What exactly is COPD?

COPD stands for “Chronic Obstructive Lung Disease” and is a chronic obstructive pulmonary disease, which currently affects approximately 384 million people worldwide and approximately 10.6 million people in Germany.

It is a chronic lung disease that develops slowly and is accompanied by persistent coughing, mucus, sputum, shortness of breath (especially during exertion) and a feeling of tightness in the chest. The airways are permanently narrow and inflamed.

The starting point is usually chronic obstructive bronchitis.

As a result of COPD, infections and the development of pulmonary emphysema (“bloated lung”) with overinflation and destruction of the lung tissue, especially the alveoli, and possibly also cor pulmonale (right heart failure) occur more frequently.

In COPD, inflammation, oxidative stress and mucus hypersecretion cause the symptoms.

What are the possible causes of COPD?

• Mainly pollutant particles (e.g. from smoking, fine dust) or gases
• Genetically caused alpha-1-antitrypsin deficiency (AAT breaks down tissue destroyed during inflammation)

What is the classic treatment for COPD?

Classical therapy mainly includes the following measures:

• lifestyle change and smoking cessation
• breathing training and physiotherapy
• Bronchodilators, corticoids, mucolytics, oxygen
• Surgery (e.g. removal of destroyed alveoli, lung transplantation)

What can micronutrients do for COPD?

One fifth of patients with chronic obstructive pulmonary disease are malnourishedIn severe COPD, the figure is almost half. Causes include increased energy consumption due to the disease (more energy is needed for breathing due to the narrowing of the airways), insufficient food intake due to a lack of appetite, and lower energy production in the mitochondria, as less oxygen is available for "burning" than in healthy people.

It has also been shown (see ESPEN 2006) that in COPD patients, even in the early stages, muscle loss This can be due to lack of exercise due to respiratory problems, nutritional deficiencies (see above) and/or chronic inflammatory processes caused by COPD. Therefore, magnesium, which is directly involved in the function of the muscles, is a standard component in the context of micronutrient therapy in COPD. In addition, the Protein intake slightly increased be: for muscle building 2.5 g protein per kilogram of body weight, for maintenance 1.9 g/kg (cf. Bargon J, Müller U; Nutrition for COPD;  Nutritional Review 2012; 2: 96).

Finally, about 1/3 of all COPD patients have osteoporosis (see copd-deutschland.de).The cause has not yet been conclusively clarified, but a connection with the treatment of inhaled cortisone (ICS) is suspected (see COPD guideline 2018). A sensible supplementation in the case of accompanying osteoporosis is therefore calcium and Vitamin D3 & K2, which is central to the regulation of calcium balance.

Since COPD causes chronic inflammation in the airways and lung tissue, two components play a central role in micronutrient therapy:

• Omega 3 fatty acids with high EPA content (therefore, algae oil should not be used, as this usually only contains a relevant DHA, but not EPA) (cf. Wey S; Orthomolecular therapy for obstructive airway diseases; EHK 2018; 67(05): 291-300)
• Antioxidants (e.g. an antioxidant complex such as ANTI-OX) as radical scavengers, because chronic inflammation leads to free radicals and these in turn lead to chain reactions and tissue damage

In addition to the information provided in the Academy article on chronic inflammation (https://qidosha.com/blogs/qidosha-academy/chronische-entzundungen) already cited studies on Omega 3 and antioxidants, there are also studies that have a clear focus on respiratory diseases, such as:

• “Omega 3 fatty acids increase pneumonia resistance (caused by Klebsiella) in mice through anti-inflammatory effects and upregulation of the nonspecific and specific immune system” (cf. Sharma S et l.; Dietary Supplementation With omega-3 Polyunsaturated Fatty Acids Ameliorates Acute Pneumonia Induced by Klebsiella Pneumoniae in BALB/c Mice. Can J Microbiol 2013, 59 (7), 503-10)
• "Omega-3 fatty acids improve survival, bacterial invasion and inflammation in the lungs in mice. The data can be transferred to humans and improve patient outcomes and pneumonia risk" (see Hinojosa CA et al.; Omega-3 Fatty Acids in Contrast to omega-6 Protect Against Pneumococcal Pneumonia. Microb Pathog 2020, 141, 103979)

Another important role in the micronutrient supply in COPD is played by amino acid L-cysteine, which, for example, in the new edition of CLEAN will be included as a central component. Here too, there is a good body of research, such as:

• “Cysteine ​​1500 mg significantly reduces the exacerbation rate in COPD by 25% compared to placebo, but only after at least 3 months of therapy. In addition, quality of life and activity improved significantly” (cf. Zheng JP et al.; Effect of carbocisteine ​​on acute exacerbation of chronic obstructive pulmonary disease (PEACE Study): a randomised placebo-controlled study; Lancet 2008; 371, 2013-2018)

Flavonoids such as e.g. quercetin are known to have an immunomodulatory effect. And there are already meaningful studies on respiratory diseases, such as: Flavonoids (0.2-1.2 g/day) reduce the incidence of upper respiratory tract infections by 33%. The number of sick days decreased by 40% (cf. Sommerville VS et al.; Effect of flavonoids on upper respiratory tract infections and immune function;Adv Nutr 2016).

The two medicinal mushrooms also represent an exciting combination Hericium & Reishi We have written a separate Academy article on their importance for the intestinal microbiome: https://qidosha.com/blogs/qidosha-academy/vitalpilze .And like the lungs, the intestine also has a barrier function and microbiota, although less than the intestine:

The more than 100 known microbiota species (bacteria, viruses, bacteriophages, fungi) "sit" on the epithelium of the lungs. They come mainly from the throat (the main germs there are Neisseria, Prevotella and Veillonella) and less frequently from the nose or intestines (e.g. through microaspiration).

The composition differs from the microbiota in the throat/nose and intestines (e.g. there are no digestive bacteria, but germs from the upper respiratory tract). But as in the intestines, the same applies to the lungs: The higher the germ diversity and the better the balance of germs, the better the protection and lung function.

Dysbiosis can occur with a decrease in the diversity of germs (eg in COPD only 28% of a healthy person!) and an increase in potentially pathogenic germs (eg Pseudomonas), eg as a result of

• cystic fibrosis, COPD, asthma, allergies, infections
• Use of medications (e.g. antibiotics, corticoids)
• Exposure to pollutants (e.g. smoking, fine dust)

Dysbiosis affects barrier function and immunity. It triggers inflammation, increases the risk of disease, worsens the stage of the disease and lung function. See also Engel M et al.; Influence of lung CT changes in chronic obstructive pulmonary disease (COPD) on the human lung microbiome; Plos One 2017; doi: 10.1371/journal.pone.0180859): Chronic obstructive pulmonary disease (COPD) can lead to structural changes in the lungs over time and to dysbiosis, which promotes the colonization of potentially pathogenic bacteria.

And a healthy microbiome in the intestine is also of great importance for the microbiome in the lungs, because the lungs and intestines are connected via the so-called "gut-lung axis" The lungs develop in the 4th week of embryonic development as a folding of the foregut and, as with the gut microbiome, the development of the lung microbiome also takes place in early life (“neonatal window of opportunity”). Similar measures as with the gut microbiome are effective here, e.g. breastfeeding and a healthy diet.

The intestinal flora and oral probiotics influence the microbiota of the lungs, e.g. via “cross talk” (exchange of information) and protect against allergies, for example:

• Direct effects e.g. through microaspiration in the lungs
• Indirect effects, including via short-chain fatty acids (SCFA), which improve the reactivity of the lung immune system

Therefore, measures in the intestine (such as medicinal mushrooms) are also relevant for the lungs.