| Emphysema |
| Medication to Treat Emphysema |
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Emphysema
cannot be cured and, except for oxygen, does not respond to any
medication. However, emphysema is frequently associated with
bronchitis and asthma and the symptoms associated with these
processes often can be alleviated with medication, hence, you
can see the value of pulmonary function and other tests designed
to discover if there is asthmatic component present:
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Bronchodilator medication |
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Corticosteroids |
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Supplemental Oxygen |
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| Bronchodilator Medication |
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Bronchodilator medication may be prescribed for airway
tightness. Bronchodilators open the airways by relaxing the muscles
around the airways. Many people with emphysema find that breathing
is easier when they use bronchodilators. The most commonly prescribed
bronchodilators are beta2 agonists, the anti-cholinergic drug ipatropium
bromide, and theophylline. |
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 These are usually inhaled and include short-acting
drugs whose effects last from three to six hours such as albuterol
(Ventolin), terbutaline (Brethine, Brethaire, Bricanyl), metaproterenol
(Alupent, Metaprel) and pirbuterol (Maxair); these agents should
be used only for those occasions when immediate relief is necessary.
There are also very short-acting (one to two hours) not-beta2
agonists such as isoproterenol (Isuprel, Norisodrine, Medihaler-Iso);
these drugs have little use and probably should be avoided.
More recently, quite long acting agents (about 12 hours) have
been introduced. These new agents are salmeterol (Serevent)
and formoterol (Foradil). Because they are long acting and
prevent asthmatic attacks, they are typically taken twice a
day. Salmeterol should not be used for an acute attack because
it requires at least 30 minutes before it is active but formoterol
can be used for an acute attack |
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The
anticholinergic drug ipratropium (Atrovent) acts to relax
the bronchial muscles. It is a slow-acting drug with virtually
no side effects. The beneficial effects of Atrovent may be
difficult to appreciate because, like salmeterol, it requires
about 30 minutes before any significant change occurs. Anticholinergic
drugs, are often more effective in the asthma that is associated
with COPD than beta-2 agonists; the opposite is true in asthma
associated with allergy.
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Theophylline
(Theodur, Slo-bid, Uniphyl, Theo-24) also acts as a bronchodilator,
relaxing the muscles around the bronchioles and stimulating
the breathing process. Theophylline should be taken only
as prescribed, however, because overdoses of the drug can
be toxic (poisonous to the body). Signs of toxicity include
nausea, vomiting, headache, insomnia and seizure. A doctor
should be contacted immediately if any of these symptoms
occur. Because theophylline is a relatively weak bronchodilator
with potential serious side effects and many interactions
with other drugs and with foods, it is used relatively infrequently. |
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| Corticosteroids |
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 The
potent anti-inflammatory medications known as corticosteroids -
commonly called steroids - may be used to help lessen the inflammation
that often accompanies emphysema. These may be taken by mouth or
inhaled. Corticosteroids can help people with COPD by inhibiting
many of substances that cause airways to narrow.
Generally, these medications
are more effective for people with chronic bronchitis with or without
emphysema, and less effective for people with emphysema alone.
Long-term use of corticosteroids that are taken by mouth may produce
a variety of side effects that worsen as the dose increases |
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 Side effects include
the bone disease osteoporosis in both men and women, weight gain
and fat redistribution, high blood pressure, loss of lean muscle
mass, and, possibly, cataracts. As with all drugs, side effects
are less with inhaled forms, since the dose is much lower.
Short-term
administration of corticosteroids for seven to ten days during
an attack is often very useful and usually without significant
side effects. If it is necessary for corticosteroids to be administered
longer, many physicians feel that doubling the daily dose and
giving that as a single dose every other morning achieves the
same benefits with fewer side effects. |
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| Supplemental Oxygen |
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 Supplemental
oxygen can help a person who cannot get enough oxygen while breathing
normally. Depending on the degree of lung damage, the doctor
may suggest either continuous (24 hours a day) or activity related
(non-continuous) oxygen therapy.
There are three types of oxygen administration devices: compressed oxygen in tanks, liquid oxygen, and oxygen concentrators. With supplemental oxygen, you will have one of these oxygen delivery devices right in your home. Compressed and liquid oxygen can be portable and, therefore, are desirable for trips outside the home. Concentrators are powered by normal home electricity; most electric companies will adjust their charges for patients using concentrators. A long, thin tube connects to the oxygen delivery device. At the other end is either a two-pronged device that delivers oxygen to your nostrils, or a mask that is worn over your nose and mouth.
 Your doctor must write a prescription for oxygen therapy. The prescription will spell out the flow rate, how much oxygen you need per minute - referred to as litres per minute (LPM or L/M) - and when you need to use oxygen.
Some people use oxygen therapy only while exercising, others only while sleeping, and some need oxygen continuously. Your physician will either order an arterial blood or a non-invasive pulse oximeter test that will indicate what your oxygen level is and help determine what your needs are.
Continuous, long-term oxygen use is the only therapy that has been shown to lengthen the life of people who have low blood oxygen levels, or hypoxemia. Alertness, motor speed, and hand strength also improve with adequate oxygen therapy. |
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This section has eight pages. Use navigation strip to access other pages.
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Peter Scott - Team Leader
