Smoker's Cough - Causes and Therapy

Smoker's cough is generally understood to mean chronic respiratory disease caused by tobacco consumption. Both chronic bronchitis and possible pulmonary emphysema (irreversible damage to the alveoli) are a relatively common consequence of many years of tobacco consumption. The symptoms and sequelae of the smoker's cough are also described in the medical literature under the collective designation COPD (chronic obstructive pulmonary disease).

contents

Smoking causes chronic obstructive lung disease
root cause
Transition from smoking cough to chronic lung disease
Diagnosis of chronic obstructive pulmonary disease
Conventional treatment
Severities of chronic obstructive pulmonary disease
Treatment methods for chronic obstructive pulmonary diseases
Pharmacological treatment
Non-drug therapy approaches
Physical training relieves the symptoms of COPD
Nutritional therapy as part of the COPD treatment
Oxygen long-term therapy in severe smoker's cough
Operations to restore lung function
Treatment of smoker's cough in natural medicine

Smoking causes obstructive pulmonary disease

Smoker's cough is generally characterized by increased secretion of the respiratory tract, as well as a corresponding cough with sputum and mild respiratory distress. Even the regular coughing up in the morning after getting up, according to the experts can already be interpreted as an indication of a developing "smoker's cough". In the worst case, severe chronic respiratory diseases that cause irreversible damage to the lungs are in danger.

The typical cough is also often used as a colloquial term for the symptoms of chronic obstructive pulmonary disease, although not all COPD diseases are due to tobacco use. In a few exceptional cases, non-smokers also suffer from a corresponding chronic respiratory disease. However, according to experts from the Department of Pulmonology at the Hannover Medical School (MHH), nine out of ten COPD patients are smokers. In addition, there are the illnesses of persons who are regularly exposed to cigarette smoke as passive smokers. According to the health authorities, tobacco consumption is the main cause of the currently three to five million chronic obstructive pulmonary diseases in Germany. COPD are mainly characterized by the interaction of three different respiratory diseases: chronic bronchitis, chronic bronchiolitis and pulmonary emphysema. At the latest when the smoker's cough reaches the stage of COPD, the affected persons face considerable health consequences and medical treatment should be initiated immediately. Although the damage to the lungs is often irreversible, various therapeutic measures can at least partially improve lung function.

Cause of smoker's cough

In the initial stage, smoking cough is characterized primarily by increased coughing on physical exercise and in the morning after getting up. To protect against the smoke secretions in the airways is increasingly formed that must be transported together with the deposits of tobacco smoke by the so-called cilia in the direction of the pharynx. This self-cleaning process of the bronchial tubes causes an increased Hustreiz with regular tobacco consumption. The respiratory tract should be freed from the toxins and pollutants of the tobacco smoke. However, in the event of persistent smoke, this self-cleaning process becomes overtaxed over time and a chronic cough develops in which the affected person usually coughs up a brownish secretion. Since the self-cleaning process can not eliminate all of the up to 12,000 noxious and toxic substances contained in tobacco smoke, further damage to the bronchi, wherein, for example, the carbonyl compounds, the phenolic and the acid components bronchitis promoting effect is attributed. In addition, the pollutants in tobacco smoke impair the regeneration and self-cleaning of the cilia, so that the smoker's cough continues to increase. Noises during exhalation and general shortness of breath are besides the coughing up of the secretion further signs of smoker's coughing.

Smoking is the leading cause of COPD. (Image: Bernd Kasper / pixelio.de)

Transition from smoker's cough to lung disease

If, despite the first signs of a developing smoker's cough, tobacco consumption is not avoided, the symptoms threaten to shift to the stage of chronic obstructive pulmonary disease, in which patients suffer from pulmonary emphysema (hyperinflation of the alveoli) rather frequently than chronic bronchitis. Inflammation of the respiratory tract in connection with the damage of the alveoli and the increased formation of secretions increasingly cause respiratory distress among those concerned, which initially occurs only during physical exertion, later in everyday situations such as climbing stairs. The lung tissue is increasingly damaged and the complaints of those affected increase. In the further course of the disease, the entire organism can be affected and threatened serious health consequences to impairments of the cardiovascular system, the muscles and bone structure. The first signs of chronic obstructive pulmonary disease include increased sweating while sleeping, fever, increased levels of inflammation in the blood, and the already mentioned sounds of exhalation and shortness of breath during physical exertion. In addition, there is an increased susceptibility to bacterial infections.

How smoking damages the lungs. This creates the so-called smoker's cough. (Image: bilderzwerg / fotolia.com)

Diagnosing chronic obstructive pulmonary disease

The smoker's cough should therefore not be understood as a "normal" side effect of tobacco consumption, but - due to the imminent health consequences - as an occasion to quit smoking and start in case of doubt with the initiation of appropriate medical treatment. The aim of the therapeutic measures should be primarily aimed at reducing or stopping the progression of the disease in terms of the quality of life of the patients. As a basic requirement for a promising treatment, the causative causes of smoking cough must be eliminated for the time being, ie smoking is strictly prohibited and passive smoking should also be avoided as far as possible. In case of doubt, appropriate weaning therapies are required. Before the actual treatment of COPD begins, a comprehensive history of the exact diagnosis of lung disease is also required. By listening to the lungs with the stethoscope and a pulmonary function test, the already existing damage to the lung can be determined in order subsequently to derive suitable therapeutic measures. The preliminary investigations also serve to rule out possible other causes of chronic cough such as bronchial asthma, pulmonary fibrosis or exogenous allergic alveolitis. According to information from the German respiratory league, physical signs that point to COPD can also be the respiratory sounds mentioned above, impaired concentration, weight loss and peripheral edema (swelling in the tissue). X-rays and computed tomography may also be helpful in detecting pulmonary emphysema of COPD.

Conventional treatment of COPD

Once the diagnosis of COPD has been established, various therapeutic measures can be taken to improve the function of the lungs. Thus, in conventional medicine, a drug treatment with inhalable drugs often takes place. These are usually administered as metered dose inhalers or with the help of powder inhalers. Occasionally, inhalation solutions to be taken by means of electrically operated inhalers are also used. In addition, the inhalation with sea salt or herbal infusions such as camomile oil is attributed to a soothing effect in COPD. The "Guidelines of the German respiratory league and the German Society of Pneumology and Respiratory Medicine for the diagnosis and treatment of patients with chronic obstructive pulmonary emphysema (COPD)" recommend a very concrete catalog of measures, which provides for different therapeutic approaches depending on the severity of the disease. There are four different degrees of lung disease.

Severity of the disease

A distinction is made between mild COPD (severity grade I) with chronic cough and sputum, in which the impairment of lung function is so low that patients often do not notice it. Moderate COPD (grade II), in which patients experience shortness of breath in addition to chronic coughing and increased secretion, especially under physical stress. The severe COPD (severity level III) in which the patients have to struggle with the previous symptoms - albeit to a greater extent. And the very severe COPD (severity grade IV) in addition to the symptoms already mentioned a chronic respiratory failure is observed, which reduces the so-called one-second exhalation capacity by more than 50 percent compared to the normal state. Patients with very severe COPD are also relatively often struggling with sudden exacerbations (worsening of the disease process) that can potentially be life-threatening. A typical symptom of the late stage of COPD is arterial hypoxemia (reduced oxygen content in the arterial blood), often accompanied by hypercapnia (increased levels of carbon dioxide in the blood). As a long-term therapy of stable COPD, the German Respiratory League recommends a "gradual increase in therapeutic measures depending on the severity of the disease". Both drug and non-drug therapies are planned to treat COPD.

Treatment of chronic obstructive pulmonary disease

According to the German respiratory league, patient training in COPD treatment is generally an important element of therapy that "substantially contributes to increasing the efficiency of management". In addition, depending on the severity of the disease various therapeutic measures are provided. For patients with mild COPD, experts recommend inhalation of bronchodilators (bronchodilators), such as anticholinergics, beta-2-sympathomimetics, and theophylline as needed, with a choice of anticholinergics and beta-2-sympathomimetics adverse effects ". With the help of the "pharmacotherapy" "a relief of the symptoms, an improvement of physical performance and quality of life and / or a reduction of the exacerbation frequency" is possible, so the guidelines of the German respiratory league. In addition to COPD grade 1 patients, one or more long-acting bronchodilator agents are recommended for long-term disease (severity II) as long-term therapy. For patients with grade III COPD, the experts also recommend "prolonged treatment with inhaled glucocorticoids", but "prolonged treatment with systemic glucocorticoids due to the frequent adverse effects should be avoided". For the patients in the final stage of the disease (severity grade IV), in addition to the therapeutic measures already mentioned, "long-term oxygen therapy for 16 to 24 hours a day can improve the prognosis," according to the German Airways League. In their guidelines, the experts also point out that "patients with COPD benefit from physical training in terms of exercise capacity and relief of dyspnea and fatigue".

Pharmacological treatment of COPD

Among the various medications recommended for the treatment of COPD, it should be mentioned that the so-called "beta-2 sympathomimetics" are said to have a relaxing effect on the muscles of the respiratory tract and bronchial tubes, thus alleviating the typical symptoms of COPD Shortness of breath, coughing and expectoration may contribute. To distinguish between the short-acting beta-2-sympathomimetics, which act almost immediately and the long-acting beta-2-sympathomimetics, which are used for long-term therapy. The "anticholinergics", which are also mentioned in the guidelines of the German respiratory tract leaflet, should also contribute to the muscle relaxation of the bronchi and, like the beta-2-sympathomimetics, bring about a relief of COPD symptoms. However, their impact is weaker and more long-term. The glucocorticoids (also glucocorticoids) should develop an anti-inflammatory effect in the respiratory tract and thus prevent acute worsening of the course of the disease (exacerbations). The also recommended for the treatment of COPD theophylline has a long-term bronchodilator effect and should be used according to the experts only if the current combination therapy with anticholinergics and beta-2-sympathomimetics is insufficient. Because it threatens significant side effects, since the drug level can be subject to strong fluctuations. The treating physicians must therefore regularly check the amount of active ingredient in the blood.

Non-drug therapies for COPD

In addition to the pharmacological therapy approaches, various non-pharmacological measures are available for the treatment of COPD. The so-called "physical measures" are usually used to support the drug treatment. The spectrum ranges from tapping massages to facilitate the Abhustens over breathing gymnastics to increase the lung performance up to postural exercises and physical training. As part of respiratory physiotherapy, patients learn various breathing techniques that can improve ventilation in the lungs, increase oxygenation and increase secretion elimination. Through the learned "Relaxation and breathing techniques, the dyspnea can be alleviated" with "breath-relieving body positions" such as the "coach seat" additionally reduce the increased airway resistance, so the statement in the "Guidelines of the German respiratory league and the German Society of Pneumology and respiratory medicine for the diagnosis and treatment of patients with chronic obstructive pulmonary disease and pulmonary emphysema (COPD) ". Thus, breathing techniques of "expiratory effective stenoses," such as the metered lip brake or breathing through a straw piece, can significantly reduce the risk of "expiratory collapse (...) due to intrabronchial pressure increase." The breathing techniques, according to the experts for the COPD patients a good option to independently relieve the symptoms of the disease.

Physical training relieves the symptoms

A key role in the long-term treatment of COPD is attributed to physical training in the guidelines of the German respiratory league. Positive effects of the training effects are, according to the German respiratory league "for COPD patients of all severity levels by randomized and controlled studies". Today, exercise exercises are an integral part of COPD treatment. Because "with increasing severity of COPD, exercise dyspnea with further decreasing exercise capacity due to physical and cardiovascular decimation results in a decrease in quality of life with the consequences of increasing social isolation and frequent onset of depression that exacerbates stress dyspnoea", explain the German Respiratory League and the German Society for Pulmonology and Respiratory Medicine in the guidelines for COPD treatment. Physical training could counteract these health problems "in COPD patients grade II and higher" and contribute to increasing the quality of life and resilience and to reduce the rate of exacerbation. For example, the experts recommend that physical training should be part of long-term therapy in COPD patients, as they benefit from increased exercise capacity and relief from dyspnea and fatigue. According to the COPD guidelines, the positive effects are achieved "especially in training programs with a duration of 4 to 10 weeks, 3 to 5 exercises per week under supervision and high training intensity near the anaerobic threshold." Exercises also "after completion of intensive inpatient rehabilitation programs in the outpatient area, for example by home training (climbing stairs, walking training) in conjunction with participation in ambulatory lung sports groups" continued. According to the German respiratory league, however, this requires an outpatient rehabilitation offer close to the home, combined with home training, for example within the framework of "ambulatory lung sports groups"..

Nutritional therapy as part of the COPD treatment

Significant weight loss in patients with chronic obstructive pulmonary disease, commonly referred to as smoker's cough, has also been observed, with COPD guidelines suggesting a decrease in body weight of more than 10 percent in the last six months or more than five percent in the last month due to illness. Here a nutritional therapy and regular weight control is required. For "underweight correlates with COPD patients with muscle weakness, limited resilience and reduced quality of life," report the experts of the German respiratory league in the COPD guidelines. The "possible weight correction of underweight patients by means of cost composition" can therefore lead to a significant improvement in symptoms. According to the German Respiratory League, corresponding nutritional therapies offer an easy-to-practice and quite promising supplement to COPD treatment. It is also important that the affected pay attention to the fluid intake and drink enough during the day, as according to the experts in dehydrated patients expectoration (coughing) is impaired. However, the German respiratory league does not see a generally beneficial effect of increased fluid intake in COPD: "The recommendation of large amounts of drink is not justified" and could even be counterproductive, according to the guidelines in the guidelines for the diagnosis and treatment of patients with chronic obstructive bronchitis and pulmonary emphysema.

Oxygen long-term therapy for smoker's cough

In addition to the treatment options for chronic obstructive pulmonary diseases already described, according to the German respiratory league a "long-term oxygen therapy", especially in patients with severity grade IV, can certainly achieve a positive effect. This applies in particular, if in the advanced stage of the disease COPD, already a weakness of the right heart (right heart failure) is present, the experts report. Respondents use a nasogastric tube to inhale oxygen from an oxygen cylinder for 16 to 24 hours per day to stabilize blood oxygen levels and reduce respiratory distress. Therapy increases resilience, respiratory mechanics are improved, and there are positive effects on the hematocrit value (proportion of cellular constituents in the blood), explain the experts of the German respiratory league and the German Society of Pneumology and Respiratory Medicine in the COPD guidelines.

Restore lung function

The last option in the treatment of chronic obstructive pulmonary diseases, according to the German Respiratory League, remains surgery, whereby a distinction must be made between surgical interventions to maintain or restore lung function and lung transplantation, ie the replacement of the damaged organ. During surgery, for example, the balloon-like enlargements of the bronchi caused by pulmonary emphysema (hyperinflation of the lungs) may be removed. Lung tissue that is no longer involved in gas exchange is excised to improve lung function and reduce dyspnea. However, according to the experts, the procedure known as lung volume reduction surgery is only promising in certain forms of pulmonary emphysema. Also, lung transplantation is a much more commonly used procedure in COPD patients as a last resort. According to the German Respiratory League, COPD is the most common indication for lung transplantation worldwide. In Germany, approximately 60 COPD patients receive a new lung each year, although certain requirements for being on the waiting list must be fulfilled. Thus, a documented at least six months abstinence from tobacco smoking, a prerequisite for registration on the waiting list. In addition, there is usually an age limit of 60 years and sufferers have to wait an average of two years before the availability of a donor organ.

Treatment of smoker's cough in natural medicine

Also in natural medicine different treatment options of the smoker's cough are shown, the measures unfold their effect, especially in the early stages of the disease. Thus, there are numerous homeopathic remedies that alleviate the coughing and reduce the risk of damage to the lung tissue. Among others, the active ingredients Acidum formicicum, Acidum hydrocyanicum, Ammi visnaga, Antimonium arsenicosum, Antimony sulfuratum aurantiacum, Antimonium tartaricum, Coccus cacti, Hamamelis virginica, Natrum sulfuricum, Phosphorus used for the treatment of COPD. In addition, there is often a physiotherapeutic treatment with so-called oscillating PEP systems in which the breathing resistance is increased and thus a positive expiratory pressure is generated. Exterminating in specialized equipment will cause physical vibration and pressure fluctuations that will dilate the bronchi, loosen and liquefy the secretions, strengthen the exhalation muscles and facilitate subsequent coughing. Despite the numerous treatment options, however, exacerbation, ie worsening of the course of the disease, can often not be avoided. Infected or cold weather, the symptoms of COPD may suddenly increase. In the event of such acute deterioration, the therapeutic measures must be promptly adjusted and, at worst, hospitalization of the patients is required. Basically, in the exacerbations of COPD three degrees of severity (mild, moderate, severe) are distinguished, with the therapy depending on the severity of the exacerbation can be done outpatient or inpatient. As soon as there is a noticeable worsening of the symptoms of the disease, they should urgently see a doctor, as the severe exacerbation can be potentially fatal and often requires hospitalization of the patient. (Fp)

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