Emphysema

Medications To Treat Emphysema

Emphysema cannot be cured and does not respond to any medication other than oxygen. 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:

Need To Know:

Often people with emphysema become suddenly worse. Increasing symptoms which include cough productive of discolored sputum, fever, and increased shortness of breath suggest the presence of an infection and are often treated with antibiotics, though this is still somewhat controversial. Some physicians treat these attacks with corticosteroids and do not administer antibiotics.

Bronchodilator Medication

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.

  • Beta2 agonists 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.
  • 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.
  • 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.

    Need To Know:

    Coffee drinkers need to use caution if they take theophylline to treat their emphysema. Caffeine intake should be limited to the equivalent of no more than six cups of coffee per day, because caffeine is chemically similar to theophylline and could increase theophylline activity, causing toxic side effects. Caffeine is found not only in coffee, but also in chocolate, cola, and certain teas.

Corticosteroids

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 withchronic obstructive pulmonary disease 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.

For more information about bronchitis, go to Bronchitis.

Long-term use of corticosteroids that are taken by mouth may produce a variety of side effects that worsen as the dose increases. 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 7-10 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.

How-To Information:

Both beta2 agonists and corticosteroids usually come in a metered-dose inhaler (MDI), and pills. MDIs are a convenient way to take inhaled medication. However, most users of the drugs do not experience their full benefits because they do not use the inhaler properly. Here are some tips on how to make sure you’re getting the most out of your medication.

First, carefully read the instructions that came with the metered-dose inhaler. Check the label to make sure the drug is the correct one and that the expiration date has not passed.

Then carefully follow these steps for using an inhaler:

  1. Remove the cap, hold the inhaler upright, and shake the inhaler.
  2. Tilt your head back slightly and breathe out all your air without forcing it.
  3. Place the MDI in your mouth and close your lips tightly around the mouthpiece.
  4. Press down once on the inhaler to release the medicine. At the same time, start to breathe in slowly (some instructions may refer to this as a “puff”).
  5. Continue to breathe in slowly for three to five seconds. The long, slow inhalation allows more medicine to go into your lungs.
  6. Hold your breath for 10 seconds to allow the medicine to settle onto your airways.
  7. Repeat puffs as directed by your doctor. Wait one minute between puffs to allow the next puff to get into your lungs better.
  8. If you use a spacer, wash it and the MDI mouthpiece once a week.

If you use inhaled dry powder capsules, close your mouth tightly around the mouthpiece of the inhaler and breathe in quickly. Most of these devices have a counter for the number of inhalations used.

Supplemental Oxygen

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’ll 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.

The tube should be long enough to allow you to move about your home. If you need to go out, portable oxygen tanks with either compressed or liquid oxygen are available. An oxygen supply company will deliver the oxygen to you and replenish your supply when necessary.

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 liters 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.

Need To Know:

Oxygen in tanks is a fire hazard. You should never smoke or burn a candle near someone who is on oxygen. Keep the oxygen far away from fireplaces or wood-burning stoves. Oxygen is not explosive but it makes fires burn faster and hotter.

Oxygen, particularly when used continuously, is expensive. Therefore, insurance companies usually follow Medicare guidelines which require that oxygen be below certain levels before authorizing payment.

 

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