Emphysema (cont.)
What is the treatment for emphysema?
Emphysema is not a curable disease, once lung damage has occurred it cannot
be reversed. The goal of treatment is to stop further lung destruction and
preserve lung function. The patient needs to know that the focus is on improving
quality of life and limiting the intrusion of emphysema on daily activities.
Smoking cessation
The number one treatment goal is to have the patient
stop smoking. Education,
counseling, support groups and medication may be used.
Medications
Bronchodilators
Bronchodilators are used to relax the smooth muscles that
surround the bronchioles and allow the breathing tubes to dilate and allow more
air flow. These medications can be inhaled using an MDI (metered dose inhaler),
powder inhaler devices, or a nebulizer machine These medications can either be
short or long acting. Recently, the propellant for the MDIs ,
chlorofluorocarbons (CFCs) have been removed from the market because of the effect of these
agents on the ozone layer in the atmosphere. These propellants have been
replaced with hydrofluoric alkanes (HFAs).
The short acting bronchodilators include the
albuterol agents (Ventolin HFA,
Proventil HFA, and Pro Air) and the anticholinergic agent,
ipratropium bromide
(Atrovent).
As an aside, in the past patients have been instructed to count the
number of puffs used from these devices or "float" the inhaler in water to
determine the amount of remaining medicine available. The HFA devices can not be
floated, and counting of the number of puffs is the only available method of
determining the continued presence of medication. One device, Ventolin HFA, has
a built in counter. It is important to understand that the mere presence of
propellant coming from the inhaler does not necessarily mean that medication is
present.
The long acting agents include salmeterol (Serevent),
formoterol (Foradil)
and tiotropium (Spiriva). Often the long acting bronchodilator is used for
controlling the symptoms of emphysema as maintenance therapy, and the short
acting one is used when symptoms flare up (rescue therapy). It is important that
the patient know which medication is prescribed, since long acting inhalers
cannot be used for rescue because the delayed onset of action.
Corticosteroids
Since most patients do not have pure emphysema and usually
also have other components of COPD, combined therapy is often prescribed which
includes a long-acting bronchodilator and an inhaled corticosteroid. The inhaled
corticosteroid (ICS) helps suppress the inflammatory components of COPD. These
agents like Advair, which is a mixture of salmeterol (Serevent) and fluticasone
(Flovent), an ICS, further simplify treatment to a single inhaler device.
Studies have been done in Europe on a similar agent, Symbicort [a combination of
formoterol (Foradil) and budesonide (Pulmicort), another ICS], and are
currently underway in the United States.
Many patients with emphysema need only
take steroids when their symptoms flare, but others require daily therapy.
Corticosteroids have direct action on the lung tissue. Absorption into the blood
stream is minimal. Prednisone, an oral corticosteroid, can be taken in addition
to the inhaled steroid should further anti-inflammatory effects be required. In
emergency situations, corticosteroids may be injected intravenously.
Antibiotics
Since patients with emphysema are at risk for infections like
pneumonia, antibiotics may be prescribed when the usually clear sputum changes
color, or when the patient presents with systemic signs of an infection (fever,
chills, weakness).
Oxygen
As the disease progresses, patients may require supplemental oxygen
to be able to function. Often it begins with nighttime use, then with exercise,
and as the disease worsens, the need to use oxygen during the day for routine
activities increases.
Next: Pulmonary rehabilitation »
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