Emphysema treatment usually involves a combination of medicine, surgery and supplemental oxygen.
Emphysema treatment usually involves a combination of medicine, surgery and supplemental oxygen to relieve symptoms or prevent complications. Emphysema is the most common cause of death among respiratory illnesses, according to Johns Hopkins Medicine. Approximately two million people in the United States have emphysema with males comprising 61 percent of these cases. It is typically a progressive illness that is slow to develop and most patients are at least 50 years of age when they are diagnosed. The most common cause of emphysema is smoking, but a small percentage of cases are due to a genetic mutation that results in the inability to synthesize a protein called alpha1-antitrypsin (AAT). This form of emphysema develops more quickly than other cases and may begin causing symptoms while patients are still in their 30s.
During inhalation, air moves down the trachea and into small airways, called bronchial tubes. These airways have branches that lead to millions of small air sacs, called alveoli. Bronchioles and alveoli are normally highly elastic and expand like a balloon as they fill with air. The alveoli then deflate as the air empties out during exhalation. Emphysema occurs when the alveoli and bronchioles lose their elasticity and restrict the flow of air. The bronchioles can collapse which prevents the alveoli from compressing completely. This can cause the alveoli to expand too much and rupture, which results in the characteristic shortness of breath in emphysema.
According to the Mayo Clinic, antibiotics may be used against respiratory infections that commonly result from emphysema, such as acute bronchitis, influenza and pneumonia. These infections make breathing more difficult and increase the amount of sputum that is produced. Broad-spectrum antibiotics can be most effective since they eradiate a wide range of bacteria, but should be used sparingly since they can also increase the number of bacteria that are resistant to antibiotics. An annual flu shot and pneumonia shot every five years after the age of 65 is usually recommended for all patients with respiratory disorders such as emphysema.
Bronchodilators open constricted airways and are most effective in treating asthma, although they can also help relieve the breathing difficulties, coughing and shortness of breath associated with emphysema. These medications include:
Inhaled anti-cholinergic agents, such as ipratropium bromide (Atrovent), block the neurotransmitter acetylcholine and cause the bronchial muscles to relax.
Inhaled beta-sympathomimetic drugs, such as salbutamol or terbutaline, mimic the effects of naturally occurring substances.
Theophylline may be taken orally to treat emphysema and other respiratory ailments
Corticosteroids can be inhaled to relieve the symptoms of emphysema caused by asthma and bronchitis. Inhaled steroids do not have as many adverse effects as oral steroids, but prolonged use can still cause high blood pressure, bone weakness, cataracts and diabetes.
Infusions of AAT may slow the progression of emphysema in people with inherited form of emphysema.
Lung volume reduction surgery (LVRS) is used to treat severe emphysema by removing small wedges of the most diseased portions of the lung. While it may seem counterintuitive to treat impaired lung function by removing lung tissue, this creates extra space in the chest cavity which allows the remaining healthy lung tissue to expand more easily and make breathing easier. According to the University of Maryland Medical Center, LVRS involves removing 20 to 30 percent of the damaged lungs and may be performed under general anesthesia as a thoracoscopy, thoracotomy or sternotomy.
A thoracoscopy is a minimally-invasive technique that requires only one-inch long incisions, but can effectively treat any part of the lungs. Three incisions are made on the side of chest between the ribs. A miniature video camera, grasper and stapler are inserted through the incisions. The most damaged parts of the lung are cut away and the lungs resealed with the stapler. The procedure is repeated for the other lung, if necessary, and then the incisions are sutured.
A thoracotomy is performed on one lung when there is a problem with the thoracoscopy. A single, five- to 12-inch long incision is made between two ribs and the ribs separated. The lung is reduced, and then the muscle and skin are closed by sutures.
A sternotomy is performed when treatment of the upper lobes of both lungs is needed. This more invasive technique involves making an incision through the breastbone. After both lungs are reduced, the breastbone is wired back together and the skin sutured.
LVRS has a higher risk than heart surgery and is one of the highest risk procedures that are performed electively. In general, the prognosis for emphysema patients receiving LVRS and medical therapy is better after two years than the prognosis for patients receiving only medical therapy. However, there is a considerable sub-group of patients who have a worse outlook after the surgery. Air leakage through the sutures and into the chest cavity is the most common complication, occurring in at least 50 percent of cases. The greatest danger with this side effect is the air pressure can become too great and collapse the lung.
Supplemental oxygen at home may provide some relief for emphysema patients with a low level of oxygen in the blood. It can increase the capacity for exercise and prolong survival, but it may not relieve breathlessness. A doctor may prescribe a portable oxygen tank if the patient develops pulmonary hypertension.