What exactly is COPD?

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

It is a slowly developing chronic lung disease with persistent cough, phlegm, sputum, shortness of breath (v.a. under exertion) and chest tightness. 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, particularly the alveoli, and possibly also cor pulmonale (right heart failure) occur more frequently.

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

What are the possible causes of COPD?

• Mainly pollutant particles (z.B. through smoking, particulate matter) or gases
• Genetically caused alpha-1 antitrypsin deficiency (AAT breaks down tissue destroyed during inflammation)

What is the classic treatment for COPD?

Classical therapy knows v.a. the following measures:

• Lifestyle changes and quitting smoking
• Breathing training and physiotherapy
• Bronchodilators, corticoids, mucolytics, oxygen
• Surgery (z.B. Removal of destroyed alveoli, lung transplantation)

What can micronutrients do for COPD?

One fifth of patients with chronic obstructive pulmonary disease is malnourishedIn severe COPD, the number is almost half. Causes include increased energy consumption due to the disease (breathing requires more energy due to the constriction 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 lead to lack of exercise due to respiratory problems, nutrient deficiencies (s.o.) and/or chronic inflammatory processes caused by COPD. Therefore, magnesium, which is directly involved in muscle function, is a standard component in micronutrient therapy for 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; Nutrition Review 2012; 2: 96).

Finally, about 1/3 of all COPD patients have osteoporosis (cf. copd-deutschland.deThe cause has not yet been conclusively clarified, but a connection with the treatment with inhaled cortisone (ICS) is suspected (see COPD guideline 2018).A sensible supplementation in the case of accompanying osteoporosis is 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 i.d.R. only a relevant DHA, but not EPA content is present) (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 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. These data can be extrapolated 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 good research, for example:

• "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 randomized placebo-controlled study; Lancet 2008; 371, 2013-2018)

Flavonoids such as Quercetin are known to have an immunomodulatory effect. There are also already significant studies regarding respiratory diseases, for example: 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 lung.They come mainly from the throat (main germs there are Neisseria, Prevotella and Veillonella) and less frequently from the nose or intestine (z.B. by microaspiration).

The composition differs from the microbiota in the throat/nose and intestine (z.B. are not digestive bacteria, but contain germs of the upper respiratory tract.) But as in the intestine, 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 bacterial diversity (z.B. in COPD only 28% of a healthy person!) and increase in potentially pathogenic germs (z.B. Pseudomonas), z.B. as a result of

• cystic fibrosis, COPD, asthma, allergies, infections
• Use of medication (z.B. Antibiotics, corticoids)
• Contamination with pollutants (z.B. Smoking, particulate matter)

Dysbiosis affects barrier function and immunity. It triggers inflammation, increases disease risk, and worsens disease stage 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 over time to structural changes in the lungs and dysbiosis, which favors 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 fourth week of embryonic development as a folding of the foregut, and like the gut microbiome, the development of the lung microbiome also takes place in early life (“neonatal window of opportunity”). Similar measures to those for the gut microbiome are effective here, d.h. v.a. z.B. Breastfeeding and healthy eating.

The intestinal flora and oral probiotics influence the lung microbiota z.B. via “cross talk” (information exchange) and protect z.B. from allergies:

• Direct effects z.B. through microaspiration in the lungs
• Indirect effects u.a. 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.