Emphysema natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Emphysema is an irreversible degenerative condition. The most important measure that can be taken to slow the progression of emphysema is for the patient to stop smoking and avoid all exposure to cigarette smoke and lung irritants.

Prognosis

Emphysema is an irreversible degenerative condition. The most important measure that can be taken to slow the progression of emphysema. Pulmonary rehabilitation can be very helpful to optimize the patient's quality of life and teach the patient how to actively manage his or her care.

Emphysema is also treated by supporting the breathing with anticholinergics, bronchodilators and (inhaled or oral) steroid medication, and supplemental oxygen as required. Treating the patient's other conditions including gastric reflux and allergies may also improve lung function. Supplemental oxygen used as prescribed (20+ hours/day) is the only non-surgical treatment which has been shown to prolong life in emphysema patients. Other medications are being researched. There are lightweight portable oxygen systems which allow patients increased mobility. Patients fly, cruise, and work while using supplemental oxygen.

Lung volume reduction surgery (LVRS) can improve the quality of life for certain carefully selected patients. It can be done by several different methods, some of which are minimally invasive. In July of 2006 a new treatment, placing tiny valves in passages leading to diseased lung areas, was announced to have good results- but 7% of patients suffered from partial lung collapse. The only known "cure" for emphysema is a lung transplant, although few patients are strong enough physically to survive the surgery. The combination of a patient's age, oxygen deprivation and the side-effects of the medications used to treat emphysema cause damage to the kidneys, heart and other organs. Transplants also require the patient to take an anti-rejection drug regimen which suppresses the immune system and creates other medical problems.

A study published by the European Respiratory Journal suggests that tretinoin (commercially available as Accutane, an anti-acne drug) derived from vitamin A can reverse the effects of emphysema in mice by returning elasticity (and regenerating lung tissue through gene mediation) to the alveoli.[1][2] While vitamin A consumption is not known to be an effective treatment or prevention for the disease, this research could in the future lead to a cure. A newer follow-up study done in 2006 found inconclusive results ("no definitive clinical benefits") using Vitamin A (retinoic acid) in treatment of emphysema in humans and stated that further research is needed to reach conclusions on this treatment.[3]

References

  1. Mao J, Goldin J, Dermand J, Ibrahim G, Brown M, Emerick A, McNitt-Gray M, Gjertson D, Estrada F, Tashkin D, Roth M (2002). "A pilot study of all-trans-retinoic acid for the treatment of human emphysema". Am J Respir Crit Care Med. 165 (5): 718–23. PMID 11874821.
  2. "Vitamin may cure smoking disease". BBC News. December 22, 2003. Retrieved 2006-11-18. Check date values in: |date= (help)
  3. Roth M, Connett J, D'Armiento J, Foronjy R, Friedman P, Goldin J, Louis T, Mao J, Muindi J, O'Connor G, Ramsdell J, Ries A, Scharf S, Schluger N, Sciurba F, Skeans M, Walter R, Wendt C, Wise R (2006). "Feasibility of retinoids for the treatment of emphysema study". Chest. 130 (5): 1334–45. PMID 17099008.



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