Are COPD and emphysema the same thing?

Differences and similarities between COPD and pulmonary emphysema


The first of a total of ten lectures for patients that were given at the Lung Symposium 2009 on October 3rd. will be held in Hattingen, will deal with the two clinical pictures COPD and pulmonary emphysema ...

Summary of the lecture by Prof. H. Teschler (Ruhrlandklinik, Dept. Pneumology-Pneumology
Respiratory and pulmonary medicine (pulmonology) is a branch of internal medicine that deals with the prevention, detection and specialist treatment of diseases of the lungs, bronchi, mediastinum (middle skin) and pleura (pleura and lung).
-Universitätsklinik, Essen) on the subject of "The clinical pictures COPD and pulmonary emphysema: similarities and differences":

Chronic obstructive pulmonary disease (COPD) is usually a chronically progressive disease of the lungs, which is characterized by narrowing and clogging of the airways with subsequent remodeling of the lung tissue. As a collective term, COPD describes a group of lung diseases that are characterized by coughing, increased expectoration and shortness of breath when exerted. First and foremost, chronic bronchitis, chronic obstructive bronchitis and pulmonary emphysema should be mentioned.

Pulmonary emphysema is the irreversible overinflation of the ventilated spaces of the small bronchioles. In so-called centriazine emphysema, the central parts of the acinar (smallest lung unit, berry-shaped end of the air vesicle ducts and sacs) are primarily affected. The main cause of this emphysema is smoking. The pollutants cause inflammation that attacks the interstitial lung tissue.

The so-called panacinar emphysema develops at the peripheral end of the acinar. The main cause of its development is the inherited deficiency of the enzyme enzyme
These are (for the metabolism of all living beings) indispensable protein bodies that, as biocatalysts, enable biochemical processes, accelerate them and allow them to run in a desired direction without being changed themselves. There are a large number of different enzymes, each one responsible for a specific process. Enzymes work according to the lock and key principle, which means that every enzyme has a special protein structure that enables it to specifically recognize the substance whose reaction it is supposed to control (substrate specificity). A variety of different metabolic processes are possible in the organism at the same time.
Alpha-1 antitrypsin. This enzyme protects the lungs from certain protein-degrading enzymes (proteases) which - if the alpha-1-antitrypsin is missing - can attack and destroy the tissue, especially the elastic fibers in the walls of the alveoli.

When the walls of the alveoli tear, the vesicles become larger and larger. A panlobular emphysema develops and, as it grows, bullous emphysema. In all of these diseases, the chronic inflammation in particular contributes to the maintenance of the disease process, which is fueled and maintained by noxious substances of various kinds (smoking, infections, environmental pollution, etc.). When suffering from COPD, patients initially complain of a cough (often played down as a smoker's cough) and an alternating amount of sputum, but only years later they complain of shortness of breath during physical exertion. In “pure” pulmonary emphysema, on the other hand, the focus is on shortness of breath during exercise.

COPD can be combined with an asthmatic reaction, which is less common in emphysema. Severe forms of COPD can often be divided into two characteristic clinical manifestations:

  • The blue bloater is a severe form of COPD that can develop from chronic (obstructive) bronchitis. These patients are mostly overweight and suffer from coughing with varying amounts of sputum. Despite a pronounced blue addiction (cyanosis, cyanosis
    Bluish discoloration of the skin and fingernails due to acute or chronic lack of oxygen.
    ) with severe oxygen deficiency (hypoxia) and accumulation of carbon dioxide in the blood (hypercapnia), the dyspnoea is rather mild. The “Blue Bloater” reacts to the lack of oxygen by increasing the formation of red blood cells (polyglobules).
  • The Pink Puffer ("pink puffers") is a type of pulmonary emphysematist with a powerless (asthenic) constitution type (caused by constantly increased muscle work of the respiratory muscles), severe shortness of breath and a rather dry cough. The patients have at most a slight cyanosis, as there is no or only a slight lack of oxygen. Only rarely (late stage) is there an accumulation of carbon dioxide in the blood (hypercapnia).

There are also similarities and differences in treatment. The common goal of treatment is to reduce or stop the progression of the disease and improve the quality of life for patients. A prerequisite for any meaningful treatment is to first switch off harmful influences. In addition, smoking must be given up in the case of COPD and pulmonary emphysema, and passive smoking must also be avoided. Quitting smoking is the only way to significantly improve the prognosis for these disorders.

A key goal in drug therapy for COPD and emphysema is to widen the bronchi in order to improve breathing. The drugs that are used for this are called "bronchodilators". With this group of drugs, the bronchi, which are narrowed due to the disease, are made more or less wide by acting on the bronchial muscles. Mainly two groups of drugs are used for this. On the one hand the "beta-2 mimetics" and on the other hand the "anticholinergics". The importance of inhalable cortisone has only been confirmed in severe to very severe COPD. Cortisone tablets help with both diseases only in the event of a severe exacerbation. Antibiotics are indicated for bacterial infections and can then usefully support other therapies.

The substitution with human alpha-1 concentrate (Prolastin HS) is only possible for patients with severely reduced blood levels of alpha-1-AT and advanced emphysema. From long-term oxygen therapy
Long-term oxygen therapy (LTOT - abbreviated from the English long time oxygen therapyAccording to the opinion of specialists, this is only indicated and useful if an oxygen measurement has already been carried out several times (usually based on a blood sample from the earlobe) and the oxygen values ​​have repeatedly turned out to be too low. Then, however, the natural substance oxygen (O2) must be used over a longer period of time, possibly even continuously. Short-term use for just a few minutes a day is generally not harmful, but medically pointless.
From the point of view of life expectancy, the COPD patient of the "blue bloater" type probably benefits more than the emphysematics, who often experiences less shortness of breath with oxygen. Non-invasive ventilation is particularly effective in COPD of a "blue bloater", but is rarely accepted by pure emphysematics - or only at an advanced stage - with good success. Lung transplantation is only possible in the most severe COPD and advanced emphysema as the last option after exhausting all other available treatment methods for otherwise largely healthy people under 65 years of age.

3rd Lung Symposium
"COPD and emphysema" - which are the decisive pillars of therapy? From prophylaxis to surgical treatment "
on Saturday 3rd October 2009
9 a.m. to 6 p.m.
Westphalian Industrial Museum
Henrichshütte - Blower Hall -
Werksstrasse 31-33
45527 Hattingen / Ruhr

Please address inquiries regarding the Lung Symposium 2009 to the head of the organization, Jens Lingemann
Lindstockstrasse 30
45527 Hattingen
Telephone: 02324 - 999 959

[email protected]