Diffusion is the gas exchange of carbon dioxide and oxygen between the alveoli and the small blood vessels in the lungs (capillaries).This in turn leads to a reduction in the oxygen content in the blood, which also leads to an insufficient supply of oxygen to the organs.

Therefore, depending on the extent to which the oxygen pressure in the blood has decreased, additional oxygen must be supplied. Depending on the state of health and oxygen pressure, this is only necessary during exercise or possibly also at rest. With increasing duration of the illness, there is also an impairment and weakening of the respiratory muscles, so that the breathing capacity is reduced. Here, a treatment with a ventilator using a breathing mask that is put on for the hour can bring about relief.

What does the end stage look like?

In addition to the typical symptoms of COPD - chronic cough and increased purulent expectoration and shortness of breath - the end stage of COPD leads to chronic respiratory failure. Due to the constant overinflation of the lungs and increasing disruption of gas exchange, the patient is no longer supplied with sufficient oxygen, which is reflected in the low oxygen pressure in the blood. In addition, those affected are no longer able to properly breathe out the carbon dioxide created in the body.

This manifests itself in severe shortness of breath at rest, reduced blood flow and can also lead to restlessness and confusion. Chronic respiratory failure can be treated with long-term oxygen therapy, home ventilation, lung volume-reducing procedures or, in extreme cases, a lung transplant.

Another symptom of the permanent insufficient supply of oxygen is expressed by cyanosis (bluish discoloration due to insufficient blood flow) of the lips and fingernails. Patients in late stages often have a so-called barrel chest due to constant overinflation and weakened respiratory muscles, a chest that is visibly inflated from the outside.

Since COPD is associated with a high level of physical strain and the entire organism is weakened as a result, end-stage patients often also suffer from associated secondary diseases. Examples of this are diabetes, osteoporosis, severely underweight, cardiovascular weakness and depression. Infections occur more frequently in the terminal stages and lead to acute attacks, the exacerbations. This can be life-threatening for the patient.

Read more about this: End-stage COPD

How does COPD work?

COPD is a chronic obstructive disease of the airways, which often begins insidiously and is initially not perceived as such and develops over the years. The airways are initially only slightly narrowed, so that the continuous loss of lung function is hardly noticed at first. In the course of the process, the cough with purulent sputum increases steadily and there is difficulty in breathing, first during exercise, later also at rest. The chronic inflammatory process leads to constant changes in the mucous membrane, increasing narrowing of the small airways (bronchi), overinflation of the alveoli and thus the formation of so-called emphysema, an excessive accumulation of air.

The individual disease courses are different, however, as they depend on the age of the patient and are also often characterized by secondary and concomitant diseases.

The clinical picture of COPD often leads to a spiral of inactivity. COPD causes breathlessness, so patients exercise less, which leads to a lack of fitness and increases the breathlessness. This spiral increases steadily and is also accompanied by depressive moods, due to which the patients also less trust themselves. In order to break this vicious circle, medical treatment and appropriate additional support are urgently needed.

Inactivity spiral: shortness of breath → less movement → depression (less confidence in yourself) → less movement

How quickly do I go through the individual stages of COPD?

How quickly COPD progresses depends on many different factors and varies from person to person. Since COPD predominantly affects smokers and cigarette smoking is considered to be the main trigger, the most decisive factor in the course and in relation to the progression of the disease is that the patient stops cigarette consumption.

Furthermore, factors such as the age of the patient, accompanying and secondary diseases, exposure to inhalative irritants (e.g. at the workplace) and the general physical condition and training condition also play a role. Overall, it can be said that the course of the disease of COPD develops over many years with constant deterioration in respiratory function and physical resilience.

Is COPD always fatal?

As the disease progresses, seizure-like deterioration and infections as part of the disease, so-called exacerbations, occur more frequently. Patients can either die from the disease itself, from recurring infections or from the accompanying diseases that are also caused by long-term cigarette consumption. The only way to positively influence the course of the disease is to give up cigarettes. Since the lungs are irreversibly damaged by COPD, an attempt can only be made to slow down or even slow down the further progression of the disease.

How can I positively influence the course?

Since COPD predominantly occurs in smokers, the best way to positively influence the course of the disease is to stop smoking. In addition to the stage-dependent drug therapy, patients should carry out a regular exercise program. In addition, there are patient training courses and rehabilitation programs in which, in particular, physical training is carried out, e.g. in lung sports groups or with targeted breathing and physiotherapy. Weight-adjusted nutrition also plays an important role. In addition, annual vaccination against influenza viruses and pneumococci is recommended as they are common causes of respiratory infections.

In this way, acute deterioration (exacerbations) and thus the complication rate can be reduced. It is particularly important for COPD patients to avoid all lung pollutants, e.g. Avoid fine dust, lungs irritating substances in the workplace or industrial and traffic fumes.

Can you stop the process?

Particularly in the case of patients who do not forego the consumption of nicotine, there is steadily increasing and irreversible damage and functional impairment of the lungs over the course of the disease. This damage leads to a severely reduced life expectancy for the patient. Since there are no causal treatment approaches, the goal is to slow down or even slow down the course of the disease and to increase the quality of life through optimal therapy, nicotine abstinence and the supportive measures listed above.

Read more on the subject at: Life expectancy in COPD