COPD: Symptoms, treatment and prognosis

Chronic obstructive pulmonary disease (COPD) is a chronic lung disease with inflamed and stiff small airways. Patients suffer from shortness of breath, chronic cough and mucus production. Everyday life can be severely impaired.

Please find more information on symptoms, causes and treatment steps of COPD in the following text. We also talk about complications, prognosis and everyday life problems.

CAUSES

What are causes and triggers for COPD?

COPD stands for chronic obstructive exposure to irritating gases such as nicotine. The following factors pulmonary disease. It is chronic lung disease in which small airways (bronchi) are inflamed and damaged mostly due to longstanding can cause COPD:

• Nicotine abuse
• pollution of the environment
• occupational stress
• infections
• hereditary diseases
• α-1 antitrypsin deficiency

The most common cause of COPD is long term smoking. 90% of all people with COPD are smokers or ex-smokers.

Collapse of small airways

With each breathing, fresh air rich, in oxygen, reaches the alveoli at the very end of our breathing system through a complex branched network of tiny air tubes (bronchi). In these alveoli, used air rich in carbon dioxide is exchanged for fresh air.

Whereas normally, the small airway tubes (bronchi) are very flexible and keep the airways open during inhalation and exhalation, in COPD they collapse due to inflammation and damage of their tissue. Doctors call this obstruction.

Consequently, the exchange of oxygen and carbon dioxide is restricted, and people affected suffer from shortness of breath. In severe cases, too little oxygen enters the body and carbon dioxide accumulates in lungs and body.

What is the difference of chronic bronchitis, COPD and emphysema?

Chronic bronchitis, COPD and emphysema are different entities. COPD usually begins with a chronic bronchitis without collapse of the lungs. It is treatable and reversible, if the trigger - usually nicotine – is eliminated. COPD, however, cannot be cured but its progression can be halted by switching off noxious agents and starting an appropriate therapy.

Large air balloons in emphysema

If COPD progresses, a so-called emphysema can develop. In Emphysema, airway passages often become more tender and airway bubbles, responsible for the exchange of oxygen and carbon dioxide (alveoli), get destroyed. Where millions of tiny bubbles previously regulated the gas exchange, there are now large, inoperable air balloons. Exchange of used air for fresh air may then be severely restricted.

If you suffer from COPD, it is important that you seek advice and treatment from your GP or lung specialist. Omitting the causative trigger and starting an appropriate treating can stop disease progression and development of an emphysema.

Symptoms

What are typical Symptoms of COPD?

The main symptom of COPD is a persistent cough, which is very often accompanied by tough sputum and is most pronounced in the early morning hours. Since the morning cough is not very agonizing at the beginning, it is often not taken seriously or is not associated with a chronic disease or long-term cigarette consumption. This can be disadvantageous, since it allows COPD to continue to progress.

Another symptom that develops slowly but steadily is shortness of breath (dyspnoea). At the beginning of the disease, shortness of breath (dyspnoea) often only occurs during phases of physical exertion, such as when climbing stairs or working in the garden. In the course of the disease, however, this often develops into permanent shortness of breath, which makes even simple everyday activities such as washing or dressing very strenuous (dyspnoea at rest).

Blue lips and swollen fingertips

Due to the chronic lack of oxygen, other typical symptoms can develop over the years. Classically, a slight blue discoloration of fingernails and lips occurs. In addition, the fingertips may dilate like balloons, a phenomenon also known as clubbing.

COPD progresses insidiously over a period of years and may deteriorate continuously. However, acute phases of deterioration can occur in which symptoms of the disease suddenly worsen considerably. This worsening of the disease is called exacerbation and is usually triggered by respiratory infections, which should be treated quickly as they can significantly accelerate the progression of the disease.

Not only men affected

COPD, which in many cases originates in a smoking career lasting many years, has become a widespread disease in the industrialized nations. It is the fourth most frequent cause of death worldwide, with older men being the most frequently affected by the disease for a long time. In recent decades, however, there has been a turnaround in the number of women affected, which can be explained by the growing number of female smokers.

Does smoking increase the risk of COPD?

The risk of developing chronic bronchitis or COPD increases with increasing cigarette consumption. It is expressed in pack years and can be calculated by multiplying the daily consumption in cigarette packs (20 cigarettes equal one pack) by the number of years a person has smoked. Smoking one pack per day for 20 years leads to 20 pack years. From about 20-30 packyears, chronic bronchitis is expected in up to 85% of all smokers, and this often leads to COPD.

Not only cigarettes count

Besides cigarette smoking, any form of smoking is a significant risk factor for COPD. This includes also passive smoking, water pipe, pipe smoking or smoking cannabis preparations. Whether there is a connection between e-cigarettes and COPD is currently still subject of scientific studies and can probably only be answered in a few years' time.

Occupational exposure to lung-damaging substances is rare, but should always be considered in certain occupational groups, such as in coal mining, since inhalation of fine coal particles can also promote the progress of COPD.

What are the COPD stages according to GOLD?

With the GOLD classification, COPD is divided into four disease stages. The criteria for this classification are proposed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD).

The COPD classification is in transition

Until 2011, the severity level was allocated only based on lung function values. Based on the lung function test results COPD was grouped into COPD 1-4 and I-IV respectively.

In recent years, however, it has been shown that the severity of disease can not solely be classified by test values, but that also clinical symptoms play a major role in classifying patients with COPD. Thus, clinical components such as the number of episodes of acute worsening and hospital admissions in the preceding year were included in the scoring system.

Clinical groups GOLD A-D

Based on the number of exacerbations and hospital admissions patients are divided into one of the four clinical stages GOLD A-D, with group A having the fewest complaints and group D the most.

The recommended therapy regimen depends on which GOLD stage and complaint group you are classified in. There is a step-by-step plan with various pulmonary sprays and medications.

COPD: walking speed indicates severity

Both the severity and the prognosis of a COPD can be very well estimated with the so-called "six-minute walk test". Dutch doctors have now come to this conclusion in a study. COPD (chronic obstructive pulmonary disease) is an increasingly common and severe chronic lung disease. It is considered a late consequence of the smoker's lung.

Under 350 meters of walking distance in six minutes it becomes critical

The scientists observed the course of the disease in 2.100 COPD patients over three years. The six-minute walking test proved to be the most reliable parameter for assessing the prognosis. Anyone who walked only 357 metres or less in the six minutes had to go to hospital more frequently. Anyone who stayed below 334 metres had a significantly increased risk of death. For comparison: healthy people usually manage around 800 metres in six minutes.3

Diagnosis

What is a pulmonary (lung) function test (PFT)?

People with COPD suffer from shortness of breath. With a lung function test, physicians can measure how many litres of air the diseased lung can still breathe in and out. These tests embrace different examination methods, that measure respiration and gas exchange of the lungs. Doctors also speak of PFTs (pulmonary function tests).

The different examination Methods include, for example:

• Spirometry
• Bodyplethysmography
• Spiroergometry.

The tests measure in different ways whether and in which form respiration and gas exchange are impaired. The individual results of lung function help doctors to distinguish between different lung diseases. Depending on the underlying problem, partial respiratory functions are altered.

In COPD and asthma, for example, the collapse of the small airways in the air can be measured. Emphysema on the other hand shows air trapping and over-inflation of the lungs, which can also be determined. And in pulmonary fibrosis, in which the lung scaffold has hardened, lung volumes are overall decreased.

Of note: a chest chest X-ray is usually part of the COPD work up, especially for patients presenting to the hospital with acute exacerbations.

Spirometry

The spirometry is the simplest lung function test. The doctor or technical assistant will explain to you each step. They will ask you to breath in and out as deeply and fast as you can. During the test you are breathing through a mouthpiece, which is connected to the spirometer. A sensor measures your air flow and calculates how many litres of air you in- and exhalation.

A very typical value that is measured is, for example, the forced expiratory volume in one second (FEV1 score). It describes how much air you can exhale in one second.

Body plethysmography: breathing in a closed pressure cabin

Body plethysmography is a somewhat more elaborate form of lung function test. During the examen, you sit in a clear plastic box, a small pressurised cabin which has about the size of an old telephone booth. While sitting you breathe in and out through a special mouthpiece.

Since you are sitting and breathing in a closed pressure system, pressure changes in your lungs while breathing are directly transferred to the cabin air and monitored. Changes in cabin pressure allow to draw back conclusions about the pressure conditions in your lungs. In body plethysmography also lung volumes from spirometry are determined.

While the results of spirometry are strongly dependent on the cooperation of the respective person, body plethysmography is largely independent of the employee. It is therefore suitable for children or for expert opinions.

Spiroergometry: breathing and cycling

In Spiroergometry your lung volumes are measured under physical strain. This happens either on a bicycle or a treadmill. During physical exertion, you breathe through a mask. As with spirometry, the lung volumes are measured.

Sometimes a blood gas analysis is also carried out under stress. This means that the oxygen and carbon dioxide levels in the arterial blood are determined, which provide information about the physical capacity to withstand stress.

The peak flow meter for home use

Lung function can also be measured at home. The so-called peak flow meter is a small, handy device that measures the maximum flow of exhalation.

Tip: When measuring, stand upright and breathe in completely and deeply once. While holding your breath briefly, put the mouthpiece on and enclose it with your lips. Then breathe out vigorously and as hard as you can. Repeat this test three times. It serves as a follow-up for people with asthma or COPD.

What are FEV1 score and FEV1/FVC ratio?

The values FEV1 score and FEV1/FVC ratio are variables from the lung function test measured by spirometry. They describe the extent to which COPD impairs your breathing. Based on the results, doctors can classify the severity of the disease. The smaller the breathing volume and the slower the flow velocity are, the more severe the COPD is.

Complex definition of single terms:

• Forced vital capacity FVC: This is a basic parameter taken by spirometry. It measures how many litres of air your lungs move with deep in- and exhalation.
• FEV1 score (one-second capacity): This value measures the volume of air that you can exhale within one second after full inhalation. To determine this value, you must inhale deeply and exhale as quickly as possible. A normal value for FEV1 score lies at around 5 litres. It depends on age, sex and body size.
• FEV1/FVC ratio: The FEV1/FVC ratio is used to differentiate between obstructive and restrictive lung problems. In patients with COPD, exhalation is slowed down and a FEV1/FCV ratio < 70% confirms the obstruction. A healthy Person exhales about 75-85% of the forced vital capacity within the first second of exhalation. In patients with COPD, however, exhalation is impaired. They exhale less than those 75-85%. Thus, the ratio between FEV1 and FCV decreases. A value below 70% confirms an obstruction. It is the first value, that is determined when diagnosing a COPD.
• FEV1% predicted: Since the FEV1 score varies with height, weight and age, its value is compared to normal standard values (% predicted). A value > 80% reflects mild obstruction, values between 50 and 79% moderate obstruction, between 30% and 49% severe and below 30% very severe obstruction.

A person with COPD stage I is in the early stages of COPD and lung function values deviate only 0-20% from normal. In COPD stage IV, however, lung function scores deviate from normal by more than 70%. These patients suffer from shortness of breath even at rest. 

FEV1 score best single prognostic factor for COPD

FEV1 score (one-second capacity) is the best single prognostic factor for COPD according to the "Guideline for the Diagnosis and Treatment of Patients with Chronic Obstructive Bronchitis and Pulmonary Emphysema (COPD)". Studies have shown relationships between the FEV1 value and the quality of life or occurrence of clinical symptoms.

Treatment

The treatment of COPD is based on several columns. These include many lung sprays and, in some cases, drugs containing cortisone. In advanced stages oxygen therapy may be necessary. Smokers must also refrain from smoking. In the following text you will find information on the treatment of COPD including many tips for life and everyday life with COPD.

How is COPD treated?

In COPD, chronic inflammatory processes lead to changes in the lungs. They become less elastic and breathing more difficult. The therapy for COPD depends on how severely your lungs are affected. There are four disease stages and different sprays or tablets that help.

Bronchodilators and inhalers

Bronchodilators are medications that relax and open airways, bronchi and lungs. In order to facilitate breathing, there are various inhalers with different drugs and modes of action on the market. They are divided into short-acting and long-acting bronchodilators.

Doctors call the fast-acting drugs SABAs (short acting beta agonist) and SAMAs (long acting muscarinic antagonist) and the long-acting drugs LABAs (long acting beta agonist) and SAMAs (long acting muscarinic antagonist). The M or B in the abbreviation describes the mechanism of action of the drugs in each of the two groups.

The fast-acting SABAs and SAMAs help acutely with shortness of breath and include Salbutamol® and Atrovent®. Slow-acting LABAs and LAMAs are long-term therapies and include Serevent® and Spiriva® for example. Combinations of the drugs are also available.

Cortisone and other pills

In addition to bronchodilators, there are also cortisone containing inhalers and combination preparations with cortisone. Examples are Pulmicort® or Viani®.

If sprays no longer help, cortisone tablets may be used, especially for treating acute attacks. Also, theophylline may be prescribed as a long-term therapy and a newer drug called Daxas® in severe cases.

Severely ill people with serious gas exchange impairment may need long-term oxygen.

Vaccines & smoking cessation

In addition to medication, non-drug measurements are a crucial part of COPD treatment. They include, for example, vaccinations against influenza and pneumonia as well as rehabilitation programmes. Since 90% of COPD diseases are caused by cigarettes, it is also very important to quit smoking. The disease cannot be cured, but its progression can be reduced.

What are the different treatment steps in COPD? 

COPD is divided into four disease stages or severity levels according to which the recommended therapy scheme is based. The classification is based on the values of the pulmonary function examination and on clinical symptoms.

Role of symptoms

For a long time, the therapy recommendations of the Global Initiative for Chronic Lung Disease (GOLD) were based solely on the severity of COPD from lung function values. In recent years, however, more emphasis is put on the clinical extent of the disease. This includes the number of exacerbations (acute worsening) in the past year, antibiotic use and the number of hospital stays. Furthermore, it plays a role, how quickly shortness of breath occurs in everyday life. Based on these criteria, patients with COPD are divided into the four disease stages A to D. Groups A and B suffer from less than one exacerbation per year, groups C and D from at least two (or a very severe one). The severity of the shortness of breath in everyday life can be determined by various scores.

Treatment algorithm for group A-D

The step-algorithm for treating COPD describes at which point in disease which type of pulmonary inhaler should be started.

This includes rapid, short-acting bronchodilators, which are administered at an early stage to relieve symptoms at short notice. Long-acting and cortisone-containing inhalers are part of the long-term therapy for advanced diseases. In addition, severely ill people with COPD also take medication in the form of tablets in a phased pattern.

The treatment recommendations for each clinical group are as follows:

• Group A: Patients with few complaints, with not more than one exacerbation in the past year and no hospital admission, belong to group A. Treatment is usually started with short-acting inhalers on demand or with long-acting inhalers on a regular basis. Under certain circumstances, treatment can also be delayed.
• Group B: Patients in group B have clear symptoms, but, like Group A, not more than one exacerbation in the past year and no hospital admission. In general, they are treated with long-acting sprays, either as single or combination therapy.
• Group C and D: Patients in groups C and D suffer from frequent exacerbations (> one in the past year) that required hospital admission. Experts differentiate further, whether a COPD crisis occurred during ongoing therapy or "completely new". In general, one or two long-acting bronchodilators are recommended. A cortisone containing inhaler may be additionally added if needed. Cortisone containing inhalers are never prescribed without bronchodilator therapy.

The treatment algorithm offers various possibilities for therapy recommendations. Several different factors play a role here. Talk to your lung specialist about which medication might be right for you.

What is a triple therapy?

Triple therapy for COPD refers to the combination of three different lung sprays prescribed for advanced disease.

Adding and combining different inhalers

According to the treatment algorithm for COPD, short-acting sprays (SABAs, SAMAs) are used for mild symptoms. Long-acting sprays (LABAs, LAMAs) form the basis of long-term therapy for severe respiratory disease.

If one long-acting spray alone is not enough, a second long-acting spray with a different mechanism of action is added to the medication. Cortisone containing inhalers are added if patients regularly take two different long-acting sprays (i.e. one LABA and one LAMA) but continue to suffer from shortness of breath and frequent exacerbations.

Those who take LABA + LAMA + cortisone (ICS) receive what is known as triple therapy with these three groups of active substances. The cortisone spray can be taken separately or in the form of a combination preparation containing all three active ingredients (e.g. Trimbow®).

Cortisone containing inhalers

People with COPD often wonder whether they need to take a cortisone containing inhalers or even pills and how high the risk of side effects is. In general, physicians prescribe cortisone containing inhalers relatively late, i.e. when the other drugs are not enough.

They are even more critical about the use of cortisone containing pills. Although they help very well in acute exacerbations, they should generally not be given as long-term therapy. The limit lies usually at 14 days.

How do I use inhalers properly?

Lung sprays form the basis of COPD treatment. Correct inhalation is an important for a successful therapy.

There are many inhalation devices on the market. They contain different drugs, and each device works a little differently. It is important for everyone that medical aerosols (drug-air mixture) and drug powder reach the lungs with inhalation.

Straight into the lungs

In order to ensure maximum medication intake, you should inform yourself beforehand how your device works. It is also particularly important that you follow a correct breathing technique so that powder or aerosol can spread well into the airways.

To do this, sit upright, breathe out slowly and completely and then take the inhaler to your mouth. You must completely enclose it with your lips so that no air or active ingredient can escape from the sides.

In the next step, you can activate the device and trigger drug release. At the same time, breathe in as deeply as you can, so that possibly plenty of the drug reaches your lungs. After inhaling, you must hold your breath for 5 to 10 seconds, as the medication will spread to all areas of your lungs during this time. Afterwards, you can take off the device and exhale calmly.

Special features of individual devices

Most devices work in a similar way. For the two most common types of inhalation, metered dose inhalers and powder inhalation, we will list a few points you should know.

Metered dose inhalers work with propellants and pressure vessels. They mix the active ingredient with air. Shake well before use. If they are new or have not been used for more than five days, you should release two shots into the air to make sure they are working.

They can also be coupled with inhalation aids that are screwed in front of the metered dose inhaler. This can be particularly helpful with cortisone sprays, as they leave less cortisone in the mouth and throat. Fungal infections (thrush) then occur less frequently, and a larger amount of the drug can reach the lungs.

In powder inhalation, the drug is kept in a capsule. Before use, it must be removed from the blister pack, inserted into the device and "pierced" by the device. After inhalation, the capsule must be removed from the device. If it is empty, you have successfully inhaled the medication completely.

Videos for illustration

You will find instructions and films for almost all inhalers on the Internet. This is also the case on the website of the German respiratory league and on YouTube. Here you can inform yourself comfortably and comprehensibly before you use your new device and thus ensure a good therapy success.

How do I breathe properly?

A correct breathing technique and continuous training help people with COPD. Physical resilience and shortness of breath improve as a result.

Breathing costs strength

Our breathing occurs subconsciously. It is controlled by the central nervous system. The main muscle is the diaphragm, which lies between the abdomen and chest. With inhalation, the diaphragm moves down towards the abdomen and air flows into the chest. With exhalation, it relaxes and moves back towards heart and chest and air leaves our lungs through mouth and nose.

During breathing, oxygen enters our body and carbon dioxide is released. This mechanism is limited in people with COPD because parts of the lungs collapse with exhalation. This makes breathing harder and more strenuous.

Diaphragm and respiratory muscles become tired

The diaphragm is supported by the so-called respiratory auxiliary muscles. These include, for example, the small muscles in the intercostal spaces.

Impaired exchange of air in the lungs makes breathing more strenuous. This also affects the respiratory auxiliary muscles. The chest becomes less mobile and the posture changes. A vicious cycle begins and breathing itself becomes even more difficult.

Pursed lip breathing and correct body posture

Proper breathing and breathing training can break and stop this cycle. Correct breathing techniques include pursed lip breathing and certain dyspnoea positions, body postures that make breathing easier.

Pursed lip breathing alleviates symptoms of shortness of breath by slowing the exhaling process. After a normal inhalation through your nose, prior to exhalation, place your lips loosely on top of each other. While breathing calmly and slowly out keep your lips slightly together, leaving a small narrow opening. This slows your exhalation. The cheeks should not be bloated, and your exhalation should not be too strong.

Also breathing facilitating positions, so-called dyspnoea positions, may help. With so-called assisted standing and sitting postures, you support yourself on your knees while standing or with your arms while sitting and facilitate your breathing.

You can find various videos and instructions on dyspnoea positions and pursed lip breathing in the internet.

Lung training in everyday life

So-called PEP systems are also used for lung training at home. These are small breathing aids that look like lung inhalers. You breathe into the device through a mouthpiece. During exhalation it builds up a pressure (PEP - positive expiratory pressure) which is transferred to the lungs. This makes it easier for mucus to dissolve and supports expectoration.

Climbing stairs, walking training and participation in lung sports are also important components of a successful therapy. All training possibilities should be continued regularly in everyday life and after in-patient rehab. It improves physical resilience and reduces shortness of breath and fatigue. This applies to all COPD stages.

Exacerbations

What is a COPD exacerbation?

An exacerbation is an acute worsening of COPD that lasts at least two days. Often an expansion of the drug therapy is enough, but sometimes a stay in hospital is necessary.

Mucus production and shortness of breath

Inflammatory changes in the lungs lead to the acute worsening. Mucus is produced and bronchoconstriction with collapse and blockage of the small airways during exhalation is further intensified. Patients suffer from increased shortness of breath, cough and sputum production.

In case of a massive deterioration, not only breathing but also gas exchange can be impaired. This leads to a lack of oxygen in the body and an increase in carbon dioxide. In addition to severe shortness of breath, this can also affect consciousness, making patients sleepy.

Steps in management of acute exacerbations

The exacerbation of a COPD is divided into four degrees of severity. Depending on the extent of the worsening, the therapy must be extended and intensified.

In the case of a slight impairment, temporarily adding short-acting respiratory inhalers may be enough. Diagnostic tests including blood samples or chest X-rays are usually not necessary. In case of moderate exacerbations, however, cortisone or antibiotics must be taken.

In case of pronounced discomfort and severe shortness of breath, hospital admission with extended diagnostic tests and therapy is unavoidable. Very severe exacerbations must even be treated in intensive care units and in some cases ventilation may be necessary. Often non-invasive ventilation with a face or nasal mask and overpressure may be enough, but in very severe cases intubation and invasive ventilation may be necessary.

Treatment adjustments after an acute exacerbation

After an acute worsening, it must be checked whether the current therapy still corresponds to the severity of the disease and is enough. This is particularly true for patients after severe and very severe exacerbations. Sometimes the treatment with inhalers must be extended, in some cases even long-term oxygen may be necessary.

Especially the time after a hospital discharge is critical. More than 30% of people with an exacerbation and an inpatient stay must be re-admitted within the first 90 days after discharge.

If you suffer from COPD, make sure that you take your medication as prescribed by your doctor and that you have a good technique for inhaling breathing sprays. This will often help you to get a good grip on your symptoms and hopefully avoid severe progressions.

COPD exacerbation: Do I need antibiotics?

Whether you need antibiotic therapy depends on the severity of the exacerbation (acute worsening) and whether there are indicators of a bacterial infection.

Antibiotics should only be started, if they are really indicated and appropriate. If taken properly, they can reduce duration and burden of the disease. If antibiotics are taken too frequently and incorrectly, bacteria can become resistant to the drug used and it will no longer work. There is a world-wide growing problem with so-called resistant bacteria.

Antibiotics for purulent yellow-green coughs

Mild COPD exacerbations usually heal without antibiotics. Moderate and severe worsening must be treated with antibiotics more often, especially when patients report purulent coughing. This speaks for a bacterial infection.

The colour of the sputum helps to decide whether purulent inflammation is likely. Yellow-green changes usually indicate a bacterial cause and should be treated with antibiotics. Occasionally a blood test, Procalcitonin (PCT), can also help. It is elevated in bacterial infections.

People with a very severe COPD exacerbation should always receive antibiotics. They are often seriously ill, treated in the intensive care unit and possibly even ventilated. They have been proven to benefit from antibiotic therapy.

Important: Sputum culture before treatment

Before starting an antibiotic treatment, a sample of sputum should be sent to a lab for a sputum culture and antibiotic sensitivity testing. Laboratory physicians determine which bacteria type triggers the infection and which substances work best against it. The antibiotic therapy can then be specifically be adapted.

It is not always possible to clearly predict whether and when an antibiotic is appropriate. The severity of an exacerbation and the evidence of bacteria caused by discoloured sputum appear to be the most reliable factors at present.

Do I need oxygen for COPD?

With COPD, gas exchange in the lungs can be impaired. Depending on the oxygen content in the blood, some people demonstrably benefit from long-term oxygen.

Blood gas test measures oxygen in the blood

The decisive factor for the administration of oxygen is the so-called blood gas analysis. Oxygen and carbon dioxide content in the arterial blood are measured here. Arterial blood is taken from the earlobe or pulse at the wrist.

The content itself is expressed as partial pressure in millimetre mercury column (mmHg) or kilopascal (kPa). In healthy people the values are between 70 and 90 mmHg (or 8-12 kPa), in older people they can drop to 60 mmHg.

Oxygen cut-off < 55

If measured pressures for oxygen drop below 55 mmHG at rest, long-term oxygen therapy is usually indicated. In selected patients with complications such as increased lung pressure or signs of cardiac stress, a therapy may also be justified if the value is below 60 mmHG. Caution is required, however, if the values for carbon dioxide rise at the same time. An increased pressure of carbon dioxide in the blood can make you drowsy and sleepy.

Long-term oxygen prolongs life

Long-term oxygen should normally be given for at least 16 hours a day. Studies have shown that people's ability to think improves and that they become more physically active again. In addition, the long-term administration of oxygen has been shown to prolong life in people with COPD. On average, they gain 2 to 3 years.

Do I need oxygen when flying? 

Whether you need portable oxygen for a flight depends the so-called partial oxygen pressure in your blood gas test. Alternatively, the oxygen saturation can be used. It is measured by using a simple finger clip and given in millimetre mercury column (mmHg) or in percentage (%).

Little oxygen above 8000 meters

Normal air usually contains 21% oxygen. In an airplane this value is artificially maintained up to an altitude of about 8000 meters. Above 8000 meters, the oxygen content in the machine drops to values of 15%.

In healthy people, the oxygen partial pressure is in the arterial blood > 70 mmHG. It decreases slightly during a flight, but usually continues to reach values > 60 mmHg. A healthy body tolerates this without any problems by breathing a little deeper and faster.

However, if people with COPD already have resting oxygen levels < 60 mmHg, the value may decrease further with increasing altitude and oxygen pressures falls < 50 mmHg, which then may lead to physical problems.

Patients with COPD that will likely reach oxygen levels < 50 mmHG on an airplane, should thus receive portable oxygen for the journey. On long journeys at great altitudes, they can otherwise experience discomfort and breathlessness under the reduced oxygen conditions.

The frequency of acute deteriorations (exacerbations) and hospital stays is also important when deciding whether oxygen is needed. Flight length, altitude and type are also included in the recommendation.

Flight preparation: visit your doctor before getting on a plane

Already your physical resilience in everyday life gives an indication of whether you need oxygen in the airplane. A rule of thumb says that people with COPD, who can walk 50-80 meters on a flat route without any problems, also manage a flight well.

Finally, your doctor will decide if you need to take extra oxygen with you on a flight. If you need it, some points need to be clarified before the trip. You will need to contact your insurance company and the airline to ask if, for example, a portable oxygen device can be taken or provided. It must also be clarified who will carry the costs.

Further Information can be found on the websites of the “Atemwegsliga” and the European Lung Foundation. In addition, there are various patient forums where you can obtain information.

Acupuncture in COPD

Patients with chronic obstructive pulmonary disease (COPD) often suffer from breathlessness or shortness of breath. At the University of Kyoto, Japan, doctors have proven that acupuncture improves shortness of breath.

In Japan, shortness of breath in lung patients has been treated with acupuncture for some time. The Japanese scientists now proved the actual performance of acupuncture in their studies. For this purpose, 35 COPD patients were treated with a real acupuncture and 34 with a “placebo” acupuncture. “Placebo” means that the needles do not penetrate the skin, which is not noticed by patients. In addition, all patients received drug treatment against lung disease.

Acupuncture versus “placebo-puncture”

Treatment sessions lasted 12 weeks. Severity of shortness (self-assessment) and six-minute walking test were evaluated. The severity of the shortness of breath in acupuncture patients improved from 5.5 to 1.9. In the placebo group, the value deteriorated from 4.2 to 4.6. The distance that lung patients were able to cover within six minutes also increased in the acupuncture treatment group from 373 to 436 meters and dropped in the “placebo” group from 405 to 386 metres.

Does yoga help patients with COPD?

Yoga may help in COPD. The different approaches including breathing exercises, meditation and strength building can help independently by tackling different problems in COPD disease. However, training should always be discussed with your doctor beforehand and adapted to your condition.

Yoga and breath training

Chronic obstructive pulmonary disease is a complex clinical picture with severe shortness of breath, general physical weakness, muscle breakdown, depression and anxiety.

In addition to medication, nicotine withdrawal, lung exercise and rehabilitation, yoga exercises can help in COPD. Breath training is one of the three main components of Yoga therapy. Several studies have shown that yoga can improve physical and mental health. Both quality of life and lung function are positively influenced in people with COPD.

It is important that the breathing exercises are adapted to your illness. In patients with COPD, the focus of breath training should be placed on exhalation. Exercises in which air is held should be avoided in these patients.

Increased fitness & decreased anxiety

Yoga therapy does not only help through breathing training, it also improves accompanying problems such as anxiety and depression. Meditation, mindfulness training and relaxation exercises relieve mind and soul and strengthen the psyche. In addition, strength and holding exercises build up muscles, increase flexibility and stabilise the body.

Each of the three components of yoga - breathing, holding exercises and meditation - can help with COPD and serve as an additional therapeutic approach.

Do you have any tips against shortness of breath in everyday life?

Depending on the extent of COPD, dyspnoea can severely influence everyday life. Getting up, dressing and combing hair may become impossible for some people. A few changes in behaviour such as showering with a stool can help.

Taking your medication and inhalers, participating in lung sports and avoiding nicotine are indispensable pillars of COPD therapy. If the air deteriorates in everyday life, relaxation and breathing techniques help in addition to taking emergency sprays. In addition, there are a few tips and tricks that can alleviate the shortness of breath in everyday life.

Take your time

It is important that you always listen to your body and take enough time for doing things. Under time pressure stress hormones rise and breathing becomes even more difficult. You therefore need a good time management and planning. Even when you get up in the morning you should not rush. Invest several minutes in stretching exercises and slowly awaken your body. Do everything in peace.

You can save strength and energy by dressing and undressing, combing your hair and showering while sitting. Shower stools and bathtub chairs, for example, are also listed in the aids directory and should be paid for by your health insurance company. Ask them for more information. You can find most products on internet pages and in specialist shops.

Comfy cloths and exercise

Make sure your clothing is as comfortable as possible. A tight bra and tight T-shirts and trousers will restrict your torso and chest and intensify the shortness of breath. Also, avoid fragrances and perfumes, they irritate the lungs.

Even if physical exertion is difficult, it is also one of the cornerstones of COPD treatment. If it is somehow feasible and possible, strain yourself as much as you can. For example, if you live on the 4th floor, try to walk one floor and use the elevator for the remaining three floors.

The whole body suffers

Chronic obstructive pulmonary disease is one of the most common diseases of lungs and bronchi. However, COPD does not only lead to shortness of breath and coughing. It often attacks the entire body and leads to serious concomitant diseases.

COPD rarely comes alone

COPD is characterized by morning cough, sputum and shortness of breath even during minor exertions. But it usually comes along with other diseases. Studies have shown that 55% of all elderly patients with COPD have at least three other diseases that need to be treated. For example, the risk of cardiovascular disease is five times higher in people with COPD and three times higher for stroke. And 19% of heart attack patients also suffer from COPD.

Diabetes, osteoporosis and depression

COPD patients also develop diabetes 1.8 times more often than healthy people. One reason for this is smoking, which promotes the development of both respiratory diseases and diabetes. In addition, drugs for COPD can promote diabetes.

Inflammation of the respiratory tract also has a negative effect on bone metabolism and leads to a reduction in bone mass, which may be one of the reasons, why osteoporosis is often associated with COPD.

Also, COPD and depression often go hand in hand. Up to 80% of lung patients also suffer from psychological disorders. According to the experience of doctors, women are mainly affected. Depression also has a negative effect on the course of COPD because it leads to longer stays and higher mortality.4

Complications and Prognosis

COPD is a chronic disease. It cannot be cured, but it´s progression can be slowed down with the right therapy. With longstanding disease and higher stages complications such as emphysema, pulmonary hypertension, frequent exacerbations or heart disease are possible. Osteoporosis, muscle loss and malnutrition can also be the result of COPD as well as anxiety and depression. 

Can COPD be cured?

As a chronic disease, COPD cannot be cured, but its progression can be stopped if triggering factors - usually smoking - are stopped and appropriate therapy is started.

Studies have shown that particularly stopping smoking has shown to prolong life in people with COPD. Also, proper medical, breathing therapies, rehab programmes, vaccines against pneumococcus and influenza as well as treatment of infections are part of the standard therapy.

Improving performance and quality of life

Overall, a good therapy improves your prognosis. Avoiding nicotine and taking the right medications can decrease symptoms, improve lung function tests and breathing and increase quality of life. The number of hospital stays decreases. Patients may recover more quickly from bronchial infections, their muscle strength in arms and legs can improve partially and anxiety and depression improve.

End stage COPD: How long will I live?

Life expectancy in COPD depends on the severity of the disease and whether you are still smoking. Yet, it is difficult to name concrete numbers. Various concomitant diseases as well as current smoking mix up the picture. Often, numbers between 3 to 10 years survival time are given for people with COPD, depending on the values of lung function. Another number named are 5 to 7 years of loss of life due to the disease.

It´s always worth stopping smoking

COPD is a chronic lung disease that cannot be cured. In 90% of cases it is caused by smoking. To slow the progression of the disease, it is important to quit smoking.

Higher COPD and smoking cost years of life

An older study called "NHANES III" gives concrete numbers. NHANES III stands for "The Third National Health and Nutrition Examination Survey". Between 1988 and 1994, approximately 34,000 subjects were interviewed and examined. Approximately 6000 of them, all over 50 years old, were selected to study life expectancy and the loss of life years due to COPD. Influence on life expectancy of the severity of COPD and smoking were investigated among other things.

In this study, people with higher COPD stage (3 and 4) lost most of their life years, especially when they continued to smoke. People who have always been non-smokers lose less life years in comparison with smokers.

Example with concrete numbers

A 65-year-old male smoker without signs of COPD has a calculated life expectancy of 14.3 years in NHANES III. With COPD grade 1 this number changes only very slightly to about 14 years. In contrast, in patients with COPD stage 3 and 4 life expectancy drops significantly to only 8.5 years. Thus, smokers with a COPD stage 3 or 4 lose about 5.8 years of life according to this study.

Ex-smokers, on the other hand, tend to have better values. A 65-year-old ex-smoker without COPD signs for example has an overall life expectancy of 17.3 years. With COPD stage 3 or 4 again, this drops to 11.7 years, a loss of 5.6 years.

COPD: How do I avoid exacerbations?

Acute worsening of COPD often occurs in autumn and winter and is caused by viruses or bacteria. If an exacerbation, an acute deterioration, occurs due to an infection, more mucus is produced, the cough becomes stronger, the shortness of breath increases.

Your doctor will usually respond by prescribing additional respiratory sprays and, if necessary, adding antibiotics or cortisone. In the case of severe exacerbations, a stay in the clinic or even in intensive care may be necessary. After an acute deterioration, everything should be done to avoid further outbreaks.

Lung sprays protect against outbreaks

Regular medication and correct inhalation technique of lung sprays are basic treatment steps for successful therapy and prevention. Active substances reach lungs and respiratory tract only with correct inhalation.

Whereas short-acting sprays are help quickly and are used to treat acute complaints, long-acting bronchodilators with or without cortisone are the cornerstone of long-term therapy. They take a little longer until they relieve symptoms.

Regular use of long-acting lung sprays protects against exacerbations. It is essential that you use all your medicines and sprays as prescribed by your doctor.

Vaccinations, nicotine stop and other factors

Vaccinations against influenza and pneumonia have also been shown to be protective against exacerbations. In selected individual cases, special drugs such as Roflumilast® or a permanent dose of macrolides (antibiotic group) are also used. Cough medicines that have an “expectorant” effect, such as acetylcysteine or carbocysteine, can also help.

In addition to drug therapy, smoking cessation, patient training, rehabilitation and lung sports are other important measures.

All the above points are designed to make your lungs as strong and resistant as possible. You can ensure that you don't catch any germs in everyday life by maintaining appropriate hygiene and washing your hands.

If you repeatedly suffer from exacerbations, ask your doctor. Check together whether your current medications are enough, whether you are taking your sprays correctly and whether you have all necessary vaccinations.

How does osteoporosis develop in patients with COPD?

In people with COPD, bone loss and osteoporosis occur more frequently. A weak bone structure is furthermore a risk factor for spontaneous bone fractures.

With age, bone degradation and osteoporosis increase. Whereas 5-10% of sixty-year-old men and women suffer from osteoporosis, this number increases to 15-35% for eighty-year-old men. In patients with COPD, the number is even higher and reaches values up to 30-70%. Different disease-related mechanisms lead to increased bone resorption.

In early stages, physicians speak of osteopenia ("too little bone"). If processes of bone loss progress, bone atrophy and osteoporosis, become more pronounced. Bone fractures due to light falls can cause problems.

Increased bone loss

People with COPD often find it difficult to exercise physically. Dyspnoea, low appetite and loss of strength are leading causes. Additionally, low body weight and weak muscles lead to only little tension on the bone structure, which usually triggers bone construction and remodelling. This furthermore leads to increase bone destruction.

Chronic inflammatory processes as seen in COPD, smoking and cortisone pills also inhibit bone formation. The negative effect of cortisone pills, however, has not been proven for cortisone lung sprays, that mainly act locally in the lungs and are only absorbed to a very small extent.

Exercise, calcium and vitamin D3

Physical functional training and balanced diet are very important to counteract the development of osteoporosis in COPD. A normal body weight is desirable, as it promotes bone formation. For smokers, a nicotine stop is unavoidable! Cigarettes not only worsen COPD, but also the accompanying osteoporosis.

People with COPD also need sufficient intake of vitamin D3 and calcium which can be taken with food or as pills. Calcium is built into the bone structure; vitamin D3 promotes the absorption of calcium from the intestine and again its incorporation into the skeleton. 1000-1500 mg calcium and 800-1000 units (I.E.) vitamin D3 should be supplied daily.

Medication against osteoporosis

Depending on the severity of osteoporosis, medication may be necessary. Doctors often prescribe so-called bisphosphonates such as Fosamax® and Actonel® or combinations with calcium and/or vitamin D3. Bisphosphonates work by inhibiting bone-degrading cells (osteoclasts). They can be administered in tablet form, as injections or infusions. Depending on the medication, they are taken daily, weekly or once a month.

Other special drugs such as selective oestrogen modulators (SERMs), derivatives of parathormone or the Prolia® antibody (denosumab) are only prescribed for very specific disease constellations independently of COPD. Depending on the mechanism, they inhibit bone resorption or promote bone-building cells.

In addition to nutrition and weight, exercise, calcium and vitamin D3 as well as drug treatment, pain management and fall prevention are important components of osteoporosis therapy.

COPD: What to do in case of lack of strength and malnutrition (cachexia)?

Early nutritional advice can help people with COPD to lose as little weight and muscle mass as possible. It is important to take in enough proteins and vitamins.

When breathing and eating become difficult

Approximately 20% of all patients with COPD suffer from malnutrition with loss of weight, muscle mass and strength. Doctors speak of cachexia. The percentage is even higher in patients with severe COPD.

People with COPD often fail to consume enough food and calories, even though they need more energy and calories than healthy people. Breathing itself is exhausting, and low appetite and shortness of breath also affect food intake. Doing groceries and preparing food itself is often too difficult, too.

Muscle atrophy and infections

Our body needs protein and energy to build up muscles and a functioning immune system. If food intake is too low, it starts breaking down proteins from our own muscles. We lose muscle mass and become even weaker, a vicious circle sets in. Additionally, it becomes much harder for the immune system to fight infections. For people with COPD and cachexia, the risk of exacerbations increases. Muscle atrophy, weight loss and weakness can severely impair everyday life and reduce the quality of life.

Meat, lentils and nuts: rich in proteins

A balanced and protein-rich diet helps cachexia and COPD to escape this cycle. Animal products such as meat - where low-fat turkey or chicken meat is often preferred - and dairy products have a high protein content. Legumes such as lentils, peas and nuts are also rich in protein. In addition to proteins, other calories, vitamins and trace elements should not be neglected. If you suffer from cachexia, ask your doctor if a dietary consultation could help. Physical training should always take place in parallel.

Why does COPD cause muscle loss?

Muscle dysfunction is usually a side effect that can be triggered by various medical problems and affects the entire body system.

With dyspnoea, any form of physical exertion can be strenuous, and a resulting inactivity leads to even more muscle loss. Also, the human body needs calories and proteins to build up muscles. If we lack proteins from food intake, our body uses proteins from our own muscles which again increases the loss of muscle mass. A vicious cycle sets off.

No strength without training

To escape this vicious cycle, physicians recommend muscle training and physical activity for patients with COPD. In addition to the general therapy with medicines, nicotine avoidance and a balanced protein-rich diet, muscle building and lung sports play a key role in COPD therapy. Do I have an increased risk for lung cancer? (H3) The question of cancer risk is often filled with fear and anxiety. We will try to answer them for you here, although the course of disease cannot be predicted in individual cases.

People with COPD occasionally worry about complications such as emphysema, heart attack or lung cancer and how long they will live. In fact, lung cancer can be one cause of death in people with COPD.

Do COPD patients more likely develop lung cancer?

Approximately 90% of people with COPD smoke or have smoked. Thus, they have an increased risk of lung cancer from nicotine use alone. In addition, COPD is a separate risk factor independent from smoking. Thus, among smokers, COPD increases the risk of lung cancer by factor two to six.

Classification into risk groups

A scoring system helps to assess who may be particularly at risk, which it increased in the following situations:

• Age over 60 years
• intensive smoking with more than 60 pack years
• BMI (body mass index) below 25 kg/m²
• proven pulmonary emphysema on chest X-ray

Patients are divided into low and high-risk groups, depending on their score.

Pack years (py) describes how many packs of cigarettes a person has smoked per day over several years. The term “60 pack years” thus describes a situation, where a person may have smoked one pack per day for a total of sixty years or alternatively two packs per day for 30 years.

Benefits of screening still unclear

Whether patients with COPD benefit from comprehensive screening with a computer tomogram (CT) of the lungs has not yet been conclusively clarified in studies. The findings are not completely clear.

Occasionally lung cancer is found on CT scan, but sometimes false positive CT results turn out to "only" have shown a benign nodule, which itself is harmless, but let to fear and potentially to an operation. It is important to know, that screening test in general should be more beneficial than harmful. And finally, CT scan go along with a chest X-ray load, that is not insignificant.

Therefore, no comprehensive CT screening is currently recommended in Germany. To what extent preventive examinations in the high-risk group will be recommended in the future, remains open.

Do I have an increased risk for a heart attack?

Patients with COPD have an increased risk for cardiovascular diseases including heart attacks.

More heart attacks with COPD

Physicians and researchers have shown that COPD can lead to cardiovascular problems independently of nicotine. Patients have a 2.5-fold increased risk of coronary heart disease, heart attack, arrhythmia, cardiac insufficiency or peripheral arterial vascular disease.

Since 90% of people with COPD smoke or have smoked, it is not easy to say whether a heart attack is due smoking or lung changes. Yet, heart problems may also be related to the lung disease itself. For example, pulmonary over-inflation leads to reduced heart filling and reduced stroke volume and is associated with cardiac insufficiency.

Furthermore, the time during and after an acute worsening of COPD (exacerbation) tends to be a very vulnerable phase in which our body is susceptible to further complications. Inflammatory and prothrombotic processes strain heart and blood vessels.

What are pulmonary hypertension and cor pulmonale?

Both pulmonary hypertension and cor pulmonale are associated with COPD.

High pressure in pulmonary vessels

When small airways collapse during exhalation, respiration and exchange of oxygen and carbon dioxide are affected accordingly. Also, structural remodelling processes take place and the lung becomes less elastic.

This increased pressure is transmitted to the small vessels that pass through the lungs and the pressure in the pulmonary arteries increases. Physicians speak of pulmonary hypertension. In severe cases, the pressure can further be transmitted to the right part of the heart.

A weak right heart

When the pressure in lung vessels and right heart rises, the heart must work very hard against this pressure. Thus, it may tire out more quickly than usual. Additionally, to keep up the circulation, it builds up its muscle which becomes thicker and bigger. At some point, the pressure may be so high, that the right chambers of the heart lose their pumping force and give in. This is called a cor pulmonale. Chronic shortness of breath and unspecific complaints such as fatigue and exhaustion are typical symptoms. Sometimes water may accumulate in legs and internal organs.

ECG, echo and right heart catheter

Resting ECG and chest X-rays may first indications of pulmonary hypertension. More detailed examines include the echocardiogram (heart ultrasound) and the right sided heart catheter.

The ultrasound shows the heart muscle in action as well as walls and valves. With special measurements physicians can also assess different pressures in heart and pulmonary vessels. The right heart catheter is an invasive test. It is performed in a hospital. With a fine wire right heart chamber and pulmonary vessels can be reached and pressures be measured.

No specific treatment

Pulmonary hypertension in COPD cannot be treated directly. Treatment options such as "pure" pulmonary arterial hypertension, i.e. pulmonary hypertension without COPD, have unfortunately not been effective so far.

The cornerstone of the therapy therefore remains the treatment of COPD with sprays and medicines. Lung sports are also an important part of the treatment. And quitting smoking is extremely important.

Are anxiety and depression normal in COPD?

People with COPD often suffer from anxiety and depression. The quality of life can be severely impaired as a result. Percentage data on the frequency of psychological complaints vary. Depressive thoughts are reported to occur in up to 80% of patients.

Withdrawal and social isolation

The physical resilience with dyspnoea first on exertion and later at rest can be so severely limiting that everyday tasks can only be mastered with difficulty. Patients therefor try to avoid leaving the house and social isolation may follow. Anxiety and depression have been shown to lead to reduced quality of life, increased visits to the doctor, more frequent exacerbations (acute worsening) and hospital stays. In addition, shortness of breath, weakness and loneliness can lead to depressive thoughts. Panic attacks and worries about the progression of the disease can lead to "end-of-life" fears.

Treating anxiety and depression in COPD

Behavioural therapy and antidepressants can help against anxiety and depression in patients with COPD. In cases of severe shortness of breath, low-dose morphine is also recommended under certain circumstances, of course always in consultation with your medical doctor. It relieves both, shortness of breath and anxiety.

Recommendations usually include a multimodal therapeutic approach. In addition to the medical treatment emphasis is put on physical training, smoking cessation, respiratory therapy and nutritional advice. In addition, patients can also learn to cope with fears and depressive thoughts. In Germany there are rehab programs that combine these treatment steps.

EVERYDAY LIFE

COPD and sexual problems: What can I do? 

Many patients with COPD have sexual problems. Sometimes, desire is missing, sometimes, it just doesn't work, and other times, patients are just too short of breath. Even though you can't turn back time, a few changes in behaviour and thinking may help.

Frequent problem

Sexual problems are very common. Physicians speak of erectile dysfunction or "restricted erection", whereby reasons and causes very.

A small study published in 2013 for example compared the sexual function of 70 people with and 68 without COPD. It showed that 78.6% of patients with COPD had erectile dysfunction. But even in the group without COPD, more than half (55%) of all patients suffered from sexual problems.

Causes

There are various causes leading to erectile dysfunction and sexual problems. Up to 90% of those affected smoke or have smoked. Smoking itself can lead to erectile dysfunction. But concomitant diseases affecting the vascular and cardiac system can also be the cause of the problem. Also, COPD and shortness of breath lead to problems during sex independently of other factors.

In addition to the underlying medical reasons, the psyche also plays an important role in these patients. Increased rates of depression or anxiety can reduce libido and influence sexual life.

A few tips

Anyone who can climb stairs and can take part in lung sports from the doctor's point of view can usually have sex without any problems. There are a few rules that should be observed.

Physicians recommend stopping eating a few hours prior sexual activity and to reduce alcohol consumption. It may also help to take all lung medications about one hour in advance. A comfortable environment, sometimes including a fan for “fresh air” in the room, complete the preparation. If air becomes scarce, simply take a break. In addition, there are potency-enhancing drugs on the market that can help you if necessary. Talk to your medical doctor about this.

As fear and depressive thoughts, as well as psychological pressure, play a particularly important role besides shortness of breath and erection problems, it is important to just give it a try and make a start. Reduce the pressure as best as you can.

Cuddling, kissing, tenderness and attentiveness also lead to inner peace, familiarity and attachment. Talk openly with your partner about both of your needs and try to find the best solution together.

COPD: What is important when performing physical exercises?

People with COPD often do not exercise enough due to shortness of breath and anxiety. At the same time, the ambitious among you should not exaggerate. It is important to find the right level of physical exertion.

Individual training

People with COPD often find everyday tasks difficult, even climbing stairs and eating can become stressful. Nonetheless, physical training is especially important and must be adapted to your possibilities. Inactivity makes everything even worse.

How much you can strain yourself depends on the severity of COPD, among other things. In mild stages, endurance training should be carried out regularly, usually at least twice a week. Suitable sports include hiking, swimming, Nordic walking and cycling.

In higher-grade COPD, muscle building is often recommended before starting endurance training. People with very severe COPD who need oxygen should take part in rehabilitation programs under medical supervision. There is a wide range of lung sports that is generally recommended.

Sports and Tips

To make it easier for you to get started and to avoid overexertion, you should keep a few things in mind.

Start slowly, warm up sufficiently and don't exaggerate. Increase your program step by step and take your medication regularly. Don’t forget your emergency lung sprays. Breathing exercises are part of the COPD treatment, as are strength and endurance training.

Even if it is difficult, give it a try. Sport has been shown to help people with COPD. It improves lung function and quality of life, builds up muscles, reduces the number of hospital stays and reduces overall mortality. Anxiety and depression also improve.

What you should not do

A little caution is advised for sports with fast acceleration. These include football, tennis and badminton. The sometimes quickly required, strong exertion can be too much for people with lung disease.

It is important that you find your personal sport. Without a little fun and joy, it is difficult to move despite breathlessness. Discuss with your medical doctor how a workout can be most useful for you and how much you can strain yourself.

Is physical exercise dangerous with COPD?

On the contrary, sport helps with COPD. Of course, the physical load must be adapted to your body and the severity of the disease.

Physical activity always helps. Only in a very few cases it can harm you.

Number of hospital stays decreases

Studies show that strength and endurance training help in all degrees of severity of COPD. Both endurance and strength training each have their own value. Usually it is the mixture that makes the difference.

A study from Copenhagen showed that patients with COPD, who performed regularly low, moderate or high physical activity were less likely to be admitted to the hospital and that they lived longer compared to those who did little or no exercise.

Can I apply for a disability pension with COPD?

In Germany, there are disability pensions for different diseases including COPD. It buffers the loss of money that occurs when you can only work for a few hours or no longer at all due to illness. But the application process is not quite simple.

When work becomes too much

Work may give structure to our daily life, secure our social contacts and ensure normality. It also distracts us when we think about problems and illnesses.

From a certain stage of illness, however, it becomes difficult to master daily work task. With COPD, shortness of breath can become so severe that every step and little physical effort becomes too much.

In certain circumstances, a talk with your employer may be helpful. You may be able to switch from full to part-time work and certain tasks may be redistributed among colleagues. If the COPD becomes so severe that you cannot work more than six hours a day, you may be eligible for a disability pension.

First Rehab

Whenever you apply for a disability pension, the German Pension Insurance (DRV) first checks whether you would profit from a rehabilitation program in order to return partially or completely back to work. They say, "rehabilitation before pension". The goal is always to reintegrate you into work life rather than stopping work. A disability pension will only be provided if rehab was not successful.

Entitlement to a reduced earning capacity pension

Anyone who can work less than three hours a day in their previous or any other occupation due to illness (or disability) is entitled to a pension with full incapacity for work. If you work more than three but less than six hours a day, you may be entitled to a partial disability pension. The time limit applies not only to the profession you have learned, but also to any other profession you may be able to pursue.

Important: In addition to medical requirements, insurance requirements must also be met before a claim can be approved. This includes the duration of years, that you paid compulsory contributions for the insured employment.

How do I get a handicapped ID?

You are entitled to a handicapped ID if your degree of disability (in German Grad der Behinderung GdB) is more than 50%.

Application at the Office for Social Affairs

In Germany, the application papers for a handicapped ID must be submitted to the Office for Social Affairs. It is important that all documents relating to COPD and other diseases complete.

For patients with COPD this includes medical certificates, pulmonary function tests and blood values as well as the name of the attending physician. Before submitting your application, you should also check with your doctor to see if you have all the papers you need.

The degree of disability (GdB)

In Germany, the degree of disability (“Grad der Behinderung” GdB) is expressed in percentage, depending on the underlying medical problem. It starts with 20% and ends at 100% disability. You receive a handicapped ID, if your degree of disability is above 50%.

The severity of the disability for an illness is determined by the Federal Ministry of Labour and Social Affairs. Patients with mild hypertension for example receive a disability degree of 0-10%. Patients after brain damage with moderate performance impairment received 50-60%.

COPD and disability

Also, patients with COPD receive under certain circumstances a degree of disability. Extent of shortness of breath, values of lung function test and blood gas analysis are crucial for decision making. For example, if symptoms already occur during light exertion such as walking and if the lung function test and blood gas analysis show significant impairment, a disability degree of more than 50% may be reached. It is classified individually for each person based on complaints and measured test values.

Ask your medical doctor for advice and help

Talk to your medical physician before submitting an application and make sure that you have all documents necessary. In Germany, a disability card comes with several advantages. The car tax reduces, protection against dismissal at work increases and you are entitled to a few extra days of holidays.

Author: Dr. med. Susanne Endres

Sources:

• ¹Vogelmeier C et al. Pneumologie 2018; 72: 253-308; Guideline for diagnosis and therapy of patients with chronic obstructive bronchitis and pulmonary emphysema (COPD), published by the Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. and the Deutsche Atemwegsliga e. V., with the participation of the Österreichische Gesellschaft für Pneumologie (Austrian Society for Pneumology)
• ²(Arch Intern Med. 2012;():1-9. doi:10.1001/archinternmed.2012.1233
• ³ATS American Thoracic Society, International Conference, San Francisco, May 13-18.
• ⁴(DGK, patient league respiratory diseases, easier atmen.de, network lung
• ⁵Wu LL, Lin ZK, Weng HD, Qi QF, Lu J, Liu KX. Effectiveness of meditative movement on COPD: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2018; 13:1239-1250. Published 2018 Apr 17. doi:10.2147/COPD.S159042