Chronic obstructive pulmonary diseaseJ44.99

Disease that can be prevented and treated, which is characterized as a "chronic, not fully reversible and typically progressive airway obstruction". The pulmoanel component is characterized by an obstruction of airway flow that is not fully reversible. It is associated with an abnormal inflammatory response caused by particles and gases, which in Europe is primarily caused by cigarette smoke.

Chronic bronchitis is assumed to be present (WHO) if a patient has had coughing + expectoration (=productive cough) for at least 3 consecutive months per year in two consecutive years.

m:>w; prevalence for Central Europe: about 13% of the population > 40 years. Preferably male smokers > 40 years with a long smoking history are affected. The prevalence is increasing in the industrialised countries. In the mortality statistics, COPD ranks 3rd worldwide (after stroke and CHD). Experts estimate the total economic costs caused by the disease at almost ten billion euros annually.

Multifactorial.

Inhalation smoking is the most common cause of COPD with almost 90% of cases. Smoking favours respiratory tract infections via mucous membrane irritation and paralysis of the ciliary transport. About 20% of inhalation smokers develop COPD.

Various environmental factors such as SO2, nitrogen oxides, fine dust pollution, etc.

For miners in the coal mining industry, compensation is paid for chronic obstructive bronchitis or emphysema (miner's bronchitis) that occurred after 31.12.1992 after the occupational disease BK-No. 4111. A prerequisite is proof of exposure to a cumulative dose of usually 100 fine dust years (mg/m3) x years.

Further recurrent viral and/or bacterial respiratory tract infections (lead to an increase in COPD (AECOPD) and accelerate the progression of the disease.

Endogenous factors such as:

• lack of or low mucociliary clearance, so-called dyskinetic cilia syndrome (Cartagener syndrome - rare)
• Immunodeficiencies such as IgA and IgG deficiency, cellular defense weaknesses.
• Alpha1-antitrypsin deficiency (Note: all patients with COPD <50 years of age should be tested for alpha1-antitrypsin deficiency.

Chronic bronchitis can be symptomatic of various cardiac and pulmonary diseases such as silicosis, left heart failure, tuberculosis, bronchiectasis.

Main symptoms: AHA symptoms: shortness of breath, coughing (coughing frequently occurring in the morning - smoker's cough), sputum. Purulent secretion with bacterial superinfection.

In "simple" chronic bronchitis, the general condition is generally good and hardly affected by respiratory distress. With progression of chronic bronchitis, increasing shortness of breath, possibly morning headaches. Difficulty in breathing can lead to weight loss and a considerable reduction in performance.

During physical exertion tachypnea and shortness of breath.

Auscultatory: mostly dry, with larger secretion quantities also damp RGs, with obstruction extended expiration with gulling and humming.

X-ray or CT examination of the thoracic organs

Nonspecific, inflammation parameters such as BSG/CRP increased, IgE, ECP for DD reasons, blood count, hematocrit, blood gas analysis.

In case of purulent sputum bacteriological sputum examination with antibiogram

Exclusion of immunodeficiency diseases (immunoglobulins quantitiav), Alpha1-antitrypsin deficiency (especially Pat. <45 years and/or COPD in the family).

bronchial carcinoma, pulmonary tuberculosis, bronchiectasis, bronchial asthma.

AECOPD (Acuteexacerbation of COPD): Acute increase in respiratory distress, coughing and/or (purulent, yellow-greenish) sputum beyond the normal level of daily fluctuations (>24 hours), in severe cases up to an acute asthma attack. Increase during the cold season.

AECOPD, severe: tachypnea, central cyanosis, use of the respiratory muscles, peripheral edema, clouding of consciousness to coma

Late complications: With further progression increasing signs of respiratory global insufficiency, with cor pulmonary and right heart failure, signs of chronic hypoxemia (cyanosis, drum beating finger, watch glass nails); increased risk of bronchial carcinoma.

Comorbidities: increased susceptibility to infections (Caution: Any incipient respiratory infection must be treated immediately with antibiotics), emphysema, bronchiectasis. About 50% of the exacerbation of COPD is caused by infectious agents, mainly respiratory viruses. The most common bacterial pathogens are H. influenza, S. peumoniae and M. catarrhalis. More rarely are Enteobactericaeae and P. aeruginosa.

The two most important pharmacotherapeutic principles for the treatment of obstructive respiratory diseases are bronchodilatation and anti-inflammation. Accordingly, bronchodilatory and anti-inflammatory substances are used, often in combination. Bronchodilators are equally important in both bronchial asthma and COPD. Since the pathological process in obstructive respiratory diseases takes place primarily in the bronchi or bronchioles, many therapeutic measures are applied topically (by inhalation). Special inhalation systems are used for this purpose.

Basic therapy

• Smoking cessation, avoidance of other noxious substances (e.g. in the workplace)
• Rehabilitation of the paranasal sinuses
• Active vaccination against influenza or specific immunotherapies
• Patient training, physical training measures
• Inhalations and/or tapping massages to facilitate expectoration, respiratory physiological therapy measures.

Medication-based antiobstructive therapy:

beta2 sympathomimetics

• Inhalable, fast/short-acting = Reliever (SABA=short -acting beta2-agonist); duration of action 4-6 hours. Application on demand. (Fenoterol, Reproterol, Salbutamol, Terbutalin)
• Inhalable, long-acting = controller (LABA= long-acting beta2-agonist); duration of action 12 hours(formoterol - e.g. Foradil®-, Salmeterol)

Inhalable sympatholytics (=anticholinergics: have significantly fewer side effects)

• Short-acting: e.g. ipratropium bromide, possibly as a combination preparation ipratropium bromide + fenoterol (e.g. Berodual®)
• Long acting (>24h): e.g. tiotropium bromide (Spiriva®)

Inhalable glucocorticoids (ICS)

Theophylline

Phosphodiesterase 4 inhibitors: e.g. Roflumilast (Daxas® 500ug/Tbl.)

Expectorants (see naturopathy below) for viscous mucus that can only be coughed up with difficulty.

Other therapies

• Long-term oxygen therapy (if necessary, non-invasive home treatment

Chronic obstructive bronchitis, unproductive cough.

Medicinal drugs are proven in practice when antitussive and broncholytic therapy is necessary.

Strongly effective antitussives are the pure alkaloids codeine and noscapine derived from opium. They may be used only for short periods.

The following medicinal drugs are indicated for nonproductive cough:

• Dry spasmodic cough: Hedera fol ium (= ivy leaves: example: Prospan 20-20-20 tr.).
• Acute coughing attacks with incipient mucus formation: Primulae radix/ Thymi herba = primrose root/thyme herb: Example: Bronchipret TP 1-1-1 Filmtabl.)
• Persistent irritating cough, low mucus production: Plantaginis lanceolatae herba = ribwort herb (Broncho Sern Syrup 1-1-1 Tbl)
• Cramping coughs with little mucus production: sundew herb (Makatussin drops Drosera 20-20-20Tr)

The following medicinal drugs are indicated for productive cough:

• Spasmodic cough with mucus production: Hedera fol ium (ivy leaves), Thymi herba (thyme herb); example: Bronchipret 40-40-40 Tr.
• Acute coughing attacks with strong mucus formation: Primrose root/Thyme herba/Sparagus herba (example: Bronchicum Elexier juice 1-1-1 teaspoon).
• Persistent cough, with tenacious mucus formation: thyme her b (Aspecton 20-20-20 tr.)
• Persistent cough, with thick mucus and fever: nasturtium, horseradish root (Angocin Anti-Infekt 4-4-4 tbl.)

Medicines for inhalation and rubbing:

These cause a sustained stimulation of blood flow in the chest. This can promote secretion. In addition, a warm chest compress can be applied.

In case of persistent cough, with viscous mucus formation

• Eucalyptus oil, spruce needle oil, peppermint oil: (Bronchoforton® ointment, rub into chest and back several times a day)
• Eucalyptus oil, pine needle oil, levomenthol (Pinimenthol® N cold ointment, rub into chest and back several times daily)
• Camphor, eucalyptus oil, levomenthol (Tumrol-N-Balsam®, rub into chest and back several times a day).

Note: When using essential oils externally, a relatively high sensitization rate of the ingredients must be taken into account. In this respect, attention should be paid to redness and itching in the area of application. Essential oils can also be used internally to promote secretolysis. Preparations containing Myrtol(e.g. Gelomyrtol) have proven effective.