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Medical Edge Newspaper Column from Mayo Clinic EMPHYSEMA: BREATHE EASIER WITH THE RIGHT TREATMENT ANSWER: Hyperinflation refers to enlarged lungs that have impaired capacity to absorb oxygen and eliminate carbon dioxide. It is not a disease but a major effect of emphysema, in which inflammation causes the fragile walls of the lungs’ tiny air sacs (alveoli) to lose elasticity (the ability to properly contract). Air becomes trapped in the alveoli, which overstretches (hyperinflates) them and compromises the patient’s ability to exhale. Further, inflammation of the air sacs causes loss of elastic tissue and loss of total surface area, resulting in a smaller number of bigger spaces. Because these larger air sacs can’t force air out of your lungs as well as small ones can, you have to breathe harder to get enough oxygen into your blood. As emphysema progresses, shortness of breath and a reduced capacity for physical activity become more marked. It may be especially hard to breathe during and after respiratory infections such as influenza (the flu). It is no exaggeration to say that the cause of emphysema is smoking, which is responsible for some 90 percent of cases. This is actually an underestimate, as a good part of the remaining 10 percent comes from breathing secondhand smoke. Occupational exposure to noxious fumes — among welders, for example — can also be a cause, as can a rare genetic defect that reduces elasticity in the lungs. The most effective emphysema treatment, by far, is smoking cessation. Conducted more than a decade ago, the Lung Health Study showed that smokers who quit cigarettes developed severe chronic obstructive pulmonary disease (COPD) at one-sixth the rate of those who continued to smoke. (COPD is a more general class of illness; its two main members are emphysema and chronic bronchitis.) When researchers from Mayo Clinic and nine other centers followed the original study’s subjects after its completion, they found that the death rate among people who quit smoking was about half that of those who continued. Among treatments that manage COPD, a simple and effective approach is to prevent flare-ups through immunization against infectious diseases — specifically, an annual flu shot and a pneumonia shot (generally given once) that protects against several different strains of pneumococcal infection. Other drug-based approaches designed to keep symptoms in check include bronchodilators, which help relieve coughing, shortness of breath and breathing difficulty by opening constricted airways. There are long-acting bronchodilators — such as salmeterol (Serevent), formoterol (Foradil) and tiotropium (Spiriva) — taken once or twice a day to provide base protection, and short-acting bronchodilators such as albuterol (Proventil, Ventolin) and ipratropium (Atrovent). These latter medications are taken only as needed and last about three to four hours. Similarly, inhaled corticosteroids can reduce the frequency of flare-ups and relieve emphysema symptoms. It is important to note that if a patient has asthma — which is frequently confused with emphysema — it is essential that administration of long-acting bronchodilators be accompanied by the use of an inhaled corticosteroid to prevent severe exacerbations or even death. Obviously, patients must seek an accurate diagnosis. Other emphysema-relief treatments include oxygen therapy (delivered by home-based devices), pulmonary rehabilitation programs (exercises and other behavioral interventions), and, in severe cases, lung volume reduction surgery (in which removal of diseased lung tissue helps remaining tissue and the diaphragm to work more efficiently) and lung transplantation. On whether hyperinflation — emphysema — can lead to any other disorders, people with COPD have substantially greater risk of cardiovascular disease, stroke and lung cancer. Such heightened vulnerability underscores the need to quit smoking and be diligent about keeping emphysema under control. --- Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com. © 2006 TRIBUNE MEDIA SERVICES, INC. |
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