Emphysema is among a group of lung disorders classified as chronic obstructive pulmonary disease (COPD).

The most common cause of emphysema is cigarette smoking, but other risk factors, such as secondhand smoke, air pollution or work-related exposure, may also play a part in the development of emphysema. In emphysema, the alveoli, or air sacs that lie deep within the lungs, become damaged and eventually burst, leaving large holes that trap air within the lungs. When air is trapped, it is difficult for the lungs to exchange oxygen and carbon dioxide, which can result in low oxygen (hypoxemia) and eventually high carbon dioxide (hypercapnia) levels in the blood. Although there is no cure for emphysema, the goal of treatment is to slow the progression of the disease, treat the obstructed airways to relieve associated hypoxia and improve quality of life. Medication Management Currently, there are no drug treatments available that have proven successful in modifying the rate of decline in lung function for those who have emphysema. There are, however, medications available to treat emphysema, which can help to reduce or abolish symptoms, increase exercise tolerance, reduce the number and frequency of COPD exacerbations and improve overall health status. Common medications used in the treatment of stable COPD include the following: y y y y Bronchodilators Glucocorticoids (limited to specific indications) Antibiotics (only during infectious exacerbations) Vaccines

Medications To Treat Emphysema Edited by Guy Slowik MD FRCS. Last updated on June 28th 2011 Emphysema cannot be curedand, except for oxygen, does not respond to any medication. However, emphysema is frequently associated with bronchitis and asthma and the symptoms associated with these processes often can be alleviated with medication (hence, you can see the value of pulmonary function and other tests designed to discover if there is asthmatic component present: y y y Bronchodilator medication Corticosteroids Supplemental oxygen

Need To Know: Often people with emphysema become suddenly worse. Increasing symptoms which include cough productive of discolored sputum, fever, and increased shortness of breath suggest the presence of an infection and are often treated with antibiotics, though this is still somewhat controversial. Some physicians treat these attacks with corticosteroids and do not administer antibiotics.

Bronchodilator Medication Bronchodilator medication may be prescribed for airway tightness. Bronchodilators open the airways by relaxing the muscles around the airways. Many people with emphysema find that breathing is easier when they use bronchodilators. The most commonly prescribed bronchodilators are beta2 agonists, the anti-cholinergic drug ipatropium bromide, and theophylline. y Beta2 agonists are usually inhaled and include short-acting drugs whose effects last from three to six hours such as albuterol (Ventolin), terbutaline (Brethine, Brethaire, Bricanyl), metaproterenol (Alupent, Metaprel) and pirbuterol (Maxair); these agents should be used only for those occasions when immediate relief is necessary. There are also very short-acting (one to two hours) not-beta2 agonists such as isoproterenol (Isuprel, Norisodrine, Medihaler-Iso); these drugs have little use and probably should be avoided. More recently, quite long acting agents (about 12 hours) have been introduced. These new agents are salmeterol (Serevent) and formoterol (Foradil). Because they are long acting and prevent asthmatic attacks, they are typically taken twice a day. Salmeterol should not be used for an acute attack because it requires at least 30 minutes before it is active but formoterol can be used for an acute attack. The anticholinergic drug ipratropium (Atrovent) acts to relax the bronchial muscles. It is a slow-acting drug with virtually no side effects. The beneficial effects of Atrovent may be difficult to appreciate because, like salmeterol, it requires about 30 minutes before any significant change occurs. Anticholinergic drugs, are often more effective in the asthma that is associated with COPD than beta-2 agonists; the opposite is true in asthma associated with allergy. Theophylline (Theodur, Slo-bid, Uniphyl, Theo-24) also acts as a bronchodilator, relaxing the muscles around the bronchioles and stimulating the breathing process. Theophylline should be taken only as prescribed, however, because overdoses of the drug can be toxic (poisonous to the body). Signs of toxicity include nausea, vomiting, headache, insomnia and seizure. A doctor should be contacted immediately if any of these symptoms occur. Because theophylline is a relatively weak bronchodilator with potential serious side effects and many interactions with other drugs and with foods, it is used relatively infrequently. Need To Know: Coffee drinkers need to use caution if they take theophylline to treat their emphysema. Caffeine intake should be limited to the equivalent of no more than six cups of coffee per day, because caffeine is chemically similar to theophylline and could increase theophylline activity, causing toxic side effects. Caffeine is found not only in coffee, but also in chocolate, cola, and certain teas. Corticosteroids The potent anti-inflammatory medications known as corticosteroids - commonly called steroids - may be used to help lessen the inflammation that often accompanies emphysema. These may be taken by mouth or inhaled. Corticosteroids can help people withchronic obstructive pulmonary disease by inhibiting many of substances that cause airways to narrow. Generally, these medications are more effective for people with chronic bronchitis with or without emphysema, and less effective for people with emphysema alone. For more information about bronchitis, go to Bronchitis. Long-term use of corticosteroids that are taken by mouth may produce a variety of side effects that worsen as the dose increases. Side effects include the bone disease osteoporosis in both men and women, weight gain and fat redistribution, high blood pressure, loss of lean muscle mass, and, possibly, cataracts. As with all drugs, side effects

are less with inhaled forms, since the dose is much lower. Short term administration of corticosteroids for 7-10 days during an attack is often very useful and usually without significant side effects. If it is necessary for corticosteroids to be administered longer, many physicians feel that doubling the daily dose and giving that as a single dose every other morning achieves the same benefits with fewer side effects. How-To Information: Both beta2 agonists and corticosteroids usually come in a metered-dose inhaler (MDI), and pills. MDIs are a convenient way to take inhaled medication. However, most users of the drugs do not experience their full benefits because they do not use the inhaler properly. Here are some tips on how to make sure you're getting the most out of your medication. First, carefully read the instructions that came with the metered-dose inhaler. Check the label to make sure the drug is the correct one and that the expiration date has not passed. Then carefully follow these steps for using an inhaler: 1. 2. 3. 4. 5. 6. 7. 8. Remove the cap, hold the inhaler upright, and shake the inhaler. Tilt your head back slightly and breathe out all your air without forcing it. Place the MDI in your mouth and close your lips tightly around the mouthpiece. Press down once on the inhaler to release the medicine. At the same time, start to breathe in slowly (some instructions may refer to this as a "puff"). Continue to breathe in slowly for three to five seconds. The long, slow inhalation allows more medicine to go into your lungs. Hold your breath for 10 seconds to allow the medicine to settle onto your airways. Repeat puffs as directed by your doctor. Wait one minute between puffs to allow the next puff to get into your lungs better. If you use a spacer, wash it and the MDI mouthpiece once a week.

If you use inhaled dry powder capsules, close your mouth tightly around the mouthpiece of the inhaler and breathe in quickly. Most of these devices have a counter for the number of inhalations used. Supplemental Oxygen Supplemental oxygen can help a person who cannot get enough oxygen while breathing normally. Depending on the degree of lung damage, the doctor may suggest either continuous (24 hours a day) or activity related (noncontinuous) oxygen therapy. There are three types of oxygen administration devices: compressed oxygen in tanks, liquid oxygen, and oxygen concentrators. With supplemental oxygen, youll have one of these oxygen delivery devices right in your home. Compressed and liquid oxygen can be portable and, therefore, are desirable for trips outside the home. Concentrators are powered by normal home electricity; most electric companies will adjust their charges for patients using concentrators. A long, thin tube connects to the oxygen delivery device. At the other end is either a two-pronged device that delivers oxygen to your nostrils, or a mask that is worn over your nose and mouth.

The tube should be long enough to allow you to move about your home. If you need to go out, portable oxygen tanks with either compressed or liquid oxygen are available. An oxygen supply company will deliver the oxygen to you and replenish your supply when necessary. Your doctor must write a prescription for oxygen therapy. The prescription will spell out the flow rate, how much oxygen you need per minute - referred to as liters per minute (LPM or L/M) - and when you need to use oxygen. Some people use oxygen therapy only while exercising, others only while sleeping, and some need oxygen continuously. Your physician will either order an arterial blood or a non-invasive pulse oximeter test that will indicate what your oxygen level is and help determine what your needs are. Continuous, long-term oxygen use is the only therapy that has been shown to lengthen the life of people who have low blood oxygen levels, or hypoxemia. Alertness, motor speed, and hand strength also improve with adequate oxygen therapy. Need To Know: Oxygen in tanks is a fire hazard. You should never smoke or burn a candle near someone who is on oxygen. Keep the oxygen far away from fireplaces or wood-burning stoves. Oxygen is not explosive but it makes fires burn faster and hotter. Oxygen, particularly when used continuously, is expensive. Therefore, insurance companies usually follow Medicare guidelines which require that oxygen be below certain levels before authorizing payment. Discover how flu shots can help prevent the worsening of COPD. Non-Medication-Related Treatment for Emphysema To further support the goals of treatment for emphysema, non-pharmacological measures include those types of treatments that don't involve medication, but which can greatly improve patient outcomes. 1. Pulmonary Rehabilitation Through assessment, exercise, education and psychological support, the goals of pulmonary rehabilitation are to reduce symptoms, improve quality of life and increase physical and emotional participation in daily activities. In a broader sense, pulmonary rehabilitation also helps to reduce overall health care costs among the COPD population. With the help of an interdisciplinary approach, benefits of a pulmonary rehabilitation program include the following: o o o o o o Improves exercise tolerance Reduces the perceived intensity of breathlessness Improves health status and quality of life Reduces the number of COPD hospitalizations and length of stay Reduces anxiety and depression Improves upper body strength and endurance

According to the Global Initiative for Obstructive Lung Disease (GOLD), an effective pulmonary rehabilitation program should last at least six weeks. Moreover, the longer that the program remains in effect, the more effective the results. Learn more about living with COPD: o o There is Hope: Treatment of COPD Trying to Adjust: Living with COPD

2. Oxygen Therapy Oxygen therapy can be administered either continuously, during activity or to relieve sudden episodes of shortness of breath. Long-term oxygen therapy (> 15 hours a day) has been shown to increase survival rates in people with COPD and helps preserve the function of all vital organs. Usually, long-term oxygen therapy is initiated during Stage IV (very severe) COPD for patients who demonstrate low oxygen saturation levels or low blood oxygen. Patients who have COPD are often prescribed medications called bronchodilators. Bronchodilators work by relaxing and expanding the smooth muscle of the airways making it easier to breath. Three types of bronchodilators are commonly used for the treatment of emphysema: beta adrenergic agonists, anticholinergics and methylxanthines. 1. Beta Agonists Beta agonists can be either short-acting (effects lasting 4 to 6 hours) or long-acting (effects lasting 12 hours or more). Beta agonists can be given orally or by inhalation. The inhaled method is preferred, however, as it is quicker in onset and has less side effects. When bronchodilators are administered by inhalation, proper use of a bronchodilator or metered dose inhaler (MDI) is an important aspect of effective treatment. The choice of an inhaler will depend upon your prescribing doctor and your ability to use them correctly, which can be determined during an office visit. Long-acting or short-acting beta agonists have been shown to improve exercise tolerance in COPD. Short-acting beta agonists include the following: o o o Albuterol Metaproterenol Terbutaline

Some examples of long-acting beta agonists: o o o Salmeterol Formoterol Bambuterol

Side effects of beta agonists are often dose related and more frequent in oral than inhaled methods of delivery. They include: o o o Rapid heart rate (tachycardia) Palpitations Premature ventricular contractions

o o o

Tremors Sleep disturbances Decreased potassium levels (hypokalemia)

2. Anticholinergics Anticholinergics are only available by the inhalation route. They have excellent bronchodilator effects and minimal side effects. Anticholinergics may be of particular benefit to those patients who are not candidates for B-agonists or methylxanthines because of underlying heart disease. The following lists some common antichlolinergics: o o o Atrovent Spiriva Combivent

The most commonly reported side effects of anticholinergics are as follows: o o o o Dry mouth Metallic taste after inhalation Closed-angle glaucoma (extremely rare) Paradoxical bronchoconstriction (confirmed in asthmatics but not in COPD)

3. Methylxanthines The mechanism underlying the beneficial effect of methylxanthines for the treatment of COPD is not well defined but may include improvement in respiratory muscle strength. There are two types of methylxanthines that are commonly used in COPD, the first of which is taken by mouth and the second, intravenously (IV). They are: o o Theophylline (oral) Aminophylline (IV)

Because of the dangers of serious side effects, care must be taken when administering these medications, especially through the IV method, as a rapid heart rate or irregular heart rhythm can occur. Serious side effects that indicate toxicity include: o o Heart dysrhythmias Convulsions

Minor side effects may also be experienced in the way of headache, nausea, vomiting, diarrhea and heartburn. Combination bronchodilator therapy -While the use of only one bronchodilator medication appears to be safe, combining them may actually increase the degree of bronchodilation with the same or less side effects.

For more information about bronchodilator inhalers, ask your healthcare provider. Not getting the answers you need? Let's talk in the COPD Forum.
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Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2006. Available from: http://www.goldcopd.org. If you have COPD, your doctor may have prescribed glucocorticoids (also known as corticosteroids, or steroids) as part of your treatment plan. While glucocorticoids do have many benefits, they also have serious risks and side effects which you should be aware of. According to the Global Initiative for Obstructive Lung Disease (GOLD), the role that oral and inhaled glucocorticoids play in the treatment of stable COPD is rather controversial and limited to certain instances. How Do Glucocorticoids Work? As they pertain to COPD, glucocorticoids work by decreasing swelling and inflammation in the airways of the lungs. Pros and Cons of Inhaled Glucocorticoids Regular treatment with inhaled glucocorticoids has been shown to reduce the frequency of COPD exacerbation and improve health status in patients with Stage III (severe) to Stage IV (very severe) COPD. However, their use does not stop the decline of forced expiratory volume (FEV1) or reduce the mortality rate associated with COPD. In addition, withdrawal from inhaled glucocorticoids can lead to COPD exacerbation in some patients and increase the likelihood of developing pneumonia. In light of this information, treatment with inhaled glucocorticoids is not indicated in patients with stable COPD, but may be recommended for patients in the more advanced stages of COPD and is standard for COPD exacerbation. Common inhaled glucocorticoids include the following: y y y y Beclomethasone Triamcinolone Fluticasone Flunisolide

For more information about specific glucocorticoids or other medications, visit About.com's Drugs A-Z. Combination Therapy Using an inhaled glucocorticosteroid that is combined with a long-acting beta agonist has been shown to reduce the frequency of COPD exacerbation, improve lung function and overall health status in patients with COPD, but again, may also increase the likelihood of pneumonia. Oral Glucocorticoids There are many existing guidelines that continue to advocate the use of short or long-term oral glucocorticoid therapy in the management of COPD. According to GOLD, however, this practice is not recommended due to a lack of sufficient evidence of benefit and a long list of adverse side effects. To follow are some common oral glucocorticoids that you may be familiar with:

y y y y

Prednisone Dexamethasone Methylprednisolone Cortisone

Side Effects of Glucocorticoids While the side effects of oral glucocorticoids are numerous and well-documented, adverse effects associated with inhaled glucocorticoids are fewer and less severe. Included below are some commonly known side effects of oral glucororticoids: y y y y y y y y y Lowered immune system (Immunosuppression) High blood sugar Weight gain Easy bruising Reduced bone density Muscle breakdown, weakness Cataracts Glaucoma Adrenal insufficiency (if used for a long period and stopped suddenly)

Inhaled glucocorticoids are more commonly associated with: y y y Skin bruising Yeast infection of the mouth and pharynx Hoarseness of the voice

For more information about side effects of certain medications, visit About.com's Drugs A-Z. Final Words About Glucocorticoids The most important aspect of any treatment plan is having the willingness to follow it. If you are not able to adhere to your plan of care, your health care provider should try to determine what barriers may be standing in the way. All treatment plans should come with a clear explanation of their purpose and probable outcomes. If your doctor does not provide this information for you, you should clarify it before you leave their office. For more information about the pros and cons of glucocorticoids, talk with your health care provider. Not finding the answers to your questions? Join us in the COPD Forum.
Source:

Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2006. Available from: http://www.goldcopd.org. Sponsored Links Gastrointestinal PathogenTest for 15 key Bacteria, Viruses and Parasites all in under 5 hourswww.luminexcorp.com/gpp Colds & DecongestantsListen as Dr. Hendley & Dr. Pappas discuss evidence-based findings.pedsinreview.aappublications.org

Fast Herpes TreatmentOral and Genital with homeopathy Natural, Safe and Guaranteedwww.antiherpes.com Definition: Antibiotics are powerful medications that help fight bacterial infection. Frequently prescribed in modern medicine, antibiotics cure disease by either killing bacteria or keeping them from reproducing. What Type of Infections Do Antibiotics Treat? Antibiotics are used to treat infections caused by bacteria. For example: y y y y strep throat bacterial pneumonia an earache caused by bacteria MRSA

What Don't Antibiotics Treat? Antibiotics do not treat infections that are caused by a virus. This means they are useless, and may do more harm than good, if you are seeking treatment for the common cold, flu, or have a fungus infection like ringworm. Side Effects of Antibiotics The most common side effects of antibiotics include: y y nausea soft stools or mild diarrhea

The following, more serious side effects should be immediately reported to your doctor: y y y y y y vomiting severe, watery diarrhea accompanied by stomach cramps allergic reaction (shortness of breath, hives, swelling of the lips, face or tongue) fainting vaginal itching or discharge white patches on the tongue

When Should I Stop Taking My Antibiotics? It is extremely important that you take your antibiotics until they are completely gone. Do not stop taking your antibiotics just because you start to feel better. Doing so may lead to antibiotic resistance, which can affect everyone. If you have any questions about your antibiotics, be sure to discuss them with your health care provider. Also Known As: Antimicrobials Antibiotics y y y COPD Exacerbation Guide to Bronchiectasis Treatment Antibiotics

A bullectomy is the surgical removal of a bulla, or a thick-walled air space, that can be caused by emphysema, infection, or a congenital defect. While technically a bulla can occur anywhere in the body, they are most often associated with the lung. A bulla's size may vary, but they are generally between .25 inches (.635 cm) and .5 inches (1.27 cm). A surgeon may remove bullae from the lungs to encourage the healthy air sacs around it to expand, and allow the lung to function at a more efficient level. Bullectomies are merely a treatment, not a cure, for lung tissue damage caused by emphysema. Pulmonary emphysema, which is also known as Chronic Obstructive Pulmonary Disease (COPD), is a disease of the lungs that is often caused by cigarette smoking. Lung tissues become damaged, enlarged, and no longer function efficiently. The alveoli, or air sacs of the lung, collapse and the tissue of the lung is not as elastic as it once was, thus greatly limiting lung capacity. Patients become short of breath and have difficulties absorbing adequate oxygen. Emphysema is a degenerative disease and is irreversible. Bullae are markedly dilated (>1cm) air spaces within the lung parenchyma that are commonly secondary to COPD. It is believed that bullae arise from a ball-valve mechanism, wherein obstruction of a bronchiole or bronchus leads to progressive distention of the areas of lung tissue where alveolar walls are already damaged. Air may flow into these areas but is unable to escape, resulting in increased pressure and further enlargement of the air space. Although bullae increase physiological dead-space, they rarely compromise pulmonary function. Unfortunately, giant bullae can exert substantial compressive effects on underlying normal lung tissue, which in turn may reduce blood flow and ventilation to potentially normal functioning lung parenchyma. The natural history of bullae is one of enlargement, causing worsening dyspnea. Excision of bullae has the following effects:
y y y y y y

expansion of the underlying compressed lung, reductions in airway resistance, functional residual capacity (FRC), pulmonary vascular resistance, and physiologic dead space, increase in the elastic recoil pressure of the lung, improvement in dynamic compliance, restoration of the mechanical linkage between the chest wall and normal lung, upward movement of the diaphragm to a more efficient position.