All-round care for COPD: diagnosis, treatment, self-management

COPD affects more than 200 million people in the world. Those affected by this chronic pulmonary disease are often slow to notice the symptoms and get a medical diagnosis. This results in secondary complications and high medical costs. That's why an early diagnosis, comprehensive treatment, and frequent monitoring routines are very important. Various devices and tools support this all-round care.

The abbreviation "COPD" stands for "chronic obstructive pulmonary disease" and refers to chronic inflammatory lung disease that causes obstructed airflow from the lungs. Early detection, medication, and additional therapeutic measures are essential to prevent disease progression and complications such as anemia, muscular dystrophy and weight loss. The goal is a patient-centered all-round care – ranging from diagnosis to self-management.

Approximately 80 to 90 percent of patients affected by this disease are current or former smokers. Environmental triggers or genetic risk factors can also contribute to the development of this disease. However, it is predominantly cigarette smoke that impedes the natural removal of toxic substances from the lungs and creates favorable conditions for the growth of pathogens. This results in chronic inflammation that severally attacks lung tissue and causes permanent and irreversible damage to structures. This eventually leads to chronic disease – COPD. Smoking has unmistakably been identified as the leading cause of COPD.

People with COPD suffer from severe shortness of breath, chronic coughing, and mucus (also called "sputum" or "phlegm"). In Germany, physicians refer to so-called AHA! Symptoms. Patients often ignore these early warning signs due to the gradual progression of the disease. COPD starts with occasional coughing and a slowly increased shortness of breath, which is why many patients are not diagnosed until the disease has reached an advanced stage.

Once the symptoms have been detected and COPD is suspected, a lung (pulmonary) function test or spirometry testing is routinely done to support an official clinical diagnosis. The test must be repeated on a regular basis since pulmonary function declines with COPD. The measurements give the doctor insights into the disease progression, the effects of the administered medications and the overall success of the treatment. Electrical impedance tomography (EIT), which requires the attachment of electrodes to the patient's chest, is used for long-term monitoring of pulmonary function. "The device measures at up to 50 frames per second in real-time, thus facilitating the continuous monitoring of tidal volume distribution in the patient's lungs," as Christian Bozsak from Dräger describes the major advantage of EIT. There are also EIT devices from Swisstom and Timpel.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) categorizes COPD into four stages of severity. Treatment decisions are based on the severity, but primarily on the symptoms of the individual patient. The main goal of treatment is to slow the progression of the disease, to prevent episodic exacerbations (acute changes) and thus improve the quality of life for patients. There is presently no cure for this disease. The first step to success is always to eliminate what causes the disease. That’s why it is crucial to quit smoking to halt the progression of COPD.

The first building block of COPD treatment consists of taking medication, especially drugs that require inhalation. They are designed to stop inflammatory processes, reduce mucus production and expand the airways. Inhalers with holding chambers are suited to avoid the potential side effects of inhalation aerosol. They also allow for deeper inhalation of medication, which improves their effect. Patients can also use positive expiratory pressure devices, which create an airway oscillation inside the airways and make it easier to expectorate the secretions with a cough or huff. PEP therapy devices like the RC Cornet from CEGLA not only improve well-being but also verifiably reduce the need for medication.

Oxygen therapy is often prescribed for chronic respiratory failure. This relieves shortness of breath, allowing the patient to exercise longer and sleep better. According to studies, it improves overall health and increases life expectancy. This treatment is available as an inpatient, as well as an outpatient option for use at home or on-the-go thanks to portable equipment.

Studies have also shown that physical activity helps to slow the progression of COPD by improving muscle strength, reducing stress and easing symptoms. Especially during the advanced stage, exercise classes for sufferers have proven helpful. In addition to sports, chest physiotherapy is another way to fight the effects of COPD. Patients learn certain breathing exercises, controlled coughing, and helpful positions to reduce shortness of breath and support breathing. The basic exercise is so-called pursed lip breathing, a technique that helps prolong expiration, reduces the respiratory rate and improves oxygen saturation and airflow.

Despite extensive treatment measures, there are cases when continued delivery of oxygen therapy via a ventilator is required. In collaboration with the University Hospital Cologne-Merheim, the Aachen-based Enmodes Company is currently developing a portable respiratory assist system.

Since COPD is a chronic disease, self-management is a key determinant of success in everyday life. Portable, lightweight devices like the Personal Best Peak Flow Meter by Philips allow patients to monitor their own expiratory flow. Based on the measurements, the treating physician can determine whether or not the treatment is successful. The Austrian Society of Pneumology provides an app (COPD-App der Österreichischen Gesellschaft für Pneumologie) that reminds users to take their medication, tracks their training, acts as a journal, contains emergency contacts and includes information and video instructions for proper breathing or inhalation techniques. The app supports all aspects of COPD treatment, thus making it an everyday companion for the patient.

A comprehensive and effective treatment not only includes medications but is made up of multiple components. That's also why a COPD treatment with medications should be complemented by other building blocks like breathing exercises, physical activity, oxygen therapy, self-management and regular medical checkups. The combination of various measures, tools and management resources can improve breathing, help ease symptoms, prevent subsequent injuries to muscles, the skeletal and metabolic system and improve the overall well-being of the patient. An all-round COPD care doesn't aim to suppress or cure the disease – the latter is currently not an option–, but intends to improve the quality of life to where COPD no longer adversely impacts the patient’s daily life.