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Treatment of Emphysema
The most essential step in any treatment plan for smokers with emphysema is to stop smoking immediately; it's the only way to stop the damage to your lungs from becoming progressively worse over time. But quitting smoking is rarely easy, and people often need the help of a comprehensive smoking cessation plan, which may include:
- A target date to quit
- Relapse prevention
- Advice for healthy lifestyle changes
- Social support systems
- Nicotine gum, tablets or patches and sometimes use of the antidepressant bupropion hydrochloride (Zyban) to help curb the irritability, depression and sleep problems that can occur in the first few weeks after quitting smoking
- Editor's Note: Nicotine tablets (and a very strong will) helped me stop smoking many years ago after my 20-plus years of heavy smoking, so nicotine chewing gum or tablets are highly recommended from a personal vantage point.
Other emphysema treatments, which focus on relieving symptoms and preventing emphysema complications, include:
- Bronchodilators. These drugs can help relieve coughing, shortness of breath and trouble breathing by opening constricted airways, but they're not as effective in treating emphysema as they are in treating asthma.
- Inhaled steroids. Corticosteroid drugs inhaled as aerosol sprays may relieve symptoms of emphysema associated with asthma and bronchitis. Although inhaled steroids have fewer side effects than oral steroids do, prolonged use can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes.
- Supplemental oxygen. If you have severe emphysema with low blood oxygen levels, using oxygen at home may provide some relief. Various forms of oxygen are available as well as different devices to deliver them to your lungs. Talk with your doctor about which is best for you and about oxygen distributors in your area. Your dealer can set up your equipment, instruct you on care and maintenance, and provide follow-up visits.
- Protein therapy. Infusions of AAt may help slow lung damage in people with an inherited deficiency of the protein.
- Antibiotics. Respiratory infections such as acute bronchitis, pneumonia and influenza are a leading complication of emphysema, increasing the amount of sputum you produce and making breathing problems worse. Broad-spectrum antibiotics may help relieve these symptoms, but should be used with caution to avoid the serious and growing problem of antibiotic-resistant bacteria.
- Inoculations against influenza and pneumonia. If you have emphysema or other forms of COPD, experts recommend an influenza (flu) shot annually and a pneumonia shot every five to seven years.
- Surgery. In a procedure called lung volume reduction surgery (LVRS), surgeons remove small wedges of damaged lung tissue. Although it seems counter-intuitive to treat diminished lung capacity by further reducing the size of the lungs, the extra space that's created in the chest cavity appears to help the remaining lung tissue and diaphragm work more efficiently. LVRS, first tried in the 1950s, fell out of favor because of little success and a poor survival rate.
The lung surgery received renewed attention 40-yrs later when the results of a large clinical trial called the National Emphysema Treatment Trial showed that LVRS could improve the lung function of certain people with severe emphysema.
Those who benefited had emphysema in the upper lobes of their lungs and a low exercise capacity even after undergoing several weeks of pulmonary rehabilitation. People who didn't have emphysema in the upper lobes of their lungs and who had a greater exercise capacity after a program of pulmonary rehabilitation did not respond well to the surgery.
For those who were helped, improvement was greatest the first six-months after the procedure. After that, lung function gradually declined. People began having more difficulty breathing, and performance in the pulmonary function tests decreased. By the 2-year mark, the lung function in many people was about the same as it was before surgery. On the other hand, eligible people who didn't have LVRS declined continuously over the two-year period. If you have severe emphysema and think you may be a candidate for LVRS, discuss the risks and benefits of the operation with your doctor. (Emphysema website editor's note: Surgeons are performing surgery for lung cancer and exploratory surgery regarding emphysema and other lung disease in the operating room live more and more in their quest for better and more lung disease treatment options.
- Transplant. Lung transplantation is an option if you have severe emphysema and other options have failed. Usually just one lung is transplanted because the survival rate has proved to be higher for people with single-lung transplants than for people with double-lung transplants.
- Pulmonary rehabilitation program. A key part of treatment involves a pulmonary rehabilitation program, which combines education, exercise training and behavioral intervention to help restore you to the highest possible level of independent living. You'll receive help with smoking cessation and your nutritional needs, and you may learn special breathing techniques and ways to conserve energy. You'll also be given an exercise program that's appropriate for you. This may include aerobic exercises such as walking and riding an exercise bike as well as special exercises for your arms and legs. (Website editor's note: Regular exercise will also nicely help people suffering from diabetes and in particular from diabetic neuropathy, due to circulation and nerve damage damage in the hands, legs and feet. Regular physical exercise may also help relieve and possibly improve arthritis pain for arthritis sufferers, especially less advanced arthritis.
Quick Tips for Living with Emphysema
Doctors can help persons with emphysema live more comfortably with their disease. The goal of treatment is to provide relief of symptoms and prevent progression of the disease with a minimum of side effects. The doctor's advice and treatment may include:
- Quitting smoking - the single most important factor for maintaining healthy lungs.
- Bronchodilator drugs (prescription drugs that relax and open up air passages in the lungs) - may be prescribed to treat emphysema if there is a tendency toward airway constriction or tightening. These drugs may be inhaled as aerosol sprays or taken orally.
- Antibiotics - if you have a bacterial infection, such as pneumococcal pneumonia.
- Exercise - including breathing exercises to strengthen the muscles used in breathing as part of a pulmonary (the term "pulmonary" refers to the lungs) rehabilitation program to condition the rest of the body.
- Treatment - with Alpha I-Proteinase Inhibitor (ALPI) only if a person has AAT deficiency-related emphysema. AIPI is not recommended for those who develop emphysema as a result of cigarette smoking or other environmental factors.
- Lung transplantation - Some recent reports have been encouraging. Experience at this point in time is limited.