Emphysema

Source: Adapted from Know Your Options: The Definitive Guide to Choosing The Best Medical Treatments, Reader

What is emphysema?

Your lungs are packed with tiny air sacs called alveoli, which are ringed by microscopic blood vessels (capillaries). In healthy lungs, air flows easily in and out. Oxygen passes efficiently into the capillaries while carbon dioxide, the waste product, returns to the lungs and is exhaled. Someone who has emphysema has fewer alveoli. The ones they have lose their elasticity, making breathing difficult.

A persistent, mucus-producing cough and shortness of breath are the first and most obvious symptoms of emphysema. Some people with emphysema describe the effort to draw enough air into their lungs as “trying to breathe through a pillow.” As the disease progresses, so does breathing difficulty. In advanced stages of emphysema, people often fight for air after just a few steps. Emphysema also taxes your heart by forcing it to work harder to circulate blood through the lungs.

Who is at risk for emphysema?

More than 3 million North Americans have emphysema. Most cases are triggered by long-term cigarette smoking. Irritants in the smoke inflame alveoli walls, which then lose their elasticity. About 3% of cases are the result of an inherited genetic abnormality called alpha-1-antitrypsin (AAT) deficiency. Exposure to airborne irritants, such as coal dust, grain particles, smoke, or textile fibers, may also lead to emphysema.

Treatment for emphysema

The goal of emphysema treatment is to slow or even halt the disease’s progression. There’s no debate: The single most important step you can take is to stop smoking. To further ease your distress, your physician will prescribe medications that open your lungs, reduce airway irritation, and when the need arises, short-circuit potentially dangerous infections. You can help reduce your emphysema symptoms by taking certain precautions, starting an exercise program, and learning special breathing techniques.

Medications for emphysema

When you stop smoking, adding drug therapy will help you breathe more easily. Whether your emphysema stems from cigarettes or a genetic abnormality, your doctor will prescribe bronchodilator drugs to relax breathing muscles and expand constricted airways. Most bronchodilators are used with a portable device called a metered-dose inhaler. It allows the drug to enter deep into your lungs. When using an inhaler, be sure to follow the proper technique, which your doctor can explain, to ensure that you receive the maximum benefit from the medication. If you can’t operate an inhaler—due to arthritis, or some other reason—a nebulizer can do all the work for you, but is not portable.

Among the bronchodilators, anticholinergic drugs, such as ipratropium (Atrovent), are often the first choice. They last for about six to eight hours and have few side effects. The other most commonly used bronchodilators are beta2-agonists, including albuterol (Proventil), metaproterenol (Alupent), and salmeterol (Serevent). Beta2-agonists act more quickly than anticholinergics, but last for only three to six hours. They are also more likely to cause anxiety, tremor, restlessness, headaches, and other side effects. Some physicians prefer the drug Combivent (a combination of ipratropium with albuterol). It’s double-barreled assault that may be superior to taking either type of drug alone.

If your respiratory system is severely inflamed due to the emphysema, you may receive corticosteroids. These drugs, taken through inhalers, include beclomethasone (Beclovent), budesonide (Pulmicort), and fluticasone (Flovent).

Emphysema makes you more vulnerable to upper respiratory infections, which can pose serious risks because they lead to bacterial infections. If you show signs of infection, your doctor will prescribe an antibiotic, such as cefuroxime (Ceftin) or levofloxacin (Levaquin). Antibiotics are useless against viral infections such as colds and the flu. Doctors frequently prescribe them to patients with emphysema whose risk of complications is so high.

For the small percentage of patients whose emphysema is caused by AAT deficiency, drug treatment involves weekly or bimonthly injections of a purified form of human AAT. This helps keep AAT levels within the normal range.

Lifestyle Changes

If you smoke cigarettes, you must quit. Should you continue to smoke, your emphysema will become worse, regardless of the medical care you receive. If you stop smoking, you will vastly improve your life—not to mention prolong it—and be able to maintain your independence. Committing to this lifestyle change is difficult for many people, but it can be done. You don’t have to do it alone: Various proven options can help you kick the habit, which include therapy, medications, and support groups.

You can also benefit from learning new breathing techniques, either through a hospital program recommended by your doctor, or by doing pursed-lip breathing on your own. Many other actions will confer benefits as well. To get the best health payoff, try to incorporate the following into your lifestyle:

• Seek out “good” air. Avoid smoke-filled rooms or places with high levels of particulates in the air. Stay indoors on cold days or when air quality is poor.
• Get plenty of fluids. Drink water—at least eight glasses a day—to thin mucus secretions. Moisten indoor air with a cool-mist humidifier.
• Protect against infections. Steer clear of people with colds or the flu: Emphysema lowers your resistance to infectious diseases, which can pose a serious threat. Wash your hands frequently to reduce the risk of contracting a respiratory infection. Get a flu shot every year and a pneumonia vaccination as recommended by your practitioner.
• Follow an exercise routine set up with the help of your doctor. Mild to moderate exercise improves endurance and cardiovascular health, reduces breathlessness, and boosts your sense of well-being.
• Find out about postural drainage, a way to drain mucus by hanging your head lower than your torso. Ask your doctor or physical therapist to teach you this technique.
• Avoid high altitudes and extreme temperatures.

Related Procedures for Emphysema

If your lung function becomes very low, supplemental oxygen can bring relief and reduce risk of medical complications. Therapy may be continuous or noncontinuous. Oxygen units may be portable or stationary.

In severe emphysema, surgery may be an option. Lung-volume reduction surgery removes the most diseased parts of the lung, allowing remaining tissue and muscles to work better. Many people who undergo lung-reduction return to their daily activities without supplemental oxygen.

If your emphysema is advanced or you have the inherited form of the disease, you could be a candidate for lung transplantation. One major transplant center reports that 83% of those who undergo this surgery survive at least one year, and 54% live at least five years. The best candidates for lung transplantation are under age 65 and in good health aside from lung disease.

Questions for Your Doctor

• Do I have the right inhaler? Am I using it correctly?
• Is it safe for me to fly?
• Would it help me significantly to move to a warmer, drier climate?
• Would I be a good candidate for a lung transplant?

Living with Emphysema

If you are living with Emphysema, here are a few tips to help you take control:

• Enroll in an outpatient rehab program. Health professionals will guide you through aerobic exercise and breathing techniques, answer questions, provide education, and direct you to support groups for pulmonary patients. Such programs improve your ability to cope with emphysema.
• Plan before you fly. Increase your mobility by ordering supplemental oxygen equipment before flying. Airlines will not allow you to bring your own oxygen unit on board the aircraft, but they’ll supply it if you ask.
• Maintain your weight. Emphysema makes it easy to lose weight. Labored breathing consumes a lot of calories and makes eating difficult. Eat several smaller meals of nutritionally rich foods each day, and take a high-potency vitamin and mineral supplement.