Chronic Obstructive Pulmonary Disease (COPD)

CPAP ventilation for COPD

Chronic obstructive pulmonary disease (COPD) represents a serious health challenge and is one of the most common causes of death worldwide.[1] The disease is characterized by persistent inflammation and progressive narrowing of the airways, which leads to a significant impairment of lung function. COPD patients often suffer from breathing difficulty, which can get worse as the disease progresses, not only during physical exertion but even at rest.

Statistics from the German Federal Statistical Office show that 6,535 deaths as a result of chronic obstructive pulmonary disease with an acute infection of the lower airways were recorded in Germany in 2021.[2] In the early stage, COPD often remains undetected, or is confused with other clinical conditions such as asthma. While COPD can follow a stable course, sufferers may experience acute, serious episodes requiring immediate medical emergency treatment.

In critical situations like these, WEINMANN’s versatile ventilators provide support, offering various safe and reliable therapy options, especially when time is of the essence.

What is COPD?

COPD stands for chronic obstructive pulmonary disease and describes a clinical condition in which the lung is damaged and the airways are permanently narrowed. The name comprises two key terms that precisely describe the nature of the disease:

  • Chronic: The word chronic makes it clear that it is a permanent, lifelong disease.
  • Obstructive: Obstructive comes from the Latin “obstructio”, which means a blockage. With COPD specifically, “obstructive” refers to the narrowed airways resulting from persistent inflammatory processes.


There are two main causes of COPD, which exacerbate each other when they occur simultaneously:

Chronic bronchitis

Chronic bronchitis is a long-term inflammation of the airways (bronchi) that destroys the cilia in the lungs. These hair-like structures are responsible for transporting mucous, which is why damaged cilia lead to bronchial congestion and cause breathing difficulties and coughing.

Pulmonary emphysema

Pulmonary emphysema involves enlargement of the air-filled spaces (alveoli) in the lungs caused by damage to the walls of the alveoli. This reduces the surface available for gas exchange, which means that less oxygen can enter the lungs and ultimately the blood.

Risk factors

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

  • Smoking tobacco is the biggest risk factor for COPD. People who smoke, or have smoked in the past, are most affected by the disease. The most effective measure for avoiding and treating COPD is to stop smoking.
  • 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 single test for alpha-1-antitrypsin deficiency is generally recommended.[3]
  • A further risk factor is long-term irritation of the lungs as a result of air pollution or inhaling harmful substances. People who are regularly exposed to dust, harmful fumes or the like in their work are at greater risk of COPD.

How does COPD manifest itself?

The lungs have a large air capacity, which is not often fully utilized in day-to-day activities. This is why COPD often remains undetected at first, or only begins to become evident during physical exertion. However, once the disease reaches an advanced stage, the symptoms also occur at rest and are accompanied by increased breathing difficulties. The main symptoms of COPD are most pronounced in the morning and comprise:

  • breathing difficulty (dyspnea),
  • chronic cough,
  • sputum.

Acute exacerbations are a further feature. This means a worsening of a chronic disease with increased symptoms. 

What types of COPD are there?

The term COPD already indicates that it is a chronic, i.e. persistent, lifelong and progressive clinical condition. Progression of the disease appears stable; however, long-term deterioration is unavoidable.

There is also acute exacerbated COPD (AECOPD), in which the symptoms suddenly become significantly worse, or in other words a flare-up. These acute exacerbations can be caused by various triggers, especially in winter. They include:

  • viral or bacterial infections, 
  • air pollution (smog), 
  • respiratory depressant medications, 
  • accidents involving the thorax and 
  • comorbidity, e.g. of cardiac origin

In such situations, the already existing chronic respiratory effort involved with COPD is further exacerbated. The exhausted respiratory muscles do not have enough strength for adequate ventilation, which can lead to hypercapnia. 

Emergency treatment of exacerbated COPD

Oxygen therapy

In cases of acute exacerbated COPD, oxygen therapy to relieve the symptoms is essential. To achieve lasting benefit, long-term oxygen therapy (LTOT) should be performed for at least 16 hours a day.

However, caution is required when administering oxygen, as excessive doses can be harmful. When a person suffers from COPD, their body adapts to a lower oxygen supply, so an excessive oxygen supply may reduce the natural respiratory drive. This can result in hypercapnia, which may have potentially serious consequences such as respiratory acidosis, apnea and death.

Non-invasive ventilation

Non-invasive ventilation (NIV) supports respiration without intubation. A positive pressure is constantly maintained in the lungs via a mouth or nose mask. NIV is used for acute exacerbated COPD and reduces the breathing effort required, while ensuring sufficient ventilation.

Invasive ventilation

Invasive ventilation is carried out by inserting a tube into the patient’s windpipe (trachea) via the mouth or a surgical opening in the windpipe (tracheotomy). Intubation is required if non-invasive ventilation cannot compensate for the respiratory insufficiency or if the patient is unconscious. 

A major study in the USA analyzed the data of 25,628 patients who received inpatient oxygen therapy during a COPD exacerbation. The pros and cons of invasive and non-invasive ventilation were investigated. It was demonstrated that non-invasive ventilation is associated with lower mortality, shorter hospital stays and lower costs compared to invasive ventilation. Non-invasive ventilation is therefore less risky and more effective.[4]

How WEINMANN ventilators support treatment

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

  • CPAP (Continuous Positive Airway Pressure): With CPAP, a continuous positive pressure is maintained. Adhesions (atelectasis) are removed or prevented, respiratory distress and breathing effort are reduced. This form of ventilation alone can often be sufficient to avoid invasive ventilation in cases of COPD, and is therefore frequently used for 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 providing pressure support during inspiration. This makes the breathing effort easier for the patient and assists evacuation of CO2.
  • BiLevel or BiPAP + ASB (Biphasic Positive Airway Pressure + Assisted Spontaneous Breathing): BiPAP, also known as BiLevel, stands for a two-phase positive pressure ventilation which allows spontaneous breathing. This mode is often used in combination with ASB and, in particular, assists ventilation in cases of COPD.