Breathe more easily again

In Germany, ten to 15 per cent of adults suffer from chronic obstructive pulmonary disease, or COPD for short. This refers to various diseases of the lower respiratory tract that affect both the bronchi and lung tissue. 

Our specialists at Schoen Clinic treat patients with COPD and pulmonary emphysema in all degrees of severity. A reduction of performance may be prevented, especially in the early stages of the disease. But patients who are already at stage III or IV or even need to be prepared for a lung transplant also receive professional treatment from us. 

Causes & symptoms

Difference between COPD and simple chronic bronchitis

Simple chronic bronchitis occurs when coughing and sputum are present for at least three consecutive months within two consecutive years.

COPD also shows changes in lung function: The narrowing of the airways cannot be completely repaired by medication. With COPD, there is an inflammation reaction in the bronchi caused by particles and gases. In addition to the bronchi, the lung tissue can also be affected. Loss of lung structure, called emphysema, occurs. This is the over-inflation and destruction of the alveoli. The destruction of the alveoli disrupts gas exchange, i.e. the absorption of oxygen into the blood and the release of carbonic acid. 

COPD not only affects the lungs but also has effects on other organ systems such as the cardiovascular system, musculature, skeleton, mind and metabolism. These effects, in turn, influence the severity of the disease.

Causes: How COPD develops

80 to 90 per cent of all COPD patients are cigarette smokers or ex-smokers. Up to 50 per cent of older smokers develop COPD. Passive smokers also have an increased risk of contracting COPD. According to the latest research, smoking THC and shisha can also cause lung damage.

COPD is caused by air pollution, for example by sulphur dioxide or dust, much less frequently than by smoking. These include pollutants in the environment as well as in the working world. Workers in coal mining are particularly at risk, but working with quartz-containing dust, grain dust, welding fumes, mineral fibres and the like also increases the risk of illness. If you suspect this, you should consult an occupational healthcare professional.

Other causes:

  • Altered immune defence
    Those affected have too few antibodies in their blood and are highly susceptible to infections because their immune system is too weak.
  • Inherited deficiency of alpha 1-antitrypsin
    Alpha 1-antitrypsin is a protein. It inhibits an enzyme that destroys elastic tissue in the lungs. This leads to increasing destruction of the alveoli, resulting in pulmonary emphysema with over-inflation and reduced gas exchange surface.
  • Destruction of the cilia in the lungs
    A congenital disorder with destruction of the cilia that occupy the bronchial mucosa and are normally responsible for the cleansing function of the lungs can also lead to pulmonary disease (COPD).

COPD – symptoms: These symptoms may occur

Lung function is limited with COPD. Even activities in daily life such as walking can lead to shortness of breath; in the event of more serious illness, even walking around the room, going to the toilet, eating or drinking. At an advanced stage, shortness of breath increasingly occurs at rest. This can be caused by a narrowing of the airway and a reduced gas exchange surface in emphysema. However, the overloading of the respiratory muscles can also cause shortness of breath at rest.

As part of the disease, acute relapses can occur, especially in autumn and winter. These are expressed by:
  • Increasing shortness of breath, even during light exertion or at rest
  • Increased coughing
  • Increase in sputum
  • Possible change in the consistency of the sputum (it becomes more viscous)
  • Discoloration of the sputum (purulent, yellow-green)

If treatment is not provided or is only provided late, this may result in further severe lung dysfunction. Hospitalisation is often necessary then.

Different types of patients with pulmonary emphysema

Pulmonary emphysema can be divided into two theoretical types, with fluid transitions between them: 
  • “Pink puffer”: Here the emphysema is highly pronounced. Patients tend to be normal to underweight, suffer from severe shortness of breath and usually have oxygen deficiency. Cyanosis (bluish discoloured lips and nail beds) is rare.
  • “Blue bloater”: This is the patient type with predominant COPD. The patients are mostly overweight, have cyanosis, but have less shortness of breath than pink puffers. There is an increase in coughing and sputum, oxygen deficiency and problems expelling carbonic acid. Increased carbon dioxide levels are thus found in the blood. These patients also develop early overloading of the right heart. Over time, patients may develop an increasing oxygen deficiency, which makes oxygen therapy necessary. The respiratory muscle pump may also be overloaded at the same time.


Diagnosis: How we diagnose COPD

First, our specialists ask you about your symptoms (medical history). We also clarify whether risk factors such as smoking and occupational stress are present. A comprehensive physical examination is then performed. 

Lung function

In any case, a lung function test is performed. This examination enables us to assess the extent of narrowing of the airways and over-inflation of the lungs. At the initial examination, this test will be repeated after administering a drug that is inhaled and dilates the bronchial tubes. After that, another lung function test is performed to see if and to what extent lung function can improve. This allows us to monitor the course of the disease.
Pulmonary function is also important in order to obtain initial indications and, if necessary, to distinguish the disease from bronchial asthma.

Measuring diffusion capacity (the ability of the lungs to absorb oxygen from the air) is a further important test. Here we determine whether a gas exchange disorder exists, which can also be present in COPD due to emphysema.

Blood gas analysis

Oxygen deficiency may occur, especially in the case of progressive disease or in combination with pulmonary emphysema. If the symptoms are very severe, it is also more difficult to exhale carbon dioxide. These two values can be determined using a blood gas analysis. 

Stress tests

For some patients, oxygen deficiency only occurs under stress. For this purpose, stress tests such as a 6-minute walking test or ergometry with blood gas analysis are carried out. This enables us, among other things, to assess your resilience and evaluate the therapeutic effects of medication. 

X-ray examination of the lungs

We always carry out an X-ray examination of the lung if pulmonary emphysema is suspected or lung cancer is to be ruled out. This is also necessary in cases of acute relapses or suspected pneumonia.

Computed tomography

High-resolution computed tomography (CT) of the lung is performed to assess the distribution and extent of pulmonary emphysema. This is particularly important prior to surgery such as a lung volume reduction or surgery on large lung bullae.

The imaging procedures are also important for excluding other diseases.

Cardiac ultrasound

An echocardiography (cardiac ultrasound) can be useful if right heart strain is suspected. Why? There is close interaction between the diseased lung and the adjacent heart. 

Laboratory examinations

In terms of laboratory tests, a diagnosis concerning alpha-1 protease inhibitor deficiency is particularly recommended for younger patients (under 50 years of age) and COPD patients who have not smoked. In the event of acute relapses, it is advisable to ascertain the inflammation values in the blood (blood count, C-reactive protein).