Emphysema Treatment

Bronchodilators

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); however because of its narrow therapeutic range and potential for toxicity, it is infrequently utilized.

Corticosteroids

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.

Antibiotics

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

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.

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References
Medically reviewed by James E. Gerace, MD; American Board of Internal Medicine with subspecialty in Pulmonary Disease

REFERENCES:

CDC.gov. Leading Causes of Death.

American Lung Association. Trends in COPD (Chronic Bronchitis and Emphysema): Morbidity and Mortality. March 2013.

Tintinalli J, etal. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th edition. McGraw-Hill Professional 2010
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