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.
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.
Literatur
Aaron SD, Vandemheen KL, Hebert P (2003) Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease. New Engl J Med 348: 2618–2625
Adcock IM, Ito K (2005) Glucocorticoid pathways in chronic obstructive pulmonary disease therapy. Proc Am Thorac Soc 2: 313–319
Anthonisen NR, Lindgren PG, Tashkin DP et al. (2005) Bronchodilator response in the lung health study over 11 yrs. Eur Respir J 26: 45–51
Barnes PJ, Stockley RA (2005) COPD: Current therapeutic interventions and future approaches. Eur Respir J 25: 1084–1106
Burge PS, Calverley PMA, Jones PW (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
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
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
Davies LR, Angus M, Calverley PMA (1999) Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomized controlled trial. Lancet 354: 456–460
Decramer M, Rutten-von-Molken MPMH, Dekhuijzen PNP et al. (2005) Effects of N-acetylcysteine on outcomes in chronic obstructive pulmonary disease (Bronchitis Randomized on NAC Cost-Utility Study, BRONCUS): a randomised placebo-controlled trial. Lancet 365: 1552–1560
Fletcher C, Peto R (1977) The natural history of chronic airflow obstruction. BMJ 1: 1645
Groenewegen KH, Schols AM, Wouters EF (2003) Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD. Chest 124: 459–467
Gross NJ (2005) Chronic obstructive pulmonary disease outcome measurements. What’s important? What’s useful? Proc Am Thorac Soc 2: 267–271
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
Nici L, Donner C, Wouters E et al. (2006) ATS/ERS Statement on pulmonary rehabilitation. Am J Respir Crit Care Med 173: 1390–1413
Niewoehner DE, Erbland ML, Deupree RH (1999) Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. New Engl J Med 340: 1941–1947
Niewoehner DE, Rice K, Cote C et al. (2005) Prevention of exacerbations of chronic obstructive pulmonary disease with tiotropium, a once-daily inhaled anticholinergic bronchodilator. Ann Intern Med 143: 317–326
Nocturnal oxygen therapy trial group (1980) Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive pulmonary disease: a clinical trial. Ann Intern Med 93: 391–398
Paggiaro PL, Dahle K, Bakran I et al. (1998) Multicentre randomized placebo-controlled trial of inhaled fluticasone propionate in patients with chronic obstructive pulmonary disease. Lancet 351: 773–780
Rabe KF, Bateman ED, O’Donnell D et al. (2005) Roflumilast – an oral anti-inflammatory treatment for chronic obstructive pulmonary disease: a randomised controlled trial. Lancet 366: 563–571
Ram FS, Wedzicha JA (2002) Ambulatory oxygen for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2: CD000238
Report of the medical research council working party (1981) Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Lancet 1: 681–686
Scanlon PD, Connett JE, Waller LA (2000) Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease. AJRCCM 161: 381–390
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
Sin DD, Wu L, Anderson JA et al. (2005) Inhaled corticosteroids and mortality in chronic obstructive pulmonary disease. Thorax 60: 992–997
Sutherland ER, Allmers H, Ayas NT (2003) Inhaled corticosteroids reduce the progression of airflow limitation in chronic obstructive pulmonary disease: a meta-analysis. Thorax 58: 937–941
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
Troosters T, Casaburi R, Gosselink R, Decramer M (2005) Pulmonary rehabilitation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 172: 19–38
van der Valk P, Monninkhof E, van der Palen J et al. (2002) Effect of disconuation of inhaled corticosteroids in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 166: 1358–1363
van Noord JA, Aumann JL, Janssens E et al. (2005) Comparison of tiotropium once daily, formoterol twice daily and both combined once daily in patients with COPD. Eur Respir J 26: 214–222
Interessenkonflikt
Keine Angaben
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hamm, H. Stadiengerechte Therapie der COPD. Internist 47, 901–907 (2006). https://doi.org/10.1007/s00108-006-1701-0
Issue Date:
DOI: https://doi.org/10.1007/s00108-006-1701-0