Airway Bypass: Treatment Option for Emphysema Lung Disease

Airway Bypass: Treatment Option for Emphysema Lung Disease

Long-term exposure to air pollution, both in the home and outdoors, is known to increase the risk of chronic respiratory illness in children. Chronic respiratory diseases are asthma, chronic cough, chronic bronchitis, emphysema and chronic obstructive airways diseases.Probably the most important exposures are to environmental tobacco smoke, but in many developing countries domestic cooking and heating are also serious sources of exposure. Ambient air pollution, from industry and – increasingly – road traffic, as well as exposures to a wide range of other indoor risk factors, such as pets, house dust and dust mite, are also important in some populations.

These various exposures contribute – along with a wide range of other factors – to several chronic illnesses in children, including asthma, chronic
bronchitis, chronic obstructive airways disease (COAD) and emphysema.Chronic obstructive pulmonary (or lung) disease (COPD or COLD) is caused by emphysema or chronic bronchitis. COPD can cause high blood pressure in the lungs. The result is a progressive enlargement of the lungs with poor function of the muscles utilized to breathe. This is associated with increasing shortness of breath on exertion.

Unlike asthma, which occurs when the muscles in your airways tighten, emphysema causes a loss of elasticity in the walls of the small air sacs in your lungs. Eventually, the walls stretch and break, creating larger, less efficient air sacs that aren't able to handle the normal exchange of oxygen and carbon dioxide.Both heart rate and breathing rate increase as the body tries to send more oxygen to its tissues. At very high altitudes, body fluid can leak into the brain (called brain or cerebral edema) or into the lungs (pulmonary edema). Both these conditions can be serious or even life-threatening.

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. 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.

Cigarette smoking is the main cause of emphysema. An inherited disorder (passed down from parents) called alpha-1 antitrypsin deficiency, or AAT deficiency, can also cause emphysema. If you are a smoker AND have this genetic disorder, the lungs become damaged more quickly. It is clear from the foregoing findings that emphysema, especially in smoking subjects, was mainly associated with oxygen- derived free radicals that damage lipids in peribronchiolar alveoli of the lung tissues accompanied with elevation in total lipid, triglyceride, total cholesterol, LDL-C levels, that may lead to the high risk of heart diseases.

Cigarette smoke can damage the cells in your lungs. As the air sacs in your lungs (alveoli) become damaged, it gets harder for you to breathe out carbon dioxide after you breathe in air. This means more carbon dioxide stays in your lungs and you have less room for oxygen to be breathed in. Once this damage occurs, it does not go away.

Smoking cessation is the most important and effective treatment. Only quitting smoking can stop the progression of lung damage once it has started. Medications used to improve breathing include bronchodilators (hand-held inhaler or nebulizer), diuretics, and corticosteroids. Antibiotics may be prescribed when respiratory infections occur. Influenza (flu) vaccines and Pneumovax (pneumonia vaccine) are recommended for people with emphysema.

Asthma medicines can make it easier for you to breathe. Ipratropium (Atrovent) is a commonly prescribed asthma inhaler. Other inhaled or oral asthma medicines may also be prescribed.

For times when you are feeling especially bad, other medicines such as antibiotics or steroids may be given for a short time. Steroids are available in forms that may be inhaled or taken by mouth.

Surgery,also called lung volume reduction surgery (LVRS), surgeons remove small wedges of damaged lung tissue. Although it seems counterintuitive to treat diminished lung capacity by further reducing the size of the lungs, the extra space that's created in the chest cavity appears to help the remaining lung tissue and diaphragm work more efficiently.

While oxygen therapy is often recommended for patients with emphysema, pulmonary specialists and thoracic surgeons evaluate patients with a severe form of the disease for reduction pneumoplasty or lung volume reduction surgery.The per-patient cost of the adoption of lung-volume–reduction surgery will be high in the short run. The effect of the use of such surgery on national health care expenditures will depend on the fraction of the estimated 2 million people with emphysema who meet the criteria for eligibility and are willing to undergo the procedure, which at present is unknown.

Researchers are studying an experimental airway bypass treatment to help people with emphysema breathe easier.

The EASE (Exhale Airway Stents for Emphysema) study will examine a treatment that involves creating pathways in the lung for trapped air to escape, which, in turn, may relieve shortness of breath and other symptoms of emphysema, said the researchers at the University of Pennsylvania School of Medicine.

"There are limited treatment options right now for these patients who struggle for each breath. This new, cutting-edge, non-surgical procedure actually creates new pathways for airflow and could offer another option for those who would otherwise possibly spend years waiting on a lung transplant list," principal investigator Dr. John Kucharczuk, a thoracic surgeon and assistant professor of surgery, said in a prepared statement.

The new small pathways in the lungs are created by using a special kind of needle. Stents are then inserted to keep the new air passages open. The procedure was developed at the University of Pennsylvania. The international, multi-center EASE study is currently enrolling patients. Call 1-866-431-3273 to learn more about the study.

Emphysema, most often caused by smoking, affects more than three million people in the United States and about 60 million people worldwide. The chronic, progressive and irreversible lung disease is characterized by the destruction of lung tissue.


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