COPD and pulmonary fibrosis: the key questions and answers

The disease COPD was until a few years still virtually unknown. There is COPD for a long time, it was only earlier under the names "chronic bronchitis" or "smoker's lung".

COPD is the abbreviation for "chronic obstructive pulmonary disease" (English: chronic obstructive pulmonary disease). In the medical jargon that means first of all that it is about a protracted to lifelong disease, in which especially the airways are narrowed. COPD is a generic term for a group of diseases that typically causes sputum, cough and respiratory distress. The focus is on chronic obstructive bronchitis and pulmonary emphysema. In both, the exhalation is especially affected.

In the vernacular, COPD is often equated with the "smoker's lung" or the "smoker's cough" as its main symptom. That's not quite true though. COPD is often caused by cigarette consumption (including passive smoking), but not always - about 20% of those affected are non-smokers. In developing countries, even pollution may play an even greater role. Other possible causes include above all acute and constantly recurring respiratory infections, as well as occupational stress, heredity and nutrition.

Avoid risk factors: Get away with the fag!

If you are a smoker or have any of the above risk factors, it is advisable to have a pulmonary function test early if you have difficulty breathing or coughing. Because the sooner this disease is discovered, the greater the chances of recovery.

At the beginning of all measures is the avoidance of known risk factors - so get away with the fag! The main therapeutic goals then consist in alleviating the symptoms, halting or slowing down the course of the disease and avoiding sudden exacerbations (acute exacerbations). In addition, the resilience and the quality of life should be improved. The basis of the treatment are drugs to dilate the bronchi (usually in spray form) and against inflammatory processes (especially cortisone sprays, including PDE-4 inhibitors).

In addition to various breathing-supporting measures, surgical interventions to reduce the lung volume are also part of the treatment spectrum. In recent years, there have been some pharmaceutical and endoscopic-operative advances in COPD therapy. The evidence is increasing for the success of an early intervention.

Last resort and only chance of recovery: the lung transplant

The last therapeutic option in COPD is lung transplantation. If all goes well, then a real cure is possible. However, the patient group in question is very small. One must not be too old and not burdened with other illnesses. The advent of donor organs is low, the intervention difficult.

Similar, but different: pulmonary fibrosis

This applies equally to idiopathic pulmonary fibrosis. Their cause is unknown (this is the medical word "idiopathic"). In contrast to pulmonary fibrosis due to known triggers, e.g. the inhalation of

  • quartz dust
  • asbestos dust
  • gases
  • fumes
  • hair spray
  • tobacco smoke

Other known causes of pulmonary fibrosis are crop protection products, certain medicines, lung damage from cardiovascular diseases or other systemic diseases.

In pulmonary fibrosis, there is no airway obstruction (obstruction) as with COPD. But a scarring of the lungs due to changes in the alveoli and in the interstitial tissue. The increase in connective tissue is probably due more to over repair than inflammatory or immunological processes. As a result, cortisone & co are not really helping either.

Until recently, oxygen therapy with portable ventilators was the only promising measure to alleviate the complaint. In the meantime, since 2011 and 2015, pirfenidone (Esbriet®) and Nintedanib (Ofev®) Two newly developed drugs available. Although they can not bring about healing like oxygen therapy, they may slow down its progression through direct intervention in the scarring process.

Nicotine abstinence, physical training and vaccinations

As is the case with all lung diseases, three medical measures are particularly recommended to the patient: saying goodbye to smoking (for example in a smoker's outpatient clinic), physical training (for example in a lung sports group) and regular vaccinations (against influenza viruses and pneumococci).

By the way: If you believe the estimates, COPD is a widespread disease with up to 6 million people in Germany, 16 million in the US and 600 million worldwide. That would be almost 10% of the human inhabitants of the earth. COPD ranks among the leading causes of heart failure and stroke worldwide.In contrast to the other top ten deadly diseases, it is the only one that increases in frequency.

Author: Dr. Hubertus Glaser