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Exazerbation der COPD

Steroide, Antibiotika oder mehr?

Exacerbation of COPD

Steroids, antibiotics or more?

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Die Exazerbation wird als akute Verschlechterung der COPD definiert, die deutlich über die individuelle tägliche Schwankungsbreite hinausgeht. Die Prävention und die suffiziente Therapie der Exazerbation sind wichtig, um die Morbidität und Mortalität der Grunderkrankung sowie deren Kosten zu reduzieren. Häufige Ursachen der Exazerbationen sind virale und/oder bakterielle Atemwegsinfektionen. Typische Errege sind H. influenzae, S. pneumoniae, M. catharralis. Bei fortgeschrittenen Stadien der chronischen Bronchitis werden zudem auch gramnegative Keime wie Klebsiella-, Proteus-, Enterobacter-Spezies, aber auch Pseudomonaden nachgewiesen. Respiratorische Viren spielen ebenfalls eine wichtige Rolle. Die Behandlung von Patienten mit exazerbierter COPD ist vom Schweregrad der klinischen Symptomatik abhängig und reicht von der ambulanten Behandlung bis zur stationären und intensivmedizinischen Therapie. Zur Basistherapie gehören kurz wirksame β2-Sympathomimetika sowie Anticholinergika, Kortikosteroide und ggf. Theophyllinderivate. Die Indikation zur Antibiotikatherapie ist nicht obligat. Sie ergibt sich aus der klinischen Symptomatik und dem Schweregrad der Exazerbation. Bei Patienten mit Hyperkapnie und respiratorischer Azidose oder drohender Erschöpfung der Atemhilfsmuskulatur kann durch eine rechtzeitige nichtinvasive Beatmung die Phase der Exazerbation überbrückt und so die Prognose verbessert werden.

Abstract

Exacerbation of chronic obstructive pulmonary disease (COPD) is defined as an acute change in a patient’s baseline symptoms sufficient to warrant a change in therapy. Prevention of exacerbation and its expedient treatment are major goals for reducing the morbidity, mortality and cost of this condition. Common causes of exacerbation are viral and/or bacterial respiratory tract infections. Typical pathogens are H. influenzae, S. pneumoniae and M. catarrhalis. In late stages of COPD an increasing number of gram-negative pathogens like Klebsiella, Proteus, Enterobacter spp., but also Pseudomonas spp. can be detected. Respiratory viruses may also play an important role in exacerbation. The treatment of exacerbation is based on the severity of the clinical symptoms and varies from outpatient therapy to hospitalisation or admission of the patient to an intensive care unit. Short-acting β2-agonists, cholinergic antagonists, corticosteroids and probably theophylline derivatives are the baseline therapy. The indication for antibiotic treatment is not obligatory and is determined by the clinical symptoms and the severity of the exacerbation. For hypercapnic patients with respiratory acidosis or imminent exhaustion of respiratory muscles, early noninvasive ventilation can be successfully used to bridge the phase of exacerbation and improve prognosis.

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  1. Medizinische Klinik III, Medizinische Universität zu Lübeck

    H. Kothe &  K. Dalhoff

  2. Medizinische Klinik III, Medizinische Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck

    K. Dalhoff

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  1. H. Kothe
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Correspondence to K. Dalhoff.

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Kothe, H., Dalhoff, K. Exazerbation der COPD. Pneumologe 3, 119–128 (2006). https://doi.org/10.1007/s10405-006-0087-y

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  • DOI: https://doi.org/10.1007/s10405-006-0087-y

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