Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) poses a serious health challenge and is one of the leading causes of death worldwide.¹ The disease is characterized by persistent inflammation and progressive narrowing of the airways, resulting in a significant impairment of lung function. Patients with COPD frequently suffer from shortness of breath, which can worsen as the disease progresses and occurs not only during physical exertion, but also during periods of rest.

According to Statista, 9,315 deaths were recorded in Germany in 2023 due to chronic obstructive pulmonary disease with acute lower respiratory tract infection.² In its early stages, the disease often goes undetected or is confused with conditions such as asthma. Although COPD can be stable, acute, severe flare-ups requiring immediate emergency medical treatment can occur.

In critical situations like these, the versatile ventilators from WEINMANN can provide support by offering various treatment options and ensuring safety, especially when things need to move quickly.

What is chronic obstructive pulmonary disease (COPD)?

COPD stands for chronic obstructive pulmonary disease and describes a clinical picture where the lungs are damaged and the airways permanently narrowed. The name includes two key terms that precisely describe the nature of the disease:

• Chronic: “Chronic” is used to clarify that this is a permanent, lifelong condition.
• Obstructive: “Obstructive” is derived from the Latin “obstructio”, which means barrier or obstruction. In COPD in particular, “obstructive” refers to the narrowed airways caused by persistent inflammatory processes.

Causes of COPD

COPD stands for chronic obstructive pulmonary disease and describes a clinical picture where the lungs are damaged and the airways permanently narrowed. The name includes two key terms that precisely describe the nature of the disease:

Risk factors

The risk factors for COPD can be divided into three categories:

1. Tobacco smoking is the biggest risk factor for COPD. People who smoke or have smoked are most affected by the disease. The most effective way to prevent and treat COPD is therefore to stop smoking.
2. Genetic predisposition also plays a role in COPD. The hereditary disease alpha-1 antitrypsin deficiency and mutations in telomerase reverse transcriptase are two genetic variations that have a causal link to the development of COPD. In cases of COPD, a one-off test for alpha-1-antitrypsin deficiency is generally recommended.³
3. Another risk factor is long-term irritation of the lungs due to air pollution or the inhalation of harmful substances. People who are regularly exposed to dust, harmful fumes or similar in their work have a higher risk of COPD.⁴

Symptoms: What are the symptoms of COPD?

The lungs have a large air capacity, which is often not fully utilized in everyday life. For this reason, COPD often goes unnoticed in the early stages or only starts becoming evident during physical exertion. At an advanced stage, however, the symptoms also occur when the person is at rest and are accompanied by increased breathing difficulties. 

The main symptoms of COPD occur more frequently in the morning and include mucus, coughing, and shortness of breath.

Acute exacerbations are another characteristic. An acute exacerbation is an acute onset and worsening of a person’s symptoms from a chronic disease. 

What forms of COPD are there?

Chronic form

The term COPD already indicates that this is a chronic, in other words persistent, lifelong and progressive clinical picture. Although its course appears stable, long-term deterioration is inevitable.

Exacerbated COPD

There is also acute exacerbated COPD (AECOPD), where the symptoms suddenly become significantly worse, for example in the form of a flare-up. These acute exacerbations can be caused by various triggers, particularly in the cold season. These include:

A person’s pre-existing chronic respiratory stress with COPD is further increased in these situations due to the increased work required to breathe. Their exhausted respiratory muscles do not have enough strength for adequate ventilation, which can lead to hypercapnia. 

Course of COPD

The course of chronic obstructive pulmonary disease (COPD) is usually insidious and progressive. In the early stages, sufferers often hardly notice any symptoms or confuse them with other diseases such as asthma or chronic bronchitis. 

Initially, shortness of breath and coughing only occur during physical exertion, but these symptoms increase over time and can eventually also occur during periods of rest. A typical feature of the disease is the gradual loss of lung function, which is driven by inflammatory processes and a permanent narrowing of the airways.

In an advanced stage, acute exacerbations often occur, i.e. there are flare-ups where the main COPD symptoms of mucus, coughing, and shortness of breath suddenly worsen. These flare-ups can be exacerbated by infections, air pollution or other triggers and often require rapid medical treatment. This is because if exacerbations occur repeatedly, they have a lasting negative impact on the patient’s general condition and increase the risk of complications.⁵

Without targeted therapy, COPD progresses inexorably, which is why it requires specific treatment.

Emergency treatment of exacerbated COPD

Oxygen therapy

With acute exacerbated COPD, oxygen therapy is essential to alleviate the symptoms. For long-term positive effects, long-term oxygen therapy (LTOT) should be administered for at least 16 hours a day.

However, caution is required when administering oxygen, as excessive doses can be harmful. The body of a COPD sufferer is adapted to a lower oxygen supply, so an excessive oxygen supply can reduce the natural respiratory drive. This can result in hypercapnia, which can have potentially serious consequences such as respiratory acidosis, respiratory arrest and death.

Non-invasive ventilation

Non-invasive ventilation (NIV) supports breathing without intubation. A positive pressure is constantly maintained in the lungs by means of a full face mask. NIV is used for acute exacerbated COPD and makes breathing easier for the patient, while ensuring adequate ventilation. 

Invasive ventilation

Invasive ventilation is performed by inserting a tracheal tube into the patient’s windpipe via the mouth or by making an incision in the windpipe (tracheotomy). Intubation is necessary if the respiratory insufficiency cannot be compensated for by NIV or if the patient is no longer conscious. 

A comprehensive study from the US analyzed the data of 25,628 patients who received inpatient oxygen therapy during a COPD exacerbation and examined the advantages and disadvantages of non-invasive and invasive ventilation. The study showed that non-invasive ventilation is associated with lower mortality, a shorter hospital stay and lower costs compared to invasive ventilation. NIV is therefore less risky and more effective.⁶

How WEINMANN ventilators support COPD treatment

The MEDUMAT Standard² and MEDUVENT Standard ventilators from WEINMANN support various non-invasive ventilation modes that are suitable for the treatment of COPD:

• CPAP (Continuous Positive Airway Pressure): With CPAP, a continuous positive pressure is maintained. Adhesions (atelectasis) are released or prevented, respiratory distress and work of breathing are reduced. In the case of COPD, this form of ventilation may often suffice on its own as an alternative to invasive ventilation and is therefore frequently used to treat this type of respiratory insufficiency.
• CPAP + ASB (Continuous Positive Airway Pressure + Assisted Spontaneous Breathing): This mode combines CPAP with assisted spontaneous breathing. It supports spontaneous breathing by activating pressure support during inspiration. This makes breathing easier for the patient and promotes the removal of CO₂.
• BiLevel + ASB (Assisted Spontaneous Breathing): BiLevel, also known as BIPAP, is a pressure-controlled form of ventilation using two different pressure levels and with the option of spontaneous breathing. This mode is often used in combination with ASB and is particularly effective in supporting ventilation for patients with COPD.

¹ https://www.rki.de/DE/Content/GesundAZ/C/COPD/Chronisch_Obstruktive_Lungenerkrankung_inhalt.html#:~:text=Die%20chronisch%20obstruktive%20Lungenerkrankung%20(%20COPD,von%20Krankheitslast%20im%20h%C3%B6heren%20Erwachsenalter.

² https://de.statista.com/statistik/daten/studie/1044166/umfrage/todesfaelle-aufgrund-chronisch-obstruktiver-lungenkrankheiten/

³ https://www.copd-deutschland.de/images/patientenratgeber/patientenbroschueren/copd-fruehzeitig-erkennen.pdf

⁴ GOLD Report 2023

⁵ 2023 GOLD Report: https://goldcopd.org/2023-gold-report-2/

⁶ Lindenauer K, Stefan MS, Shieh M-S, et al.: Outcomes associated with invasive and noninvasive ventilation among patients hospitalized with exacerbations of chronic obstructive pulmonary disease. JAMA Intern Med 2014; 174: 1982–93.