Emphysema

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Treatment

Emphysema is an irreversible condition and the goals of treatment are to reduce symptoms and to slow progression of the disease. The most important step is to quit smoking. Smoking cessation can slow the decline of lung function considerably.

For information about quitting, please see Ways to Quit Smoking.

Patients who have emphysema may be encouraged to practice pursed-lip breathing to help improve air flow in the lungs. Breathing slowly through puckered ("pursed") lips may allow patients to exhale more effectively. Patients who are healthy enough often are encouraged to exercise regularly. It is important to consult a physician before beginning an exercise program.

Treatment for emphysema may include the following:

• Medications
• Oxygen therapy
• Respiratory therapy
• Surgery

Medications
Patients who have emphysema should be sure to take all medicines as directed by a qualified health care provider. There are a number of different types of medications that can be used to treat emphysema. Some types are inhaled (e.g., through an inhaler or a nebulizer), and others are taken orally (e.g., in pill form).

Inhalers and nebulizers deliver medication directly into the lungs, which can result in fewer side effects; however, if these devices are used incorrectly, the medication may be ineffective. A spacer device is a tube that can be used with an inhaler to help patients take the medication correctly.

Bronchodilators (e.g., anticholinergics, beta agonists, theophylline) can be used to treat acute exacerbations (called short-acting medications) or to prevent symptoms from worsening (called long-acting medications). Antibiotics (e.g., penicillin) often are used to treat infections that cause acute exacerbations and anti-inflammatory drugs (e.g., steroids [prednisone]) can be used to reduce lung inflammation.

Short-acting bronchodilators include albuterol (Ventolin®, Proventil®), pirbuterol (Maxair®), terbutaline (Brethine®), and metaproterenol (Alupent®). Long-acting medicines include sustained-release albuterol, salmeterol (Serevent®), ipratropium bromide (Combivent®), and theophylline (Bronkodyl®, Theolair®). Long-acting medications should not be used to treat acute symptoms because they take longer to work and symptoms may continue to worsen in the meantime.

Side effects of these drugs include the following:

• Heart palpitations
• Increased blood pressure
• Nausea
• Nervousness
• Thrush (infection of the mouth or throat)
• Tremor

Patients who have familial emphysema (alpha-1 antitrypsin deficiency emphysema) may be treated with an alpha-1 protease inhibitor (e.g., Aralast®, Prolastin®), which usually is administered intravenously (i.e., through a vein). Prior to infusion, patients may be given other medications to reduce the risk for an allergic reaction. Signs of an allergic reaction include difficulty breathing, hives, itching, and low blood pressure. Other side effects include dizziness, headache, and pain or redness at the injection site.

Oxygen Therapy
Oxygen therapy often is necessary to treat advanced cases of emphysema. Prior to treatment, physicians measure blood oxygen levels (e.g., using oximetry or performing an arterial blood gas [ABG]) to help determine if the patient may benefit from oxygen therapy. Studies have shown that oxygen therapy prolongs life in patients with emphysema who have low levels of blood oxygen.

In most cases, oxygen (O2) is delivered through a small tube (called a nasal cannula) from an oxygen tank to the patient's nose. Some patients require extra oxygen while walking, exercising, or sleeping, and others require it continuously. Portable oxygen units also are available. It is important to follow instructions carefully when using supplemental oxygen.

Respiratory Therapy
This treatment, which is performed by respiratory therapists, involves monitoring the condition of patients who have emphysema and regulating the medical equipment used in treatment. Respiratory therapists make sure medical equipment is functioning properly, adjust settings as instructed by a physician, and instruct patients in the correct use of the equipment. They also perform physical therapy to help preserve or improve lung function.

Surgery
Surgery may be used to treat emphysema in a select group of patients. Types of surgery include lung reduction surgery (involves removing damaged areas of lung tissue to allow healthy tissue to function more effectively) and lung transplant surgery (only considered in select patients with end-stage disease). Patients who have advanced disease are at increased risk for surgical complications, including death.

Prognosis

The prognosis (expected outcome) for patients who have emphysema varies, depending on the severity of the condition and whether or not the patient continues to smoke. Although the disease is progressive and irreversible, patients who stop smoking and receive oxygen therapy generally have a longer life expectancy.

Prevention

The most effective way to prevent emphysema is to avoid smoking cigarettes. This is especially important for people who have AAT deficiency.

Maintaining a healthy lifestyle (e.g., exercising regularly, eating properly), avoiding exposure to air pollution and second-hand smoke, and receiving prompt medical treatment for respiratory infections also can help prevent emphysema.

Anyone who experiences symptoms of emphysema (e.g., shortness of breath, cough, difficulty breathing while exercising), especially with a history of cigarette smoking, should see a physician as soon as possible. Prompt medical treatment can help slow progression of the disease.

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