Die chronisch obstruktive Lungenerkrankung (COPD) als Systemerkrankung

Zusammenfassung

Die COPD ist durch eine voranschreitende, typischerweise nur teilweise reversible Atemwegsobstruktion definiert. Sie geht mit einer pathologischen Inflammationsreaktion der Lunge auf inhalative Noxen (allen voran Zigarettenrauch) einher. In zahlreichen epidemiologischen Studien konnten signifikante Zusammenhänge zwischen einer reduzierten Einsekundenkapazität (FEV₁) und der Mortalität an kardiovaskulären, metabolisch-nutritiven und anderen extrapulmonalen Erkrankungen gefunden werden. Auch ist bekannt, dass COPD-Patienten zu einem großen Teil nicht an der pulmonalen Grunderkrankung, sondern an Störungen anderer Organe sterben. Diese lungenfernen Erkrankungen werden in ursächlichem Zusammenhang mit der COPD gesehen. Unklar ist, ob es sich um systemische Konsequenzen oder Komorbiditäten handelt. Die Verbindung zwischen der COPD und den extrapulmonalen Manifestationen der Erkrankung könnte eine systemische Inflammationsreaktion sein, wobei die genauen Mechanismen noch nicht bekannt sind.

Ein Ansatzpunkt, der dieser neuen Sichtweise Rechnung trägt, ist die Entwicklung von Score-Systemen, die den Schweregrad der COPD nicht allein anhand der Lungenfunktion festlegen. Ein erstes solches Score-System ist der BODE-Score. Ausgehend vom Konzept der COPD als Systemerkrankung wird ein Behandlungskonzept benötigt, das zum einen eine differenzierte medikamentöse Behandlung der pulmonalen und extrapulmonalen Manifestationen beinhaltet. Zum anderen müssen physiotherapeutisch-rehabilitative Maßnahmen dem nicht-medikamentös behandelbaren Anteil der Erkrankung ausreichend Rechnung tragen. Ein solcher multimodaler, krankheitsübergreifender Behandlungsansatz ist in den aktuellen Leitlinien nicht enthalten.

Abstract

Chronic obstructive pulmonary disease (COPD) is defined as a progressive, usually only partially reversible, obstruction of the airways The disease is associated with an inflammatory response of the lungs to noxious particles, particularly cigarette smoke. Numerous epidemiological studies have shown a significant association between impaired lung function and the presence of cardiovascular, metabolic or other extrapulmonary comorbidities. Systemic inflammation may be the missing link between COPD and its extrapulmonary manifestations, although the exact mechanism of this relationship remains unclear. The development and validation of score systems that classify COPD severity, not only by changes in lung function, is an important step. The BODE score (body-mass index, airways obstruction, dyspnea, exercise capacity) is such a system. Based on the concept of COPD as a systemic disease, a concept is needed which describes in detail the pharmacological treatment of the pulmonary and extrapulmonary manifestations of the disease. In addition, the part of the disease that is treatable with physiotherapy and rehabilitation must be fully taken into account. Such multimodal treatment regimens have so far not been implemented into clinical guidelines.

Schlüsselwörter

chronisch obstructive Lungenkrankheit (COPD) - Komorbidität - Risikofaktoren - koronare Herzkrankheit - Diabetes mellitus - Osteoporose

Keywords

ccronic obstructive pulmonary disease (COPD) - comorbidity - risk factor - coronary heart disease - diabetes mellitus - osteoporosis

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