Skip to main content
SpringerLink
Log in

Neue Therapiekonzepte bei COPD

New therapeutic approaches to COPD

  • Schwerpunkt: Was ist gesichert in der Therapie?
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Die Einteilung der Schwere der Erkrankung in 4 Stadien ist die Grundlage des Therapiekonzepts der chronisch obstruktiven Lungenerkrankung (COPD). Neben der pharmakologischen Behandlung sind Prävention und Rehabilitation mit Trainingsbehandlung wesentliche und feste Bestandteile der Therapie der COPD. Die Entwöhnung von der Zigarette ist in jedem Stadium von entscheidender Bedeutung für den Verlauf der Erkrankung. Grundlage der medikamentösen Behandlung in allen Stadien sind die inhalativen kurzwirksamen Bronchodilatatoren als Bedarfsmedikamente und ab dem Stadium II die Dauerbehandlung mit langwirksamen Bronchodilatatoren. Theophyllinpräparate haben in den höheren Schweregraden als zusätzliche Medikation einen Stellenwert. Inhalative Steroide sind indiziert bei den schweren Formen der stabilen COPD ab Stadium III, die systemische Gabe nur als Kurzzeittherapie in der Exazerbation. Weiterführende Behandlungen für schwerkranke Patienten sind die Sauerstofflangzeittherapie, die intermittierende nicht invasive Beatmung und evtl. operative Verfahren.

Abstract

Classification of severity of the disease is the basis of the therapeutic concept for chronic obstructive lung disease (COPD). Besides pharmacological treatment, preventive measures and rehabilitation with training are the main parts of COPD therapy. Weaning patients of cigarette smoking is of utmost importance in every stage for the course of the disease. Inhalative short acting bronchodilators on demand are the basis of treatment in all stages as well as long acting bronchodilators from stage II on as continuous medication. Theophyllines are of additional importance in higher degrees of the disease. Inhalative steroids are indicated in severe stages III or higher, systemic steroids only during exacerbations as short course therapy. Oxygen long time treatment, intermittent non-invasive ventilation, and operations in some cases are additional therapies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Anthonisen NR, Manfreda J, Warren CP, Hershfield ES, Harding GK, Nelson NA (1987) Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 106: 196–204

    CAS  PubMed  Google Scholar 

  2. Barnes PJ (1999) Genetics and pulmonary medicine. 9 Molecular genetics of chronic obstructive pulmonary disease. Thorax 54: 245–252

    CAS  PubMed  Google Scholar 

  3. Behnke M, Taube C, Kirsten D, Lehnigk B, Jorres RA, Magnussen H (2000) Home-based exercise is capable of preserving hospital-based improvements in severe chronic obstructive pulmonary disease. Respir Med 94: 1184–1191

    Article  CAS  PubMed  Google Scholar 

  4. Burge PS, Calverley PM, Jones PW, Spencer S, Anderson JA, Maslen TK (2000) Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. BMJ 320: 1297–1303

    Article  CAS  PubMed  Google Scholar 

  5. Calverley P, Pauwels R, Vestbo J et al. (2003) Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: a randomised controlled trial. Lancet 361: 449–456

    Article  CAS  PubMed  Google Scholar 

  6. Casaburi R, Mahler DA, Jones PW et al. (2002) A long-term evaluation of once-daily inhaled tiotropium in chronic obstructive pulmonary disease. Eur Respir J 19: 217–224

    Article  CAS  PubMed  Google Scholar 

  7. Celli BR, Cote CG, Marin JM et al. (2004) The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 350: 1005–1012

    Article  CAS  PubMed  Google Scholar 

  8. Dahl R, Greefhorst LA, Nowak D et al. (2001) Inhaled formoterol dry powder versus ipratropium bromide in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 164: 778–784

    CAS  PubMed  Google Scholar 

  9. Donohue JF, van Noord JA, Bateman ED et al. (2002) A 6-month, placebo-controlled study comparing lung function and health status changes in COPD patients treated with tiotropium or salmeterol. Chest 122: 47–55

    Article  CAS  PubMed  Google Scholar 

  10. Elliott MW (2002) Noninvasive ventilation in chronic ventilatory failure due to chronic obstructive pulmonary disease. Eur Respir J 20: 511–514

    Article  CAS  PubMed  Google Scholar 

  11. Green RH, Singh SJ, Williams J, Morgan MD (2001) A randomised controlled trial of four weeks versus seven weeks of pulmonary rehabilitation in chronic obstructive pulmonary disease. Thorax 56: 143–145

    Article  CAS  PubMed  Google Scholar 

  12. Hak E, van Essen GA, Buskens E, Stalman W, de Melker RA (1998) Is immunising all patients with chronic lung disease in the community against influenza cost effective? Evidence from a general practice based clinical prospective cohort study in Utrecht, The Netherlands. J Epidemiol Community Health 52: 120–125

    CAS  PubMed  Google Scholar 

  13. Hosenpud JD, Bennett LE, Keck BM, Fiol B, Boucek MM, Novick RJ (1998) The Registry of the International Society for Heart and Lung Transplantation: fifteenth official report—1998. J Heart Lung Transplant 17: 656–668

    CAS  PubMed  Google Scholar 

  14. Jones SE, Packham S, Hebden M, Smith AP (1998) Domiciliary nocturnal intermittent positive pressure ventilation in patients with respiratory failure due to severe COPD: long-term follow up and effect on survival. Thorax 53: 495–498

    CAS  PubMed  Google Scholar 

  15. Jorenby DE, Leischow SJ, Nides MA et al. (1999) A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med 340: 685–691

    Article  CAS  PubMed  Google Scholar 

  16. Konietzko N, Fabel HH (2000) Weißbuch Lunge 2000. Thieme, Stuttgart New York

  17. Lung-Health-Study-Group (2000) Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease. N Engl J Med 343: 1902–1909

    Article  PubMed  Google Scholar 

  18. Magnussen H, Goeckenjan G, Kohler D, Matthys H, Morr H, Worth H, Wuthe H (2001) Leitlinien zur Sauerstofflangzeittherapie. Pneumologie 55: 454–464

    Article  CAS  PubMed  Google Scholar 

  19. Mahler DA, Donohue JF, Barbee RA et al. (1999) Efficacy of salmeterol xinafoate in the treatment of COPD. Chest 115: 957–965

    Article  CAS  PubMed  Google Scholar 

  20. Maurer JR, Frost AE, Estenne M, Higenbottam T, Glanville AR (1998) International guidelines for the selection of lung transplant candidates. The International Society for Heart and Lung Transplantation, the American Thoracic Society, the American Society of Transplant Physicians, the European Respiratory Society. Transplantation 66: 951–956

    Article  CAS  PubMed  Google Scholar 

  21. Mehran RJ, Deslauriers J (1995) Indications for surgery and patient work-up for bullectomy. Chest Surg Clin N Am 5: 717–734

    CAS  PubMed  Google Scholar 

  22. Murray CJ, Lopez AD (1996) Evidence-based health policy—lessons from the Global Burden of Disease Study. Science 274: 740–743

    Article  CAS  PubMed  Google Scholar 

  23. National Emphysema Treatment Trial Research Group (2003) A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med 348: 2059–2073

    Article  PubMed  Google Scholar 

  24. Nichol KL, Margolis KL, Wuorenma J, Von Sternberg T (1994) The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. N Engl J Med 331: 778–784

    Article  CAS  PubMed  Google Scholar 

  25. Niewoehner DE, Erbland ML, Deupree RH et al. (1999) The Department of Veterans Affairs Cooperative Study Group Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. N Engl J Med 340: 1941–1947

    Article  CAS  PubMed  Google Scholar 

  26. O’Donnell DE, Fluge T, Gerken F et al. (2004) Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD. Eur Respir J 23: 832–840

    PubMed  Google Scholar 

  27. Pauwels RA, Buist AS, Calverley PMA, Jenkins CR, Hurd SS (2001) Global Strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop Summary. Am J Respir Crit Care Med 163: 1256–1276

    CAS  PubMed  Google Scholar 

  28. Pauwels RA, Lofdahl CG, Laitinen LA, Schouten JP, Postma DS, Pride NB, Ohlsson SV (1999) Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society Study on Chronic Obstructive Pulmonary Disease. N Engl J Med 340: 1948–1953

    Article  CAS  PubMed  Google Scholar 

  29. Ram FS, Lightowler JV, Wedzicha JA (2003) Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev: CD004104

    Google Scholar 

  30. Sandford AJ, Weir TD, Pare PD (1997) Genetic risk factors for chronic obstructive pulmonary disease. Eur Respir J 10: 1380–1391

    Article  CAS  PubMed  Google Scholar 

  31. Scanlon PD, Connett JE, Waller LA, Altose MD, Bailey WC, Buist AS (2000) Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease. The Lung Health Study. Am J Respir Crit Care Med 161: 381–390

    CAS  PubMed  Google Scholar 

  32. Sin DD, Tu JV (2001) Inhaled corticosteroids and the risk of mortality and readmission in elderly patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 164: 580–584

    CAS  PubMed  Google Scholar 

  33. Szafranski W, Cukier A, Ramirez A et al. (2003) Efficacy and safety of budesonide/formoterol in the management of chronic obstructive pulmonary disease. Eur Respir J 21: 74–81

    Article  CAS  PubMed  Google Scholar 

  34. Tashkin DP, Cooper CB (2004) The role of long-acting bronchodilators in the management of stable COPD. Chest 125: 249–259

    Article  CAS  PubMed  Google Scholar 

  35. Toma TP, Hopkinson NS, Hillier J et al. (2003) Bronchoscopic volume reduction with valve implants in patients with severe emphysema. The Lancet 361: 931–933

    Article  Google Scholar 

  36. GOLD (2003) Update 2003.http://www.goldcopd.com

  37. van der Valk P, Monninkhof E, van der Palen J, Zielhuis G, van Herwaarden C (2002) Effect of discontinuation of inhaled corticosteroids in patients with chronic obstructive pulmonary disease: the COPE study. Am J Respir Crit Care Med 166: 1358–1363

    Article  PubMed  Google Scholar 

  38. van Nord J, Aumann J, Janssens E, Folgering H, Müller A, Cornelissen P (2003) Tiotropium maintenance therapy in patients with COPD and 24-h spirometric benefit of adding once or twice daily formoterol during 2-week treatment periods. Am J Respir Crit Care Med 167: A 95

    Google Scholar 

  39. Vestbo J, Sorensen T, Lange P, Brix A, Torre P, Viskum K (1999) Long-term effect of inhaled budesonide in mild and moderate chronic obstructive pulmonary disease: a randomised controlled trial. Lancet 353: 1819–1823

    Article  CAS  PubMed  Google Scholar 

  40. Vincken W, van Noord JA, Greefhorst AP, Bantje TA, Kesten S, Korducki L, Cornelissen PJ (2002) Improved health outcomes in patients with COPD during 1 yr’s treatment with tiotropium. Eur Respir J 19: 209–216

    Article  CAS  PubMed  Google Scholar 

  41. Wedzicha JA, Muir JF (2002) Noninvasive ventilation in chronic obstructive pulmonary disease, bronchiectasis and cystic fibrosis. Eur Respir J 20: 777–784

    Article  CAS  PubMed  Google Scholar 

  42. Williams JH, Moser KM (1986) Pneumococcal vaccine and patients with chronic lung disease. Ann Intern Med 104: 106–109

    PubMed  Google Scholar 

  43. Worth H, Buhl R, Cegla U et al. (2002) Leitlinien der Deutschen Atemwegsliga und der Deutschen Gesellschaft für Pneumologie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD). Pneumologie 56: 704–738

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Klinik Donaustauf, Universität Regensburg

    M. Pfeifer

  2. Klinik Donaustauf, Ludwigstraße 68, 63063, Donaustauf

    M. Pfeifer

Authors
  1. M. Pfeifer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Pfeifer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pfeifer, M. Neue Therapiekonzepte bei COPD. Internist 45, 1395–1401 (2004). https://doi.org/10.1007/s00108-004-1293-5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-004-1293-5

Schlüsselwörter

Keywords

Search

Navigation