In the U.S., 2 million people suffer with emphysema, a long-term, progressive disease that causes irreversible lung damage. Emphysema and chronic bronchitis are the two most common conditions that make up chronic obstructive pulmonary disease (COPD). Around 150,000 Americans die from COPD each year. That’s about one death every four minutes.
To relieve its debilitating symptoms, emphysema treatment options have evolved from medications and surgery to new minimally invasive implants. Over two dozen American and European hospitals participating in a new study are treating severe emphysema patients with nonsurgical devices to help them breathe easier.
How Lung Damage Occurs
Smoking is the leading cause of emphysema. It’s most likely to develop with cigarette use, but cigar and pipe smokers also are susceptible. Your risk increases with the number of years and amount of tobacco you smoked. Long-term exposure to airborne irritants including second-hand tobacco and marijuana smoke, air pollution, coal and silica dust as well as manufacturing fumes also can cause emphysema.
A typical pair of human lungs contains about 700 million clustered air sacs (alveoli) that resemble bunches of grapes. Emphysema causes the inner walls of these spherical alveoli to weaken gradually. Your air sacs rupture eventually, creating one larger air space instead of many small ones. This reduces the surface area of your lungs and the amount of oxygen that reaches your bloodstream. The elastic fibers that open the small airways leading to your air sacs also face slow destruction.
Recognizing Emphysema’s Gradual Symptoms
According to the Mayo Clinic, you can have emphysema for years before symptoms begin. It impairs or destroys your lung tissue involved in the exchange of oxygen and carbon dioxide gases. When you exhale, your damaged alveoli don’t work properly.Trapped old air doesn’t leave room for fresh, oxygen-rich air to enter your lungs. It also causes your lungs to overinflate. Severe hyperinflation, or big lungs, impairs how your lungs, heart, chest wall and breathing muscles work.
Because of difficulty expelling air, you become progressively short of breath. Severe symptoms like breathlessness, cough and mucus production limit your ability to perform normal daily activities. Exercise is often too much of a strain. Eventually, you struggle to breathe — even when you’re resting.
The first step for emphysema patients is to quit smoking. If you need help, your doctor can prescribe a smoking cessation drug like Chantix (Varenicline). Standard emphysema medications include Qvar (Beclomethasone), an oral aerosol inhaler. Its small corticosteroid particles relieve inflammation in your lungs and open airways that make breathing difficult. Therapies like pulmonary rehabilitation and supplemental oxygen also can help.
If your case is severe, your doctor may recommend lung volume reduction surgery. Cutting out 50 percent of both upper lobes can reduce hyperinflation. Making your lung and chest cavity smaller encourages your breathing muscles and chest wall to work better. The National Emphysema Treatment Trial of 1,218 advanced emphysema patients discovered that certain subjects with specific anatomy experienced survival improvements that could be durable for up to 17 years in follow-up. In carefully selected patients, this disease-modifying therapy improves outcomes and survival.
Introducing Lung Volume Reduction Coils
U.S. investigators are testing various new bronchoscopic techniques that make the lungs smaller without surgery. A current multi-center study is evaluating a new minimally invasive therapy that could improve breathlessness. It involves small, elastic, shape-memory coils made of a common medical implant metal.
Using a bronchoscope, doctors deliver 10 tiny RePneu Lung Volume Reduction Coils into each diseased lung. The coils are straight during insertion into targeted areas based on a CAT scan. After placement, they bounce back to their original shape. These devices compress the lung tissue to help restore elasticity. Re-tensioning healthier portions of each lung increases its recoil to expand and tighten the small airways, which facilitates emptying the lung.
This procedure helps each lung inflate and deflate more effectively, improving airway function and breathing — both at rest and during exercise. In just one hour, patients in early trials felt an average of 18 percent improvement in lung function. That’s an improvement in the ability to complete six-minute walk tests of about a quarter of a mile. Participants also reported decreased breathlessness and improved quality of life.
The ongoing study aims to recruit 315 patients in 30 European and American centers. Clinical trials began in Europe in 2009 and opened in the U.S. in 2013. Study patients receive two sets of coils four months apart. Each implant procedure takes less than an hour. The multi-center study is currently enrolling patients all over the country. Learn more if you want to participate.
While this coil procedure can improve your quality of life, it’s not a cure. Like all treatments, it can only slow the progression of emphysema. It can’t reverse the damage, but it can postpone your need for a possible lung transplant.
When to Seek Medical Attention
See your doctor if you’ve had unexplained shortness of breath for several months, especially if it’s getting worse or interfering with your daily activities. Don’t try to attribute it to your age, weight or being out of shape.
Immediate medical attention is necessary if you’re so short of breath that you can’t speak or climb stairs, exertion turns your lips or fingernails blue or gray or you lose your normal mental alertness. Diagnosis and treatment can reduce your symptoms and make life worth living again.