Treatment of severe COPD: physiology of lung volume reduction treatment and opioids for refractory dyspnea

Chronic obstructive pulmonary disease (COPD) is a common disease. In the Netherlands, there are 600.000 patients with COPD. Furthermore, it is the third leading cause of death worldwide. The most common symptoms of COPD are dyspnea and coughing. Patients with severe COPD suffer from dyspnea despite their treatment. This often leads to a poor quality of life. An important cause for dyspnea in severe COPD is hyperinflation. In hyperinflation, air is retained in the lungs, which leaves less room for breathing. For a selection of patients with COPD and hyperinflation, lung volume reduction treatments are available. These treatments can be performed via surgery or bronchoscopy. Research has demonstrated that lung volume reduction treatments lead to improved dyspnea, exercise tolerance, and quality of life. This thesis describes research on the working mechanism of lung volume reduction treatments, specifically the effects on gas exchange of oxygen and carbon dioxide, and hyperinflation during exercise. Furthermore, other treatment options for severe COPD are described. Additionally, the clinical trial ‘MoreFoRCOPD’ is described in this thesis. This trial investigates the effect of opioid-like medication on dyspnea in severe COPD. Since this study has not yet been completed, the results will be published later on.