Emphysema Treatment and Management

Focusing on bronchodilators to relax airways and reduce air trapping.

Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.

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Emphysema: Treatment and Management

While emphysema involves permanent structural damage that cannot be reversed, comprehensive management can significantly improve symptoms, exercise capacity, and quality of life. The goals of treatment at Liv Hospital are to relieve symptoms, prevent disease progression, improve exercise tolerance, and prevent and treat complications and exacerbations. Our approach is multidisciplinary, involving pulmonologists, thoracic surgeons, respiratory therapists, and nutritionists to address every facet of the patient’s health. We move beyond simple inhaler prescriptions to offer advanced interventional and surgical options for eligible candidates.

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Smoking Cessation: The Single Most Important Intervention

Stopping smoking is the only medical intervention that has been proven to slow the accelerated decline in lung function. It is the cornerstone of emphysema management.

  • Pharmacotherapy: Utilization of nicotine replacement therapies (patches, gum, lozenges) and medications like varenicline or bupropion to manage withdrawal.
  • Counseling: Behavioral support groups and counseling to address the psychological dependence.
  • Harm Reduction: Complete cessation is the goal; reducing the number of cigarettes is insufficient to stop the inflammation and destruction. Vaping should also be strictly avoided as it perpetuates airway inflammation.
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Bronchodilator Therapy

Bronchodilators are central to symptom management. They work by relaxing the smooth muscles around the airways, which helps to reduce air trapping and deflating the lungs.

  • Long Acting Muscarinic Antagonists (LAMA): These are often the first line therapy. They block the bronchoconstricting effect of acetylcholine, keeping airways open for 24 hours.
  • Long Acting Beta Agonists (LABA): These stimulate beta receptors to relax airway muscles.
  • Dual Therapy: Combining a LAMA and a LABA in a single inhaler is superior to either alone in improving lung function and reducing symptoms in emphysema.
  • Short Acting Bronchodilators: Used as “rescue” medication for immediate relief of sudden breathlessness

Inhaled Corticosteroids

Unlike in asthma, inhaled corticosteroids are not used as monotherapy in emphysema. They are typically reserved for patients who have a history of frequent exacerbations or those with a component of asthma (high blood eosinophils). When used, they are combined with long acting bronchodilators (Triple Therapy: LAMA plus LABA plus Steroid) to reduce inflammation and prevent flare ups. Overuse can increase the risk of pneumonia, so they are prescribed judiciously.

Oxygen Therapy

For patients with severe resting hypoxemia (low blood oxygen levels), long term oxygen therapy is the only therapy other than smoking cessation proven to extend life.

  • Criteria: It is indicated if the PaO2 is less than 55 mmHg or oxygen saturation is less than 88 percent at rest.
  • Duration: To be effective for survival, oxygen must be worn for at least 15 to 18 hours per day.
  • Ambulatory Oxygen: Portable concentrators allow patients to maintain mobility and participate in pulmonary rehabilitation.
  • Palliative Oxygen: In some cases, oxygen is used to relieve breathlessness even when blood levels are not critically low, although this is controversial.

Pulmonary Rehabilitation

This is a comprehensive intervention that includes exercise training, education, and behavioral modification.

  • Muscle Retraining: Emphysema leads to deconditioning of the leg and arm muscles. Rehab strengthens these muscles so they use oxygen more efficiently, reducing the burden on the lungs.
  • Breathing Techniques: Physiotherapists teach pursed lip breathing and diaphragmatic breathing to manage dyspnea and reduce panic during exertion.
  • Energy Conservation: Learning how to perform daily tasks with less effort.
  • Psychological Support: Addressing the anxiety and depression associated with chronic breathlessness.

Nutritional Support

Pulmonary cachexia is a significant issue in emphysema. Breathing burns a lot of calories.

  • High Calorie Diet: Patients often need a diet rich in protein and calories to prevent muscle wasting.
  • Small Frequent Meals: Large meals can distend the stomach and press on the diaphragm, worsening breathlessness. Eating smaller amounts more often helps avoid this.
  • Supplements: Vitamin D and calcium are essential for bone health, mainly if steroids are used.

Surgical Interventions

For select patients with advanced emphysema, surgical options can provide significant relief.

  • Lung Volume Reduction Surgery (LVRS): This procedure involves removing the most damaged, emphysematous portions of the lung (usually the upper lobes). By reducing the size of the overinflated lung, the remaining healthier lung tissue can expand better, and the diaphragm can return to a more normal shape, improving mechanics.
  • Bullectomy: If a single giant bulla is compressing the lung (occupying more than one third of the hemithorax), surgically removing it allows the compressed lung to re-expand.
  • Lung Transplantation: For younger patients with severe disease and no other options, lung transplantation offers the potential for restored function. It is a complex procedure with strict eligibility criteria.

Endobronchial Valve Therapy

This is a minimally invasive alternative to LVRS. One-way valves are placed in the airways leading to the most diseased parts of the lung via a bronchoscope.

  • Mechanism: The valves allow air and mucus to escape from the diseased lobe but block air from entering.
  • Atelectasis: Over time, the treated lobe collapses (atelectasis), which reduces hyperinflation and improves the function of the healthier lobes and the diaphragm.
  • Selection: Success depends on the absence of collateral ventilation between the lung lobes, which is assessed before the procedure.

Alpha 1 Antitrypsin Augmentation Therapy

For patients with a genetic deficiency, weekly intravenous infusions of alpha-1 antitrypsin protein derived from human plasma can raise blood and lung levels of the protein. This therapy slows the destruction of lung tissue but does not reverse existing damage. It is a lifelong therapy aimed at preservation.

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FREQUENTLY ASKED QUESTIONS

Why do I need to take inhalers if the damage is permanent?

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Multiparametric MRI is an advanced imaging technique that combines standard anatomical sequences with functional sequences like Diffusion-Weighted Imaging and Dynamic Contrast-Enhanced imaging. This provides a comprehensive assessment of the prostate, allowing doctors to distinguish between benign conditions like BPH and significant prostate cancer, and to guide targeted biopsies.

CT scans do involve exposure to ionizing radiation, which carries a small theoretical risk of cellular damage over time. However, modern CT scanners use dose-modulation technology to minimize this exposure to the lowest level necessary for a diagnostic image. The benefit of an accurate and timely diagnosis for serious urological conditions typically far outweighs the minimal risk of radiation.

Many modern orthopedic implants are MRI-safe, although they may cause some image distortion. However, older pacemakers, defibrillators, and certain metal clips may be unsafe in the strong magnetic field. It is critical to inform the imaging team of any metallic implants so they can verify their safety compatibility or recommend an alternative test like a CT scan.

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