Emphysema is a chronic lung condition that causes shortness of breath. It is a form of chronic obstructive pulmonary disease (COPD) and is caused by damage to the alveoli (air sacs) in the lungs. As emphysema progresses, the inner walls of the air sacs weaken and rupture, creating one larger air space instead of many small ones. This reduces the surface area available for gas exchange, making it harder to breathe.
There is currently no cure for emphysema, but various treatments can help relieve symptoms and slow the progression of the disease. The main goals of emphysema treatment are to:
- Relieve shortness of breath and improve quality of life
- Slow disease progression
- Prevent and treat complications
- Improve exercise tolerance
The latest emphysema treatments focus on lung volume reduction, new bronchoscopic procedures, advanced medications, oxygen therapy, pulmonary rehabilitation, and lifestyle changes like quitting smoking.
Lung Volume Reduction
Lung volume reduction surgery (LVRS) is a procedure that removes damaged lung tissue to allow healthier parts of the lungs to expand and work better. Studies have found that properly selected patients can see reduced shortness of breath and improved exercise capacity from LVRS.
However, LVRS is a major procedure and does carry risks of complications. Less invasive bronchoscopic lung volume reduction (BLVR) procedures have been developed in recent years. BLVR uses a bronchoscope (thin, flexible tube with a camera) inserted through the mouth or nose to place tiny one-way valves inside the airways to block off the worst areas of emphysema and reduce lung volume.
The two main types of BLVR procedures are:
- Endobronchial valve placement – One-way valves are placed in the airways to allow air to escape, but prevent air from entering the diseased portion of the lung. This causes the blocked area to collapse.
- Lung coils – Nitinol coils are placed in the airways to compress diseased lung tissue.
Studies show BLVR can provide benefits similar to LVRS with shorter recovery times. Patients experience less shortness of breath and can be physically active for longer periods.
Advanced Bronchoscopic Procedures
In addition to BLVR, other new minimally invasive bronchoscopic procedures are being studied for emphysema treatment:
- Targeted lung denervation – The nerves that signal the airways to constrict are disrupted so the airways remain open.
- Biologic lung volume reduction – Sealants or valves containing substances that cause localized inflammation and scarring to shrink areas of lung are placed bronchoscopically.
- Bronchial thermal vapor ablation – Heat energy is applied inside the airways to damage lung tissue and reduce hyperinflation.
These techniques can improve breathing with shorter recovery times than traditional surgery. More research is needed to compare the effectiveness and safety of the different procedures.
Medications
Inhaled medications are commonly used to treat emphysema symptoms:
- Bronchodilators – Help relax the muscles around airways and improve airflow. Types used include beta-agonists like albuterol and anticholinergics like ipratropium and tiotropium.
- Inhaled steroids – Reduce airway inflammation. Examples include beclomethasone, budesonide, fluticasone.
- Combination inhalers – Contain both a bronchodilator and corticosteroid to improve efficacy.
Roflumilast and other oral phosphodiesterase-4 inhibitors are newer medications that target inflammation underlying COPD. Studies show they can modestly improve lung function and reduce exacerbations.
Antibiotics may be prescribed during symptom flare-ups to treat bacterial lung infections that often aggravate COPD.
Emerging Medications
Researchers are studying new drug treatments to better manage emphysema, including:
- CXCR2 antagonists to reduce neutrophilic inflammation
- Drugs that inhibit TGF-beta signaling to slow tissue remodeling
- Stem cell therapies to repair lung damage
While no new medications have been approved specifically for emphysema in recent years, better targeting of the underlying disease processes may lead to new treatment options in the future.
Oxygen Therapy
Many people with emphysema eventually require supplemental oxygen as the disease progresses and their blood oxygen levels drop. Oxygen therapy has proven benefits:
- Relieves shortness of breath
- Improves mental alertness and sleep quality
- Enhances exercise capacity
- Slows progression of cor pulmonale (right heart failure due to COPD)
- Prolongs survival in people with severe resting hypoxemia
Oxygen can be delivered through nasal prongs, a mask or transtracheal catheter. A portable oxygen concentrator allows more freedom for activities outside the home.
Liquid Oxygen Systems
For some emphysema patients requiring high-flow supplemental oxygen, portable liquid oxygen systems provide an alternative to compressed gas cylinders. Liquid oxygen converts to a gas as it passes through a vaporizer for delivery through a nasal cannula.
Benefits of portable liquid oxygen include:
- Lightweight and easy to maneuver
- No need to refill oxygen tanks
- Allows higher flow rates than portable oxygen concentrators
Pulmonary Rehabilitation
Pulmonary rehabilitation combines exercise training, education and counseling to improve physical fitness and quality of life in COPD patients. Programs are typically 6-12 weeks long and tailored to each person’s needs.
Pulmonary rehab has been shown to:
- Increase exercise capacity
- Improve shortness of breath
- Reduce anxiety and depression
- Decrease COPD hospitalizations
A maintenance program after completing pulmonary rehab can help sustain benefits. Tai chi, yoga and other breathing control techniques can also help manage COPD symptoms.
Lifestyle Changes
Making healthy lifestyle changes can help people with emphysema breathe easier:
- Quit smoking – Stopping smoking is critical to prevent faster progression of emphysema.
- Avoid lung irritants – Steer clear of air pollution, chemical fumes and dust when possible.
- Eat healthy – Choose fruits, vegetables, whole grains and lean proteins. Being overweight strains breathing.
- Exercise – Staying active improves fitness levels, just pace yourself. Walking and water workouts are good options.
- Practice good breathing habits – Techniques like pursed lip breathing can help you inhale and exhale more efficiently.
- Get vaccinated – Flu and pneumonia vaccines help prevent dangerous respiratory infections.
Making these changes part of your daily routine can help minimize emphysema symptoms.
Conclusion
While there is currently no cure for emphysema, new treatments are helping improve quality of life and slow progression of the disease. Bronchoscopic lung procedures provide benefits similar to surgery with shorter recovery times. Combination inhalers and emerging oral medications more effectively reduce inflammation and open airways. Lifestyle changes like smoking cessation, exercise and pulmonary rehab are key parts of emphysema management.
Research continues on better medications to repair lung damage and target the underlying disease processes. With more advanced treatments on the horizon, the future looks brighter for people suffering from emphysema.