New Developments
Medications
Progress is continually being made in the treatment of asthmatic
bronchitis, chronic bronchitis, and emphysema. A bronchodilator medication
(an anticholinergic), is available in metered-dose devices. The other
major type of inhaled bronchodilator is called a beta agonist. Both
medications can be used together. Both are sold in a metered-dose inhaler
(separately and mixed together for convenience). Since these
bronchodilators work on the respiratory system in different ways, they can
be used together to treat COPD.
A new treatment that may be effective in a rare hereditary form of
emphysema is being tested on volunteers. A replacement for the inherited
deficiency of alpha-one antitrypsin is commercially available. Although it
restores a protective material in the lungs, its effectiveness in
preventing the progression of emphysema remains to be proven.
Surgery that removes areas of major lung damage is called lung volume
reduction surgery (LVRS) and may make breathing easier for people with
emphysema. In some patients, this operation can improve shortness of
breath and quality of life. The mechanisms behind this improvement are
complex, but it is thought that by removing the overinflated and diseased
parts of the lungs, the diaphragm muscle may work better. The upper parts
of the lung (apices), are often the most destroyed parts.
The upper
lungs take up a lot of space for expansion of the rest of the relatively
normal lung but don’t play a very important part in breathing. Extensive
evaluations must be done through scans and tests of heart function to
determine if you are a good candidate for LVRS. At the present time,
Medicare does not reimburse for this operation. This may change, depending
on the results of the National Emphysema Therapy Trial (NETT). This trial
compares the results from lung surgery plus pulmonary rehabilitation to
pulmonary rehabilitation alone. The results of the NETT trial will be
known soon.
Qualified surgeons are now offering this operation to selected patients
on an individual basis when patients have ways to pay for the surgery
other than through Medicare. Patients should be evaluated by
pulmonologists and surgeons working together before going ahead with this
treatment.
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