Der Internist

, Volume 47, Issue 9, pp 901–907

Stadiengerechte Therapie der COPD

Schwerpunkt: COPD
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Zusammenfassung

Die Behandlung der COPD hat in den letzten Jahren deutliche Fortschritte gemacht und steht zunehmend auf dem Boden der evidenzbasierten Medizin. Die Tabakentwöhnung bleibt die wichtigste und wirksamste einzelne Behandlungsmaßnahme und muss mit entsprechendem Nachdruck angestrebt werden. Gerade in den Frühstadien der COPD sollten intensive Maßnahmen zur Nikotinentwöhnung ergriffen werden, um das katastrophale weitere Fortschreiten der Erkrankung zu verhindern. Die medikamentöse Therapie der COPD ist in den leichteren Stadien 0–II zunächst symptomorientiert. Asymptomatische Patienten benötigen in diesen Stadien keine medikamentöse Dauertherapie. Die Rehabilitation ist spätestens ab Stadium II der Erkrankung indiziert. In den Stadien III–IV profitieren die Patienten von einer Dauertherapie mit inhalativen Kortikosteroiden, am besten in Kombination mit lang wirksamen Bronchodilatatoren. Systemische Kortikosteroide sind hingegen als Dauertherapie auch in niedriger Dosierung kontraindiziert. Ihr Stellenwert beschränkt sich auf die kurzfristige Behandlung der akuten Exazerbation. Mit diesen Maßnahmen können v. a. die Lebensqualität und die Morbidität günstig beeinflusst werden. Über die Senkung der Infektexazerbations- und Hospitalisationsraten wird darüber hinaus die Senkung der Mortalität der COPD angestrebt.

Schlüsselwörter

COPD Nikotinentwöhnung Rehabilitation Medikamentöse Therapie Inhalative Kortikosteroide 

Stage appropriate therapy for COPD

Abstract

The treatment of chronic obstructive pulmonary disease (COPD) has improved substantially over recent years, and is increasingly based on evidence from prospective studies. Cessation of smoking is the most important and effective single measure which can be taken. In the early stages, intensive measures for nicotine withdrawal should be taken to prevent the catastrophic effects of disease progression. Pharmacological treatment of COPD in the earlier stages (0–II) should be symptom oriented. Asymptomatic patients at these stages do not require permanent pharmacotherapy. From Stage II, COPD patients benefit from pulmonary rehabilitation programs. Patients with stages III and IV should usually be put on long-term corticosteroid inhalation, preferably in combination with long-acting bronchodilators. Systemic corticosteroids, even at low doses, are not indicated. They are useful only for the short-term treatment of acute exacerbations. These treatment modalities improve the quality of life and morbidity of COPD patients. They also decrease exacerbations and hospitalization rates, which should help to reduce mortality due to this important disease.

Keywords

COPD Nicotine withdrawal Rehabilitation Pharmacological therapy Inhaled corticosteroids 

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Akutkrankenhaus u. Rehabilitationsklinik für Atemwegs- und TumorerkrankungenAsklepios NordseeklinikWesterland/Sylt

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