What is COPD?
The international technical term “COPD” is an inherited from the English abbreviation for chronic obstructive pulmonary disease and refers to chronic obstructive bronchitis (COB) with or without emphysema. “Obstructive” stands for a narrowing of the respiratory tract – both diseases are characterized by the fact that the airflow is obstructed, especially when exhaling. The abbreviation COPD thus serves as a collective term for the two chronic obstructive pulmonary diseases COB and emphysema. Smoking is the leading cause of COPD.
While almost all lung diseases have continued to increase over the last decade, the development of chronic obstructive pulmonary disease ( COPD ) is particularly dramatic. According to the White Paper Lung 2015, 14,970 men and 11,048 women died from this irreversible respiratory disease in the year 2011. Thus, the number of deaths was almost 25 percent higher than in 2005.
Exact statements on the frequency of COPD, however, are more difficult because of the high number of undiagnosed cases of undiagnosed diseases. Experts assume that about 10 to 12 percent of the over 40s in Germany are affected. According to a forecast, the summit should be reached in 2050 with eight million COPD patients. Effects of smoking bans in public space on the COPD rate are – unlike in cardiovascular diseases – so far not detectable. More often than before, there are also patients who have never smoked and have COPD. Apparently, play in the development of lung disease in addition to the risk factor number one – the tobacco smoking- other environmental influences also matter. In Germany, about 8-12% of the population suffer from COPD. The disease is thus more common than asthma, pneumonia and lung cancer combined. So far, the disease broke out often between the 40th and 55th year of life, with the age of 50 years, the incidence increased significantly and reached its peak in the seventh decade of life. However, today many young people start smoking already much earlier (at 13.6 years, as of 2005), so that COPD cases may occur more often in the future even at a younger age. For smokers who smoke for about 20 years, a COPD forms in about 15-20%. Regardless of cigarette consumption, COPD occurs in men almost twice as often as in women. Also, those with low socioeconomic status are more likely to be affected. In addition, the disease may be more prevalent within certain families, indicating hereditary predisposition, but not yet proven.
Worldwide (according to estimates of the World Health Organization WHO) about 600 million people are affected by COPD. In the United States, COPD is the fourth leading cause of death – it is already third in Europe. There has been a strong increase, mainly due to smoking, over the last 3 decades. Between 1960 and 1998, male COPD mortality increased by 344%; in women in the same period by 1000%. It is expected that by 2020, the disease will take third place among the world’s leading fatalities.
COPD Causes & Risk Factors
In the Western world, 80-90% of COPD cases are caused by smoking.
Tobacco smoking increases the risk of developing COPD by a factor of 13 and is the major risk factor for the development of so-called smoker’s disease (= COPD). Up to 50% of older smokers have COPD. The risk of developing COPD is determined by the total number of cigarettes smoked throughout the year (on the basis of the so-called pack years or pack-years). A pack-year means that a smoker over the period of one year a pack of cigarettes daily average smoked Has. Whereby this information can be converted accordingly to the respective, personal consumption. For example, 20 pack years may mean: smoked 2 boxes a day for 10 years or smoked one pack a day for 20 years.
In Germany, more than a quarter of the non-smoking population is regularly exposed to secondhand smoke. According to estimates of the European Respiratory Society, 4,000 non-smokers in Germany die each year from the effects of secondhand smoke, including over 900 patients with COPD caused by passive smoking. Children who passively “smoke around” in their environment often suffer from respiratory infections and are at an increased risk of developing bronchial asthma or other respiratory diseases. The now largely nationwide existing smoking bans are therefore necessary.
Cause of COPD is not always smoking. The genes also play a role and can cause a congenital hereditary disease – the so-called alpha-1-antitrypsin deficiency.
A familial accumulation of COPD is also known, but usually, a COPD is not inherited “directly”. However, there is a rare hereditary disease, alpha-1-antitrypsin deficiency. People with this condition regularly experience severe COPD with emphysema when they smoke.
COPD is progressive lung disease
Basically, COPD is a severe, progressive lung disease. Shortness of breath initially occurs only during exercise, in advanced stages but also at rest. But COPD is not just a lung disease – in advanced stages, there are other symptoms that suggest that COPD is a systemic disorder that can affect many different organs of the body. A primary feature is an increasing decline in performance with rapid weight loss (so-called ” COPD wasting“- within a few weeks, the weight can be reduced by several kg!). The symptoms include changes in muscle mass and bone density, as well as mental health problems. Fear and depression affect 40-70% of sufferers. In severe cases, there are also changes in the cardiovascular system. The so-called cor pulmonale arises from acute or chronic pressure increases in the pulmonary circulation as a result of oxygen depletion (hypoxemia). Even edema in the legs can form (right heart failure) due to an overload of the right heart.
Malnutrition occurs in 20-60% of COPD cases and may be present at a normal weight. It requires special nutritional therapy for the wasted Pink Puffer, whereas the overweight Blue Bloater requires weight loss. Malnutrition also lowers lung resistance – the phagocytes in the alveoli (the so-called alveolar macrophages, which “digest” normally-contaminated foreign matter) are less active, studies have shown.
In addition to a loss of muscle mass, it comes as part of the spread over the body (systemic) inflammation and changes in the muscle structure with significant loss of function. Patients with pulmonary emphysema show in comparison with sufferers with chronic obstructive bronchitis a much more significant loss of muscle mass. This explains why not only shortness of breath, but also a depletion of muscle strength limits the physical performance of those affected, with physical protection or lack of exercise that drives forward power loss and also promotes the development of osteoporosis (decrease in bone density) strong – by the way, much more than for Example a cortisone therapy. Also, certain hormones (testosterone and growth hormone) are less produced in COPD, which also affects the physical performance and may be a cause of depressive moods.
COPD Impact & Costs
The COPD affects the entire body: In COPD, there are not only changes in the lungs, but including the metabolism of muscles and bones and the cardiovascular system. In a scientific study involving more than 6,000 patients with mild to moderate COPD, more patients died from cardiovascular disease (especially heart attacks and strokes ) than from COPD. In fact, impaired lung function is a risk factor for cardiovascular disease. This is probably due to inflammatory processes that affect the whole body in COPD. This reinforces further smoking these effects of COPD. This is also demonstrated by the fact that smokers lose weight; a particularly disadvantageous effect in underweight COPD patients.
Coughs and Ejections
Even smokers who do not (yet) have COPD suffer much more frequently than nonsmokers with a cough and sputum. Conversely, cessation of smoking results in a decrease in smoking cessation. A smoking cough is also a risk factor for worsening lung function and the likelihood of future hospitalization.
Smoking and lung function
Numerous scientific studies have clearly shown that smoking leads to a deterioration in lung function. Smoking in adolescence reduces normal lung growth, which is also detectable during later life.
Furthermore, smoking accelerates the annual decline in lung function in the late adult phase, and especially in old age, and more so the longer and the more heavily smoked. On the other hand, it has been clearly shown in scientific studies that after smoking cessation, the annual decrease in lung function is reduced to that of nonsmokers. After the end of smoking, there is initially even a certain (re) increase in lung function.
Smoking inhibits pulmonary oxygen uptake and causes bronchial hypersensitivity (increased bronchial irritability ). If COPD is not yet present, stopping smoking leads to a decrease in this bronchial hypersensitivity. While COPD has already occurred, smoking cessation still leads to a reduction, but no longer to normalization of bronchial hypersensitivity.
Long-term Oxygen Therapy
Patients with advanced COPD often have a decreased blood oxygen concentration. In severe hypoxia, it may then be necessary to perform an oxygen long-term therapy. Smoking during oxygen therapy is life-threatening because of the risk of possible severe burns.
Nicotine dependence and continued
Smoking COPD patients have a particularly high degree of dependence, which is also reflected in their inhalation pattern. They inhale deeper and faster than smokers without COPD. The hyperinflation underlying pulmonary emphysema also promotes the deposition of particles in the lungs – that is, the harmful effects of smoking are further increased in the presence of a smoker’s lung. In severe COPD cases requiring oxygen therapy, concurrent smoking is life-threatening because of the risk of possible severe burns.
Risk of depression The existence of a smoker’s lung increases the risk of depression, especially in women. Conversely, COPD patients with depressive symptoms often experience unfavorable disease processes (higher mortality, longer stays in hospital, maintenance of tobacco use). Overall, there is a complex relationship between smoking, COPD and depression, which makes tobacco cessation difficult for depressed COPD patients. In addition, smokers also have higher than average other mental illnesses.
The total economic cost of COPD in Germany is estimated at well over 17 billion euros per year. It is estimated that 7,7 billion euro per year could be saved with general abstinence from tobacco. In addition to the number of hospital treatment days, COPD is one of the most important causes of illness in Germany besides pneumonia and lung cancer. Among the number of sick leave days, the COPD is even at the top – with about 3.9 million days in 2002 alone.
Do I have COPD?
The symptoms of COPD develop slowly over several years. Chronic coughing is often not taken seriously, especially by smokers, even if it persists for months and years. After 20 to 25 years of consuming 20 cigarettes a day, the cilia of the mucous membranes in the respiratory tract are largely destroyed. A constant “smoker’s cough” is then the only way to at least partially clean the lungs of pollutants and microorganisms. Regular coughing with or without expectoration should be taken as an alarm sign but seriously and the person concerned as possible to give up the smoking cause. Only in this way can the progression of a COPD disease be slowed down and in many cases even brought to a standstill. Signs of incipient constriction of the respiratory tract are breathing sounds: rattling noises or (sometimes retractable) wheezing, occasionally also the tightness of the chest and shortness of breath during exercise. Signs of progressive narrowing or emphysema are shortness of air at low load and later also at rest.
When it comes to frequent coughing, repeated respiratory infections or breathing difficulties under physical stress, some sufferers like to apologize for lack of fitness or their age, even though COPD is the cause. To find out if your symptoms are already suggestive of COPD, you can take a COPD test . In any case, coughing that lasts more than 8 weeks, and respiratory distress should be clarified under pressure from the doctor.
COPD self healing
With COPD, life expectancy is reduced by an average of 5-7 years, but this prognosis can be improved again with optimal therapy and consistent self-management. Even possible complications such as respiratory infections, pneumonia, pneumothorax, and cor pulmonale can be largely avoided by appropriate treatment and preventive measures.
Life expectancy, among other factors, depends on the individual FEV1 (one-second capacity or “one-second air”) – depending on how much air you can exhale in a second with as much effort as you can. It lies with:
- 10 years if FEV1> 1.25 liters
- 5 years, when FEV1 0.75 – 1.25 liters
- 3 years if FEV1 <0.75 liters (30% of those affected die within one year!)
Favorable prospects exist if the narrowing of the bronchi still proves to be reversible, which can be seen in the bronchospasmolytic test. On the other hand, old age and low values of the one-second capacity (FEV1), as well as the oxygen content of the blood or too high a carbon dioxide content of the blood, are unfavorable.
COPD patients should be aware that their one-second capacity (FEV1) will be reduced by about 30 ml per year. If you continue to smoke, this value increases 3 times! Then the FEV1 decreases by about 90 ml per year.
In order to maintain the usual quality of life as long-term as possible, patients should follow the treatment recommendations of their pulmonologist. On the other hand, it is also up to the patient himself to meaningfully support the drug treatment by:
- the task of smoking through effective smoking cessation
- moderate physical training (eg lung sports ),
- Breathing gymnastics and
- a healthy diet.