Emphysema Treatments and drugs

The most important step in any treatment plan for smokers with emphysema is stopping smoking; it's the only way to stop the damage to your lungs from becoming worse. But quitting is never easy, and people often need the help of a comprehensive smokingcessation plan, which may include:

• A target date to quit
• Relapse prevention
• Advice for healthy lifestyle changes
• Social support systems
• Medications, such as nicotine gum or patches and the prescription medications bupropion hydrochloride (Zyban) and varenicline (Chantix)

Nicotine replacement products and prescription medications may help curb the irritability, depression and sleep problems that can occur during the first few weeks after quitting smoking.

Other emphysema treatments, which focus on relieving symptoms and preventing complications, include:

• Bronchodilators. These drugs can help relieve coughing, shortness of breath and trouble breathing by opening constricted airways, but they're not as effective in treating emphysema as they are in treating asthma.
• Inhaled steroids. Corticosteroid drugs inhaled as aerosol sprays may relieve symptoms of emphysema associated with asthma and bronchitis. Although inhaled steroids have fewer side effects than oral steroids do, prolonged use can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes.
• Supplemental oxygen. If you have severe emphysema with low blood oxygen levels, using oxygen at home may provide some relief. Various forms of oxygen are available as well as different devices to deliver them to your lungs. Talk with your doctor about which is best for you and about oxygen distributors in your area. Your dealer can set up your equipment, instruct you on care and maintenance, and provide follow-up visits.
• Protein therapy. Infusions of AAt may help slow lung damage in people with an inherited deficiency of the protein.
• Antibiotics. Respiratory infections such as acute bronchitis, pneumonia and influenza are a leading complication of emphysema; infections increase the amount of sputum you produce and make breathing problems worse. Broad-spectrum antibiotics may help relieve these symptoms, but should be used with caution to avoid the serious and growing problem of antibiotic-resistant bacteria.
• Inoculations against influenza and pneumonia. If you have emphysema or other forms of COPD, experts recommend an influenza (flu) shot annually and a pneumonia shot every five years after age 65.

• Surgery. In a procedure called lung volume reduction surgery (LVRS), surgeons remove small wedges of damaged lung tissue. Although it seems counterintuitive to treat diminished lung capacity by further reducing the size of the lungs, the extra space that's created in the chest cavity appears to help the remaining lung tissue and diaphragm work more efficiently.

  A large clinical trial called the National Emphysema Treatment Trial showed that LVRS could improve the lung function of certain people with severe emphysema. Those who benefited had emphysema in the upper lobes of their lungs and a low exercise capacity even after undergoing several weeks of pulmonary rehabilitation.

  Improvement in lung function was greatest the first six months after the procedure. After that, lung function gradually declined. By the two-year mark, the lung function in many people was about the same as it was before surgery. If you have severe emphysema and think you may be a candidate for LVRS, discuss the risks and benefits of the operation with your doctor.

• Transplant. Lung transplantation is an option if you have severe emphysema and other options have failed.

• Pulmonary rehabilitation program. A key part of treatment involves a pulmonary rehabilitation program, which combines education, exercise training and behavioral intervention to help restore you to the highest possible level of independent living.

  You'll receive help with smoking cessation and your nutritional needs, and you may learn special breathing techniques and ways to conserve energy. You'll also be given an exercise program that's appropriate for you. This may include aerobic exercises, such as walking and riding an exercise bike, as well as special exercises for your arms and legs.