Emphysema (Lung Condition) (cont.)
Charles Patrick Davis, MD, PhD
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
George Schiffman, MD, FCCP
George Schiffman, MD, FCCP
Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
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Quitting smoking is the most effective therapy for people with emphysema. Consequently, successful cessation is a major goal for people with COPD/emphysema. This goal usually can be reached with cooperation between the doctor, patient, family members, and friends. Quitting smoking usually requires patient education about the risks of smoking, methods to help the patient quit smoking (including a target date to quit), and follow-up support. Many people will relapse, but they still should be encouraged to try to change their lifestyle and attempt to quit again.
Many people may benefit from both self-help and group smoking cessation programs. Patients need to understand that nicotine is responsible for their addiction to smoking and may benefit from a program that allows them to slowly withdraw from nicotine addiction. There are several types of pharmacological interventions such as nicotine chewing gum, transdermal nicotine patches, and other treatments such as varenicline (Chantix) and Zyban that may be used to help the patient overcome their nicotine addiction.
Most patients with the emphysema utilize bronchodilators that dilate airways and decrease airflow resistance. Some bronchodilators are short-acting while others are long-acting. However, these drugs provide symptomatic relief, but do not stop the progression of the disease nor do they decrease mortality. Short acting Beta-2 agonists (SABA) relax bronchial smooth muscle (such as albuterol [Ventolin, Proventil, Proventil-HFA, AccuNeb, Vospire, ProAir], levalbuterol [Xopenex], and metaproterenol]).
Other forms are more long acting and usually need to be taken once or twice a day and include salmeterol (Serevent), indacaterol (Arcapta Neohaler), and formoterol (Foradil); often referred to as long acting Beta agonists, LABA.
Another long acting group of medications acting through a different mechanism of bronchodilation are called long acting muscarinic antagonists or LAMA. These include drugs like tiotropium and aclidinium.
Some patients have benefited from the use of theophylline (Respbid, Slo-Bid, Theo-24, Theolair); however because of its narrow therapeutic range and potential for toxicity, it is infrequently utilized.
Corticosteroids (for example, fluticasone [Flonase, Feramyst] or budesonide [Entocort EC, Uceris ER]) usually inhaled (ICS, inhaled corticosteroid) are used to decrease the inflammatory components of COPD/emphysema; they are usually added to the treatment protocol that includes a long – acting bronchodilator. Often these drugs are administered in combination, LABA and ICS and include Advair, Symbicort, Dulera, and Breo.
Roflumilast, a selective phosphodiesterase inhibitor, is used to improve shortness of breath and increase lung function in some people with emphysema, but most evidence shows that it can reduce exacerbations.
Finally, antibiotics are often used to treat the infections that frequently occur with people with COPD/emphysema because of the body's poor ability to keep mucous and other debris from blocking airways. The most utilized antibiotics are amoxicillin (Amoxil, Trimox, Moxatag, Larotid), doxycycline, trimethoprim/sulfamethoxazole (Bactrim, Septra), and azithromycin (Zithromax, Zmax). There is data supporting the use of chronic azithromycin to reduce COPD exacerbations, and that this may be more related to anti-inflammatory properties of this antibiotic and not so much its ability to kill bacteria.
Oxygen therapy may be an important part of therapy to help people improve their function and duration of their lives. Patients with moderate to severe emphysema should be tested to see if their oxygen levels fall to abnormal levels with sleep and exercise. If so, supplemental oxygen should be supplied. Many people with emphysema own personal finger oximeters that inform them when their oxygen levels drop, especially during exercise.
Medically Reviewed by a Doctor on 4/16/2014
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