COPD (Chronic Obstructive Pulmonary Disease)

COPD is lasting damage to the lungs that narrows the airways and destroys the air sacs, making it hard to empty the lungs. It covers chronic bronchitis and emphysema. Unlike asthma, the airflow limitation does not fully reverse, and the disease usually progresses slowly over years.

The damage already done cannot be repaired, but much can be changed. Stopping smoking slows the decline to near the normal rate of ageing. Inhalers, exercise training and vaccination reduce breathlessness and flare-ups. Many people are diagnosed late because they put their cough and breathlessness down to age or smoking.

Symptome

• Breathlessness on exertion that gradually worsens
• A cough on most days, often with phlegm
• Wheeze and chest tightness
• Frequent or slow-to-clear chest infections
• Tiredness and reduced ability to exercise
• In advanced disease, weight and muscle loss and ankle swelling
• Flare-ups with more breathlessness and a change in phlegm colour or amount

Ursachen und Risikofaktoren

Tobacco smoking causes the large majority of cases in most countries; the risk rises with the number of pack-years. Indoor smoke from cooking or heating with wood, dung or coal is a major cause where these fuels are used, especially in women. Long exposure to dusts and fumes at work, such as in mining, welding, textiles and farming, contributes. Alpha-1 antitrypsin deficiency is an inherited cause to consider in anyone with emphysema under 45 or with little smoking history. Poor lung growth from prematurity or severe childhood infections, and long-standing undertreated asthma, also raise the risk.

Wie es diagnostiziert wird

• Spirometry: Required for diagnosis. A ratio of FEV1 to FVC below 0.7 after a bronchodilator confirms airflow obstruction; FEV1 grades its severity.
• Symptom and flare-up history: The mMRC breathlessness scale, CAT score and number of exacerbations in the past year determine treatment group.
• Chest X-ray or CT: Excludes other disease and shows emphysema. Low dose CT also serves as lung cancer screening in eligible smokers.
• Blood tests: Blood count including eosinophils, which predicts benefit from inhaled steroids, and alpha-1 antitrypsin level once.
• Oxygen saturation and blood gases: Identify who may need long-term oxygen.
• Full lung function and walk test: Gas transfer, lung volumes and 6 minute walk distance before surgery or valve treatment.

Behandlungsmöglichkeiten

• Stopping smoking: The single most effective intervention at any stage. Combining support with nicotine replacement or varenicline works best.
• Long-acting bronchodilator inhalers: A LAMA, a LABA, or both in one device, are the mainstay for breathlessness.
• Inhaled steroid: Added for people with frequent flare-ups and raised eosinophils. It slightly raises pneumonia risk.
• Pulmonary rehabilitation: A 6 to 8 week supervised programme of exercise and education. It improves breathlessness and quality of life more than any inhaler.
• Vaccinations: Influenza, pneumococcal, COVID-19 and RSV vaccines reduce flare-ups.
• Long-term oxygen: Prolongs life only in people with persistently low blood oxygen, used for 15 or more hours a day.
• Lung volume reduction: Endobronchial valves or surgery for selected people with severe emphysema and marked hyperinflation. Lung transplantation is a last option for a few.

Wenn es dringend ist

Seek emergency care locally if you are severely breathless at rest, cannot finish sentences, have blue lips, new confusion or drowsiness, chest pain, or a high fever with worsening phlegm that is not responding to your rescue pack. Sudden one-sided chest pain with breathlessness may be a collapsed lung.

Reisen nach Türkiye zur Behandlung

COPD needs lifelong local follow-up, and a flare-up far from home is risky, so routine care should not involve flying. A visit may be reasonable when you are stable for a defined purpose: a complete assessment with CT, full lung function and a specialist opinion, or evaluation for endobronchial valves, which involves a bronchoscopy and about 3 to 5 nights in hospital with a meaningful risk of collapsed lung in the first days. If your resting oxygen saturation is below about 92 to 95 percent, ask for a fitness-to-fly assessment, as you may need in-flight oxygen.

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