Emphysema: Treatment Options

by Food and Drug Administration (FDA)

(Page 2 of 2)

There are a number of treatments that can help patients with emphysema, but the most important step is to stop smoking. Stopping smoking when the airflow obstruction is mild or moderate slows the development of disabling shortness of breath. However, "stopping smoking at any point in the disease process," Saia insists, "provides some benefit. " People with emphysema should also try to avoid exposure to other airborne irritants.

Treatments include:

Bronchodilator medicines: This class of medication works by relaxing the muscles around the airways. They are typically indicated for the relief of bronchospasm in patients with reversible obstructive airways disease. More commonly used to treat asthma, they may be prescribed for emphysema patients if there is a tendency toward airway constriction or tightening. Some of the more common bronchodilator medicines include: albuterol, terbutaline, ipratropium bromide, and theophylline. Inhaled medicines, which go directly into the lungs and have less exposure to other parts of the body, are often tried first because they usually begin working in less than five minutes with a lower incidence of side effects.

"Valuable additions to bronchodilator therapy are blood tests used to monitor pharmacological agents such as theophylline," adds Steven Gutman, M.D., director of the division of clinical laboratory devices in the Food and Drug Administration's Center for Devices and Radiological Health. "Although tests for measuring theophylline have been available for decades," he says, "there continue to be refinements in this testing which make them more accurate and accessible. "

Anti-inflammatories (corticosteroids): Since emphysema may be associated with inflammation, doctors may prescribe a corticosteroid to soothe and ultimately heal the delicate lining layer of the air passageways, making them more resistant to obstruction. Inhaled steroids do not carry an FDA-approved indication for COPD but are used off-label by many clinicians. The type of steroid contained in these preparations is not the type that builds muscles. Long-term use of oral corticosteroids is commonly associated with a variety of dose-dependent side effects, such as osteoporosis (in both men and women), weight gain and fat redistribution, hypertension, loss of lean body mass, and high blood sugar. Commonly used corticosteroids include the oral preparation prednisone and several inhaled corticosteroids.

Oxygen therapy: Supplemental oxygen can benefit the patient whose lung function is severely impaired and cannot absorb enough oxygen from the air. Long-term oxygen therapy prolongs life in patients like Gooden, who have low blood oxygen levels (hypoxemia). This therapy reduces the excess red blood cells, which helps improve mental functioning and heart failure. It may also improve shortness of breath during exercise.

Lung reduction surgery: Emphysema sufferers may find relief from their symptoms with this surgical procedure. It often eliminates the need for oxygen and significantly enhances breathing function. This technique, which is a minimally invasive procedure, requires two or three small incisions made in the chest and a tiny camera inserted through one of the incisions to view the lung. Through another incision, a special stapling device is inserted to cut portions of the lung so that the healthy lung tissue has more room to expand. Prospective patients need to undergo careful testing prior to consideration of this surgery.

Transplant surgery: A lung transplant is a highly invasive, complex procedure that carries substantial risk. Because of known complications of any organ transplant surgery, this option is only viable in a very small, select group of patients.

Exercise programs can be carried out to improve a person's independence and quality of life, and decrease the frequency and length of hospital stays, even though lung function doesn't improve. Gains in conditioning, though, Saia cautions, are quickly lost if a person stops exercising.

The Future

The key to managing emphysema, Saia insists, is to identify the disease as early as possible. Methods continue to be developed to help physicians find the earliest signs so that preventive and therapeutic measures can be instituted.

But with current treatments, even those who are severely afflicted with emphysema and are homebound, like Gooden, can be made more comfortable and can experience a higher quality of life

Inherited Emphysema

There is a rare inherited form of the disease called alpha 1-antitrypsin deficiency (A1AD) related emphysema. People with A1AD lack a protective protein called alpha 1-antitrypsin (AAT), or alpha 1-proteinase inhibitor. Without AAT, a natural enzyme called neutrophil elastase that initially fights bacteria and cleans up dead lung tissue can run rampant and eventually damage lung tissue.

For people with A1AD, the missing or defective protein, alpha 1, can be replaced or augmented. In December 1987, FDA approved the first specific treatment for A1AD-related emphysema, called Prolastin, which raises the level of AAT in the blood and may protect the lung tissue from the destructive enzyme. The replacement therapy is derived from human plasma that has been screened and tested for viruses, and it is usually taken in weekly intravenous infusions.

About the Author

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