Respiratory diseases even without Covid-19

Corona has been with us for more than two years now. In winter, the symptoms of colds and FluOften, symptoms appear that we can no longer identify and that make us feel insecure.

However, respiratory diseases can have many causes - these do not always have to be related to the corona virus.

COPD caused by smoking

An adult breathes in and out twelve to twenty times per minute. A total of around 20 liters of air are moved through the trachea and bronchi every day to supply the body with oxygen and expel carbon dioxide. The sacs (alveoli) arranged in a grape shape in the two lungs ensure the reliable exchange of gases.

Long-term inhalation of harmful particles, such as smog, pollutants in the workplace, but above all smoking, can lead to chronic obstructive pulmonary disease (COPD). This causes a permanent narrowing of the airways, which makes breathing out particularly difficult. Such a narrowing occurs when the small airways become inflamed, leading to excessive mucus production and destruction of the lung tissue (pulmonary emphysema).

Underestimated widespread disease COPD

This serious and incurable end-stage Disease is still greatly underestimated. 87 percent of Germans do not know what the abbreviation COPD stands for. In Germany alone, almost eight million people suffer from COPD, a widespread disease that has now moved up to third place in the statistics of causes of death. Almost 90 percent of COPD patients in Germany are current or former smokers.

COPD early detection

With COPD, the most serious damage occurs in the early stages. The earlier the disease can be diagnosed, the better the chances of preserving lung function as much as possible. Everyone can help reduce the risk of COPD or, if the disease already exists, preserve as much lung capacity and quality of life as possible. The first step is to stop smoking, as well as to do regular exercise or targeted lung sports.

In addition, a flu vaccination, a vaccination against bacterial pneumonia and against pertussis (whooping cough) are urgently recommended. Since COPD patients also have an increased risk of severe Covid-19 courses, they should definitely get vaccinated against corona and follow the corona protection rules exactly.

Diagnosis primarily involves measuring lung function by determining airway resistance and the volume of air that remains in the lungs after complete exhalation. This test provides information about the performance of the lungs and any existing limitations. X-rays or computer tomography expand the diagnostic spectrum. In the advanced stages of COPD, arterial blood gases are also measured to determine disturbances in gas exchange in the lungs.

COPD is not curable

Four patient groups - A, B, C and D - cover the entire spectrum. This classification takes into account the severity of the symptoms and the "risk of exacerbation" (technical term for the deterioration of the general condition with increasing shortness of breath). Patients with an exacerbation that is not in the Hospital were assigned to groups A or B, depending on whether they had mild or severe symptoms. Groups C and D refer to patients with at least two exacerbations or a deterioration requiring inpatient treatment.

Every exacerbation is dangerous and there is always something left behind. Lung function will be worse afterwards. In autumn and winter in particular, flu infections or bacterial pneumonia can exacerbate this.

Unfortunately, COPD and bronchial carcinoma (lung cancer) are a common combination.

According to today’s understanding, COPD is not “only” a respiratory disease (airway disease), but a systemic disease (a disease of the whole body). The most common accompanying diseases are Hypertension, Coronary heart disease, heart failure, muscle and bone atrophy and mental illnesses. The experience of acute shortness of breath is traumatic for those affected.

treatment of COPD

There are two goals in the treatment of COPD: reducing symptoms and preventing acute exacerbations. The focus of treatment is anti-obstructive (bronchodilator) medication with short-acting beta-2 agonists (SABA), long-acting beta-2 agonists (LABA) and long-acting anticholinergics (LAMA). In addition, there is anti-inflammatory therapy with an inhalable cortisone (ICS). The use of these medications depends on the severity of the disease:

• Group A (few symptoms, low risk of exacerbation): SABA or SAMA
• Group B (severe symptoms, low risk of exacerbation): LAMA or LABA or combination
• Group C (few symptoms, high risk of exacerbation): LAMA or LABA/LAMA or LABA/ICS
• Group D (severe symptoms, high risk of exacerbation): additional ICS.

The triple combination (LAMA, LABA and ICS) is approved for patients who are unstable despite dual therapy. The additional administration of an ICS has a positive effect on the frequency of exacerbations, but it also increases the risk of pneumonia. However, for every 19 exacerbations prevented, only one additional case of pneumonia occurs.

The right moment for the additional administration of an ICS

This is where the data from the IMPACT study can help. This study examined over 10.000 patients with moderate to severe COPD, all of whom had suffered at least two exacerbations in the previous year. Compared to dual combinations, these patients had an advantage when they received a triple combination. The annual rate of moderate and severe exacerbations fell significantly. The study also provided evidence of reduced mortality with triple therapy. All patients who suffer at least two moderate or severe exacerbations per year should therefore receive a triple combination with additional ICS (inhalable cortisone).