What Are the Treatments for Emphysema?

Emphysema can’t be cured, but there are a number of treatments that relieve symptoms by making it easier for you to breathe. They can also prevent other problems and keep the disease from getting worse.

This article deals with some of the most common treatments. Which ones your doctor recommends will depend on how severe your symptoms are.

Bronchodilators

These drugs relieve symptoms by relaxing the muscles in the lungs and making the air passages wider. Bronchodilators often use an inhaler (“puffer”). They also come in pill or liquid form, but these don’t work as well as an inhaler, and they can have more side effects.

There are short-acting and long-acting bronchodilators. The short-acting drugs work faster but don’t last as long. The long-acting ones don’t work as fast, but they last longer. If your emphysema symptoms are mild, your doctor may recommend you take short-acting bronchodilators during flare ups. As your symptoms get worse, you may have to take daily doses of long-acting bronchodilators.

Bronchodilators come in two forms:

  • Anticholinergics stop the muscles around your airways from tightening. They also make it easier to clear mucus from the lungs.
  • Beta-agonists relax muscles around the airways.

Your doctor may prescribe short-acting beta-agonists only when you need them, to control your symptoms. They start working within 3 to 5 minutes and last 4 to 6 hours. But they may cause your heart to race. They can also cause shakiness and cramping in the hands, legs, and feet. These side effects can make you feel anxious. That, in turn, can make it harder for you to breathe.

Short-acting anticholinergics start working in about 15 minutes and last 6 to 8 hours. Long-acting forms of these drugs can take about 20 minutes to work and last up to 24 hours. The most common side effects of these drugs are dry mouth and difficulty peeing.

If you have advanced emphysema, your doctor may prescribe a long-acting inhaled bronchodilator. They’re used on a regular schedule to open your airways and keep them open.

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PDE-4 Inhibitors

Newer oral drugs called phosphodiesterase-4 (PDE-4) inhibitors have also proved to work in treating chronic obstructive pulmonary disease (COPD).

A number of clinical trials showed the PDE-4 drug Roflumilast improved lung function when used with bronchodilator therapy. Some studies found it also led to fewer flare-ups.

The FDA approved Roflumilast for bronchitis, not emphysema, but the two conditions often have similar symptoms.

Steroids and Combination Medicines

Steroids reduce swelling and mucus in your airways so you can breathe easier. Usually, you breathe them in with an inhaler.

Over time, steroids can have serious side effects, including weight gain, diabetes, cataracts, high blood pressure, weakened bones, and increased risk of infection.

Your doctor may recommend you use steroids along with beta-agonist or anticholinergic bronchodilators. This provides more benefits than using either drug alone. It’s also easier because you have one inhaler instead of two.

Mucolytics

These drugs help thin the mucus in your lungs so you can cough it up easier. Studies show using them can reduce flare-ups, especially if your emphysema is more severe.

Protein Therapy

Some people have an inherited form of emphysema that’s caused by a lack of the protein alpha-1 antitrypsin (AAT). Getting infusions of AAT can help slow down lung damage.

Oxygen Therapy

As your emphysema progresses, you may need extra oxygen to help you breathe on your own. Your doctor will prescribe how much oxygen you need and when you should be taking it. You can take supplemental oxygen in one of the following three ways:

  • Oxygen concentrator. This device removes other gases from the air and gives you near-pure oxygen. (Air normally contains 21% oxygen.)
  • Liquid system. This is supercooled, pure oxygen stored in a canister that looks like a thermos.
  • Oxygen cylinders. These contain 100% oxygen, stored under high pressure in large or small tank-like containers.

Vaccines

The flu vaccine doesn’t treat emphysema directly, but doctors recommend you get one every year. They also suggest you get a pneumonia shot every 5 to 7 years to prevent infection. If you have emphysema, you have higher odds of serious problems from flu and pneumonia.

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Surgery

There are a number of different types of operations for more serious cases of emphysema. They include:

  • Lung volume reduction surgery (LVRS). In this procedure, a surgeon removes part of one or both of your lungs. The goal is to take out your nonworking air sacs so it’s easier to breathe. This is major surgery, so your heart has to be strong and the rest of your lungs need to be healthy before you can have it. You’ll also need to quit smoking and complete a pulmonary rehabilitation program before the operation.
  • Bullectomy. In rare cases, air sacs in the lungs caused by emphysema grow larger and can press against healthy parts of the lung. These oversized sacs are called bullae. A bullectomy is surgery to remove them.
  • Lung Transplant. Lung transplants are possible for the most severe cases. This is a 6- to 10-hour surgery, after which you’ll be in the hospital for 8 to 21 days -- if there are no complications. The two biggest risks of the operation are infection and rejection of the transplanted organ.

New Treatments on the Horizon

Researchers are developing ways to treat severe cases of emphysema without major surgery. They include:

  • One-way valves. In this procedure, the doctor places valves in diseased parts of the lung. The valves block airflow and mucus to those areas so the healthy areas of the lung can work better.
  • Lung volume reduction coil treatment (LVRC). The doctor inserts straightened nickel-titanium coils into the lungs. There, they act as a spring that pulls together diseased areas, making them smaller. As with the one-way valve, the goal is to allow the healthy parts of the lung to work better.
  • Broncoscopic thermal vapor ablation (BVTA). This procedure reduces lung volume by using heated water vapor to cause scarring. It’s designed for people who have severe emphysema in the upper lobes of their lungs.
  • Airway bypass. Doctors place a stent, or tube, into severely diseased airways, allowing air that’s trapped in the lungs to escape. The stent also contains the drug paclitaxel to stop tissue growth inside the airways.
  • Targeted lung denervation (TLD). Researchers are also looking at removing certain nerves around the airways with this procedure. It targets nerves that make your muscles contract and produce too much mucus. A small pilot study found TLD was safe. Patients showed improvements, but researchers say more study is needed into this technique.
WebMD Medical Reference Reviewed by Paul Boyce, MD on March 14, 2019

Sources

SOURCES:

Tammy Wichman, MD, associate professor, pulmonary critical care, University of Nebraska Medical Center.

Yasufuku, K., Innovations in Thoracic Surgery, An Issue of Thoracic Surgery Clinics of North America, Elsevier, 2016.

Annals of Internal Medicine: “In the Clinic: Chronic Obstructive Pulmonary Disease.”

Medical Devices: “Technology update: bronchoscopic thermal vapor ablation for managing severe emphysema.”

International Journal of Chronic Obstructive Pulmonary Disease: “Role of mucolytics in the management of COPD.”

Thorax: “Targeted lung denervation for moderate to severe COPD: a pilot study.”

American Academy of Asthma, Allergy and Immunology: “Beta2-Agonists (Bronchodilators).”

Columbia University: “Emphysema and Chronic Obstructive Pulmonary Disease (COPD).”

American Lung Association “Managing Your COPD Medications.”

Cleveland Clinic: “Emphysema.”

Cleveland Clinic Center for Continuing Education: “Chronic Obstructive Pulmonary Disease.”

University of California San Francisco: “Emphysema Treatments,” “Lung Transplant.”

University of Massachusetts Medical School: “Therapeutic Class Overview Phosphodiesterase (PDE) 4 Inhibitors.”

National Health Service (United Kingdom): “Bronchodilators.”

American Thoracic Society: “Surgery for COPD,” “What is Alpha-1 Antitrypsan Deficiency?” “Oxygen Therapy,” “Medicines Used to Treat COPD.”

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