Photographer:Fotograaf: Joey Roberts/ Simone Golob
“An incurable disease? We are inclined to think that it leads to death.” Nothing could be farther from the truth in the case of the lung disease COPD (Chronic Obstructive Pulmonary Disease), says Annemie Schols, professor of Nutrition and Metabolism in Chronic Diseases and director of research school Nutrim. Many COPD patients - whose lungs are damaged because of lung infections or loss of alveoli and who suffer from tightness of the chest and coughing - eventually die from something else.
“It is true that we don't have a cure for those damaged alveoli,” says Schols, but to subsequently use the term ‘incurable’ for COPD, is taking things too far. “Much too fatalistic, but also a one-sided approach. We have to be holistic in our thinking, because looking at health from a broader perspective, COPD is a complex chronic disease. There are of course very serious cases, people who have to go through life tied to an oxygen cylinder, which is really terrible, but they are a small minority. The rest, in a manner of speaking, can live to become eighty, with a good quality of life.”
How is that possible? Not by dealing with the lungs themselves, but with the effects that the disease has on the body: “Poor condition or losing weight without wanting to. In the first textbook on lung disease from 1898, it says that patients suffering from pulmonary emphysema - a particular type of COPD - tend to lose weight. It was approached in a fatalistic way at the time: accept it, was the advice given, nothing could be done about it.” Nor did the nineteenth-century doctors fail to notice typical complaints such as tiredness and shortness of breath. Their ‘solution’: take it easy, no exertion. Meanwhile, in the Netherlands (“we are leaders, Maastricht is even considered internationally to be a pioneer”), there is a completely different view on the treatment: exercising is deemed extremely important and is stimulated. “Again, it doesn't cure the alveoli, but it increases physical fitness, the quality of life and the chances of survival.”
There is also interest in nutrition, but there could be much more, Schols concludes, because there is a lot to be gained in that area. “Emphysema patients often keep air in their lungs, which increases shortness of breath. As a result, everything costs a lot of energy, even eating. You see these people losing weigh unwillingly. They don't just lose fat, but also muscle tissue. It is an early sign of a serious disorder in the body. In some people, a reduction of their lung capacity through an operation or an endoscopic intervention may provide relief. We see that these people spontaneously start gaining weight again. Others benefit from our nutritional advice and treatment in order to gain weight.”
Why does this not happen often enough? “Our whole society is focussed on losing weight. In people's minds, losing weight is healthy. But being fat or thin is not the whole picture. With a BMI above 25, you are not necessarily overweight and with a BMI between 20 and 25 you are not always healthy. Certainly in the case of the chronically ill and in older people, we must look at the composition of that weight: how much fat and how much muscle tissue they have.”
Schols feels that better communication about COPD and the treatment options is of great importance. Not in the last place because a million people in the Netherlands suffer from chronic lung diseases such as asthma, lung cancer, or COPD. “Diabetes, rheumatism, cardiovascular diseases, they are all well known. COPD is relatively unknown. The English name doesn't help.”
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