Die chronisch obstruktive Lungenerkrankung (COPD) – Rationale Diagnostik und Therapie

Zusammenfassung

Die chronisch obstruktive Lungenerkrankung (COPD) kann im Allgemeinen mittels Anamnese und Spirometrie in der hausärztlichen Versorgung diagnostiziert werden. Unklare Lungenfunktionsbefunde erfordern zusätzliche Untersuchungen beim Pneumologen. Ergänzende Untersuchungen werden aus differenzialdiagnostischen Erwägungen und zur prognostischen Einschätzung durchgeführt. Eine wesentliche Beeinflussung des Verlaufs und der Prognose ist nur durch den Rauchstopp zu erzielen. Patientenschulungen und rehabilitative Maßnahmen wie der Lungensport verbessern die Lebensqualität. Die medikamentöse Therapie mit inhalativen Bronchospasmolytika als Monotherapie sowie in freien und fixen Kombinationen ist symptomatisch wirksam. Der Einsatz inhalativer Kortikosteroide (ICS) sollte angesichts des erhöhten Pneumonierisikos auf klare Indikationen, zum Beispiel COPD-Patienten mit gleichzeitigem Asthma, beschränkt werden.

Abstract

In general chronic obstructive pulmonary disease (COPD) can be diagnosed in family practice from history and spirometry. Inconclusive spirometry findings have to be assessed further by techniques available in a pulmonologist’s office. Further testing is done for differential diagnostic reasons and for prognostic appraisal. Successful smoking cessation importantly alters the natural downhill course of the disease. Patient education and rehabilitative interventions (e. g. participation in lung sport groups) help to improve life quality. Medical therapies with bronchospasmolytics applied by inhalation as monotherapies, free and fixed combinations have symptomatic benefit. Considering the increase of pneumonia risk from inhaled corticosteroids their use should be restricted to patients with a straightforward indication, e. g. coexisting asthma.

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