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Übersicht COPD

Diagnostik, Prävention und Therapie

Overview of COPD

Diagnostics, prevention and treatment

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Der Pneumologe Aims and scope

Zusammenfassung

Die chronisch obstruktive Lungenerkrankung (COPD) ist durch eine nicht vollständig reversible Atemflusseinschränkung charakterisiert und mit hoher Morbidität, Mortalität und Kosten verbunden. Die vermeidbare, typischerweise progredient verlaufende, aber behandelbare Erkrankung wird als pulmonale Komponente einer chronischen Multimorbidität angesehen. Die Diagnosestellung erfolgt anhand von Klinik und Spirometrie. Als bedeutendster Risikofaktor gilt inhalativer Zigarettenrauch, weshalb in der Behandlungsstrategie eine absolute Tabakkarenz die wichtigste präventive Maßnahme der COPD darstellt. Multimodale pharmakologische und nichtpharmakologische Therapieansätze sollen die Lebensqualität und die Lungenfunktion verbessern sowie Exazerbationen verhindern. Für eine gut selektionierte Patientengruppe mit Lungenemphysem können bronchoskopische Maßnahmen in ausgewiesenen Zentren eine mögliche Behandlungsoption darstellen.

Abstract

Chronic obstructive pulmonary disease (COPD) is characterized by an incompletely reversible impairment of airflow and is associated with high morbidity, mortality and costs. The avoidable and typically progressive but treatable disease is seen as a pulmonary component of chronic multimorbidity. The diagnosis is made based on clinical symptoms and spirometry. The most important risk factor is inhalation of cigarette smoke, which is why in the treatment strategy an absolute cessation of smoking is the most important preventive measure for COPD. Multimodal pharmacological and non-pharmacological treatment approaches aim to improve the quality of life and lung function and to prevent exacerbation. For selected patient groups bronchoscopic measures in referral centers can represent a possible treatment option.

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Author information

Authors and Affiliations

  1. Klinik für Innere Medizin, Pneumologie, Schlaf- und Intensivmedizin, UKGM, Philipps-Universität Marburg, 35043, Marburg, Deutschland

    B. Beutel, T. Greulich, C. Vogelmeier & A. Rembert Koczulla

Authors
  1. B. Beutel
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  2. T. Greulich
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  3. C. Vogelmeier
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  4. A. Rembert Koczulla
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Corresponding author

Correspondence to B. Beutel.

Ethics declarations

Interessenkonflikt

B. Beutel, T. Greulich, C. Vogelmeier und A. R. Koczulla geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

C. Geßner, Leipzig

O. Karg, Gauting

H. Olschewski, Graz

CME-Fragebogen

CME-Fragebogen

Welches ist kein gesicherter Risikofaktor für die Entwicklung einer COPD?

Frühgeburtlichkeit

Inhalativer Zigarettenrauch

Verbrennung von Biomasse in geschlossenen Räumen

4‑Beta-1-Antitrypsinmangel

Familiäre Disposition

Welche Aussage zur Komorbidität bei COPD ist falsch?

Mehr als 50 % der COPD-Patienten haben >4 Komorbiditäten.

Ein Viertel der COPD-Patienten haben eine kardiovaskuläre Komorbidität.

Mehr als 90 % der COPD-Patienten haben eine Komorbidität.

Depressionen treten bei COPD-Patienten vermehrt auf.

Muskelatrophie ist eine Komorbidität der COPD.

Welche Aussage zum Pneumothorax bei COPD-Patienten ist korrekt?

Pneumothoraces werden bei COPD-Patienten nicht beobachtet.

Eine Einschränkung in der Lungenfunktion gilt als Prädiktor für Pneumothoraces.

Pneumothoraces treten vermehrt im linken Lungenflügel auf.

Pneumothoraces treten vermehrt im rechten Lungenflügel auf.

Pneumothoraces treten vermehrt bei subpleural betontem Lungenemphysem auf.

Ab welchem Wert des Tiffenau-Index wird eine obstruktive Ventilationsstörung definiert?

<1b

<0,9

<0,8

<0,7

<0,6

Welche der folgenden Maßnahmen ist für eine Tabakentwöhnung am wenigsten geeignet?

Ökonomische Anreize

Cytisine

Varenicline

Verhaltenstherapeutische Ansätze

Akupunktur

Welche Aussage zur Vakzinierung bei COPD-Patienten ist richtig?

Eine Vakzinierung wird bei der COPD nicht empfohlen.

Es sollte bei COPD-Patienten nur eine Vakzinierung gegen Pneumokokken erfolgen.

Es sollte bei COPD-Patienten nur eine Vakzinierung gegen Influenza erfolgen.

Es wird eine Vakzinierung gegen Influenza und Pneumokokken empfohlen.

Nur der Polysaccharid-Impfstoff (PSV-23) hat eine Zulassung zur Vakzinierung gegen Pneumokokken bei COPD.

Wie hoch ist die „number needed to treat“, um durch rehabilitative Maßnahmen nach COPD-Exazerbation weitere Hospitalisierungen wegen Exazerbation zu vermeiden?

4 Patienten

8 Patienten

12 Patienten

16 Patienten

20 Patienten

Welche Aussage zur inhalativen Kortisontherapie (ICS) bei COPD ist korrekt?

Für die Risikogruppe B ist die ICS/LABA-Kombination der LAMA/LABA-Kombination überlegen.

ICS-bedingte Pneumonien haben eine erhöhte Mortalität.

Eine ICS-Monotherapie ist bei Patienten mit leichtgradiger COPD indiziert.

Die ICS/LABA-Kombination führt zu signifikant mehr unerwünschten Arzneimittelwirkungen als die LAMA/LABA-Kombination.

Die ICS/LABA-Kombination wird von GOLD für die Risikogruppen C und D empfohlen.

Welches der folgenden Verfahren ist nicht zur endoskopischen Volumenreduktion geeignet?

Ventile

Coils

Fibrinkleber

Heißer Dampf

Nitriol-Spiralen

Bei wie viel Prozent der COPD-Patienten findet man einen AAT-Mangel?

1 %

5 %

10 %

15 %

20 %

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Beutel, B., Greulich, T., Vogelmeier, C. et al. Übersicht COPD. Pneumologe 14, 35–45 (2017). https://doi.org/10.1007/s10405-016-0089-3

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