Chronic Obstructive Pulmonary Disease (COPD) and Emphysema

COPD stands for chronic obstructive pulmonary disease. Emphysema is a form of COPD.

Causes | Emphysema | vs Asthma | Medical Treatment | Pulmonary Rehab | Surgery | Next Steps

Key Info

• COPD is a group of diseases that cause damage to the lungs and restrict their ability to obtain oxygen, restricting oxygen flow in the blood.
• Medical and rehabilitation programs and therapy are available to patients with COPD to help them combat their symptoms
• Surgical treatments for COPD include lung volume reduction surgery and lung transplantation

Over 15 million Americans have been diagnosed with COPD. Evidence suggests that another 15 million have COPD but remain undiagnosed. COPD is presently the third leading cause of death in this country and the 2nd leading cause of disability.

Causes of COPD

Most COPD is related to cigarette smoking, but recent evidence suggests that 25% of those with COPD never smoked. Increasingly environmental factors are felt to play a role in the development and worsening of COPD. There is also an inherited form of COPD called alpha-1 antitrypsin deficiency.

All COPD is not the same. There are those with more of a chronic bronchitic form of COPD and some with a more emphysematous form, meaning it is related to emphysema.

Emphysema

Emphysema is a progressive, destructive lung disease in which the walls between the tiny air sacs are damaged. As a result, the lungs lose their elasticity causing exhalation, or breathing out, to become more and more difficult. Air remains trapped in the overinflated lungs, leading to progressive shortness of breath.

COPD vs Asthma

COPD and asthma are both obstructive lung diseases marked by shortness of breath but asthma is by definition reversible while with COPD the airflow obstruction is either irreversible or only partly reversible. The mainstay of therapy in asthma is inhaled corticosteroids while in COPD it is long acting bronchodilators. Over time some asthmatics may develop an irreversible component, a variant of COPD. Because both are common diseases they can occur together. Estimates suggest that as many as 20% of COPD patients have ACOS, the asthma/COPD overlap.

Medical Treatments for COPD

Treating and preventing exacerbations—or flares of disease—are critical factors in managing COPD. People with frequent exacerbations (2 or more a year), have a more rapid deterioration in lung function, more frequent hospitalizations, and higher mortality.
There are many medical options for treating emphysema/COPD.

Smoking Cessation

• The primary recommendation for preventing and treating COPD is to stop smoking.

Bronchodilators

• Bronchodilators relax the muscles of the bronchi, the major air passageway in the lungs. This allows air to get in and out easier. These medications are available in pill or liquid form (taken orally), or as an aerosol spray (inhaled).

Steroids

• Steroids are powerful anti-inflammatory medications. The only role for systemic steroid therapy in COPD is for 5-10 days during an acute exacerbation. Longer term treatment with systemic steroids in COPD has not been shown to have any benefit and can carry significant risks. The potential side effects of long term systemic steroid use include osteoporosis, diabetes, weight gain, cataracts, muscle weakness, cataracts, and hypertension.

Anti-Infective Agents

• Antibiotics are frequently used during acute bronchitis to fight bacterial infections. Flu and pneumonia vaccinations are recommended for all patients with COPD. The influenza shot is administered yearly while the pneumonia shot is administered every five years.

Oxygen Therapy

• Oxygen therapy in patients with a resting O2 saturations less than or equal to 88% has been shown to improve quality of life and survival.

Nutrition

• Proper nutrition is critical for emphysema patients. Weight loss, which is common in patients with advanced emphysema, can be caused by inadequate food intake in individuals too short of breath to eat. However, most weight loss in COPD patients is due to the increased metabolic demand of respiratory muscles that are overworked because of emphysema damage.

Pulmonary Rehabilitation for COPD

Pulmonary rehabilitation has clear benefits for patients with COPD. Exercise increases endurance, improves shortness of breath, increases maximal oxygen consumption, and improves quality of life. Numerous studies have documented improvement in symptoms, maximum oxygen consumption, and quality-of-life measures. A decrease in the number of hospitalizations has also been shown in patients who participate in pulmonary rehabilitation programs.

Benefits do vary among individuals, however, and consistent participation in an exercise regimen is necessary to maintain improvements. In addition, it has not been shown that pulmonary rehabilitation produces any change in pulmonary function tests (PFTs) or overall oxygen requirements for individuals.

Surgical Treatment for COPD

If medical treatment does not alleviate the symptoms of COPD, or symptoms and exacerbations increase, surgery may be an option. However, in order to be a candidate for surgery, there are specific criteria. These include not being a current smoker, participating in a pulmonary rehabilitation program, and being strong enough to receive surgery.

There are two types of surgery performed for COPD, Lung Volume Reduction Surgery and Bullectomy.

• Lung Volume Reduction Surgery involves removing parts of the lung that are most affected by COPD. Removal of lung tissue seems counterintuitive, but it allows the remaining, healthy parts of the lung function more efficiently.
• Bullectomy involves the removal of bullae from the lungs. Bullae are large air sacs in the lungs that form when a large number of alveoli are destroyed by COPD. These air sacs interfere with breathing.

If damage to the lungs is too severe or surgery does not alleviate symptoms, a doctor may recommend a lung transplant.

Next Steps

If you need help for a lung or chest issue, we’re here for you. Call (212) 305-1158 or request an appointment online to get started today.

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Symptoms, stages, causes, treatments, and outlook

Emphysema is a type of chronic obstructive pulmonary disease (COPD). In this condition, the air sacs in the lungs become damaged and stretched. This results in a chronic cough and difficulty breathing.

Smoking is the most common cause of emphysema, but other factors can also cause it. There is currently no cure, but quitting smoking can help improve the outlook.

In the United States, around 3.8 million people (1.5% of the population) have received a diagnosis of emphysema. In 2017, 7,085 people (2.2 people in every 100,000) died with the condition.

Keep reading to learn more about emphysema, including the causes, symptoms, and treatment options.

Emphysema is a type of COPD. With emphysema, lung tissue loses elasticity, and the air sacs and alveoli in the lungs become larger.

The walls of the air sacs break down or are destroyed, narrowed, collapsed, stretched, or over-inflated. This means that there is a smaller surface area for the lungs to take oxygen into the blood and remove carbon dioxide from the body.

This damage is permanent and irreversible, but there are ways of managing the condition.

The key symptoms of emphysema include:

• shortness of breath, or dyspnea
• a chronic cough that produces mucus
• wheezing and a whistling or squeaky sound when breathing
• tightness in the chest

At first, a person may notice these symptoms during physical exertion. However, as the condition progresses, they can also start to happen during rest.

Emphysema and COPD develop over a number of years.

In the later stages, a person may have:

• frequent lung infections and flare-ups
• worsening symptoms, including shortness of breath, mucus production, and wheezing
• weight loss and reduced appetite
• fatigue and a loss of energy
• blue-tinged lips or fingernail beds, or cyanosis, due to a lack of oxygen
• anxiety and depression
• sleep problems

Learn more about late stage COPD here.

The Emphysema Foundation of America have expressed concern about how COVID-19 might affect people with emphysema.

They urge people with COPD to familiarize themselves with the symptoms of COVID-19. These can resemble the symptoms of COPD and emphysema. A person should contact their doctor if they have any unusual symptoms or a high fever.

They recommend taking full precautions to avoid exposure to the virus, including:

• frequently washing the hands and encouraging others to do the same
• avoiding people who may have had contact with the virus
• frequently wiping surfaces
• wearing a face covering such as a mask in public places
• avoiding crowded gatherings

They also advise:

• maintaining at least a 30-day supply of medication
• keeping a stock of household necessities, including food and other basics
• checking with local providers about plans to maintain oxygen supplies
• making a plan in case of sickness

Learn more about CODID-19 and COPD here.

The Global Initiative for Chronic Obstructive Lung Disease sets out the stages of COPD.

Generally, the stages are based on a combination of airflow limitation, symptoms, and exacerbations.

A doctor can use a breathing test to measure lung capacity. The test measures the forced expiratory volume in 1 second (FEV1).

Based on FEV1, the stages are as follows:

• Very mild, or stage 1: FEV1 is about 80% of normal.
• Moderate, or stage 2: FEV1 is 50–80% of normal.
• Severe, or stage 3: FEV1 is 30–50% of normal.
• Very severe, or stage 4: FEV1 is less than 30% of normal.

The stages help describe the condition, but they cannot predict how long a person is likely to survive. Doctors can carry out other tests to learn more about how serious a person’s condition is.

In most cases, emphysema and COPD result from cigarette smoking. However, up to 25% of people with COPD have never smoked.

Other causes appear to be genetic factors, such as an alpha-1 antitrypsin deficiency, and exposure to environmental irritants, including secondhand smoke, workplace pollutants, air pollution, and biomass fuels.

People with small airways in proportion to their lung size may be more at risk than those with wider airways, according to a 2020 study.

In addition, not all people who smoke develop emphysema. It may be that genetic factors make some people more susceptible to the condition.

Emphysema is not contagious. One person cannot catch it from another.

Treatment cannot cure emphysema, but it can help:

• slow the progress of the condition
• manage the symptoms
• prevent complications
• boost a person’s overall health and well-being

Supportive therapy includes oxygen therapy and help with quitting smoking.

The sections below will look at some specific treatment options in more detail.

Drug therapies

The main medications for emphysema are inhaled bronchodilators, which can help relieve symptoms. They relax and open the airways, making it easier for a person to breathe.

The inhaler delivers the following bronchodilators:

• beta-agonists, which relax bronchial smooth muscle and help clear mucus
• anticholinergics, or antimuscarinics, such as albuterol (Ventolin), which relax bronchial smooth muscle
• inhaled steroids, such as fluticasone, which help reduce inflammation

If a person uses them regularly, these options can improve lung function and increase exercise capacity.

There are short-acting and long-acting drugs, and people can combine them. Treatment may also change over time and as the condition progresses.

Lifestyle therapies

People can take steps to manage their symptoms, improve their quality of life, and slow the progression of emphysema. The sooner a person takes these steps, the more helpful they will be.

Some things to try include:

• quitting or avoiding smoking
• avoiding places where there are air pollutants, if possible
• following or developing an exercise program
• consuming a healthful diet
• drinking plenty of water, to loosen mucus and help keep the airways open
• breathing through the nose in cold weather or using a face covering to keep out cold air
• practicing diaphragmatic breathing, pursed-lip breathing, and deep breathing

Pulmonary rehabilitation is a program of care that encourages people with emphysema to learn about and manage their condition. There is a focus on developing and maintaining healthful lifestyle choices.

Making these changes may not alter the overall course of the condition, but it can help people manage the symptoms, improve their exercise capacity, and boost their quality of life.

People should also ensure that they meet with their healthcare provider regularly and receive their routine vaccinations, including those for flu and pneumonia.

Oxygen therapy

In time, breathing can become more difficult, and a person may need oxygen therapy some or all of the time. Some people use oxygen overnight, for example.

Various devices are available, including large tanks for home use and portable oxygen kits for traveling.

People should discuss the most suitable options with their healthcare provider.

Surgery

People with severe emphysema may sometimes need to undergo surgery to remove damaged lung tissue and reduce large spaces that develop in the lungs due to the condition.

Transplantation of one or both lungs can improve a person’s quality of life. However, there are some risks involved, such as the chance of infection.

A healthcare provider will help the person decide whether or not surgery is a good idea for them.

Treating exacerbations

Other treatment options can help during a flare-up or if complications arise. These options may include:

• oxygen therapy, to relieve worsening symptoms
• antibiotics, to treat a bacterial infection
• corticosteroid drugs, to reduce inflammation
• other medications, to relieve severe coughing and pain

The outlook for a person with emphysema will depend on individual factors and how well they manage their condition. It takes several years to progress to the final stages of COPD or emphysema, but lifestyle factors play a role.

Quitting smoking can significantly improve the outlook. According to the National Heart, Lung, and Blood Institute, COPD can progress quickly in people with alpha-1 antitrypsin deficiency who also smoke.

Research suggests that for those who have never smoked, COPD will modestly reduce their life span. People who do smoke, however, can expect their life span to be significantly shorter.

Emphysema and COPD affect not only life span, but also a person’s quality of life. Taking lifestyle measures to manage the condition can help a person maintain a good quality of life for longer.

How does COPD affect life expectancy? Learn more here.

Emphysema is a type of COPD, and there are different types of emphysema, depending on which part of the lungs it affects.

These are:

• paraseptal emphysema
• centrilobular emphysema, which affects mainly the upper lobes and is most common in people who smoke
• panlobular emphysema, which affects both the paraseptal and centrilobular areas of the lungs

During diagnosis, a CT scan can show which type of emphysema is present. The type does not affect the outlook and treatment.

A doctor will carry out a physical examination and ask about the person’s symptoms, lifestyle habits, and medical history.

They may also recommend tests to confirm the diagnosis and rule out other conditions.

If the person has never smoked but appears to have emphysema, the doctor may suggest testing for an alpha-1 antitrypsin deficiency.

The following sections will look at some diagnostic tests for emphysema in more detail.

Lung function tests

Lung function tests measure the lungs’ capacity to exchange respiratory gases. They can:

• confirm a diagnosis of emphysema
• monitor disease progression
• assess response to treatment

Spirometry is one type of lung function test. It assesses airflow obstruction by measuring FEV.

For this test, a person blows as fast and hard as they can into a tube. The tube is attached to a machine that measures the volume and speed of the air that they blow out. FEV1 determines the stages of emphysema.

Other tests

Other tests include imaging, such as a chest X-ray or CT scan of the lungs, and arterial blood gas analysis, to assess oxygen exchange and carbon dioxide levels.

Avoiding or quitting smoking is the best way to prevent emphysema from developing or getting worse.

Other strategies include:

• eating a healthful diet
• establishing and maintaining a moderate weight
• avoiding air pollution, if possible
• taking steps to prevent infection, such as receiving routine vaccinations

Emphysema involves irreversible damage to the lungs, which can eventually be life threatening. It mostly affects people who smoke, but people who do not smoke can develop it, too.

Seeking early treatment and taking measures to manage the condition can help enhance a person’s health and well-being and may improve their life span.

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is the name for a group of lung conditions that cause breathing difficulties.

It includes:

• emphysema – damage to the air sacs in the lungs
• chronic bronchitis – long-term inflammation of the airways

COPD is a common condition that mainly affects middle-aged or older adults who smoke. Many people do not realise they have it.

The breathing problems tend to get gradually worse over time and can limit your normal activities, although treatment can help keep the condition under control.

Information:

Coronavirus advice

Get advice about coronavirus and COPD from the British Lung Foundation

Symptoms of COPD

The main symptoms of COPD are:

• increasing breathlessness, particularly when you’re active
• a persistent chesty cough with phlegm – some people may dismiss this as just a “smoker’s cough”
• frequent chest infections
• persistent wheezing

Without treatment, the symptoms usually get progressively worse. There may also be periods when they get suddenly worse, known as a flare-up or exacerbation.

Find out more about the symptoms of COPD.

When to get medical advice

See a GP if you have persistent symptoms of COPD, particularly if you’re over 35 and smoke or used to smoke.

Do not ignore the symptoms. If they’re caused by COPD, it’s best to start treatment as soon as possible, before your lungs become significantly damaged.

The GP will ask about your symptoms and whether you smoke or have smoked in the past. They can organise a breathing test to help diagnose COPD and rule out other lung conditions, such as asthma.

Find out more about how COPD is diagnosed.

Causes of COPD

COPD happens when the lungs become inflamed, damaged and narrowed. The main cause is smoking, although the condition can sometimes affect people who have never smoked.

The likelihood of developing COPD increases the more you smoke and the longer you’ve smoked.

Some cases of COPD are caused by long-term exposure to harmful fumes or dust. Others are the result of a rare genetic problem which means the lungs are more vulnerable to damage.

Find out more about the causes of COPD.

Treatments for COPD

The damage to the lungs caused by COPD is permanent, but treatment can help slow down the progression of the condition.

Treatments include:

• stopping smoking – if you have COPD and you smoke, this is the most important thing you can do
• inhalers and medicines – to help make breathing easier
• pulmonary rehabilitation – a specialised programme of exercise and education
• surgery or a lung transplant – although this is only an option for a very small number of people

Find out more about how COPD is treated and living with COPD.

Outlook for COPD

The outlook for COPD varies from person to person. The condition cannot be cured or reversed, but for many people, treatment can help keep it under control so it does not severely limit their daily activities.

But in some people, COPD may continue to get worse despite treatment, eventually having a significant impact on their quality of life and leading to life-threatening problems.

Information:

Social care and support guide

If you:

• need help with day-to-day living because of illness or disability
• care for someone regularly because they’re ill, elderly or disabled – including family members

The guide to care and support explains your options and where you can get support.

Preventing COPD

COPD is largely a preventable condition. You can significantly reduce your chances of developing it if you avoid smoking.

If you already smoke, stopping can help prevent further damage to your lungs before it starts to cause troublesome symptoms.

If you think you need help to stop smoking, you can contact NHS Smokefree for free advice and support. You may also want to talk to a GP about the stop smoking treatments available.

Find out more about stopping smoking and where to find a stop smoking service near you.

Video: COPD

This video explains more about COPD (bronchitis and emphysema).

Media last reviewed: 16 April 2021
Media review due: 16 April 2024

Page last reviewed: 20 September 2019
Next review due: 20 September 2022

Emphysema – Better Health Channel

Emphysema and another lung condition known as chronic bronchitis (persistent cough with phlegm) are both features of a common lung disease called chronic obstructive pulmonary disease (COPD).

Emphysema is generally caused by cigarette smoking or long-term exposure to certain industrial pollutants or dusts. A small percentage of cases are caused by a familial or genetic disorder, alpha-1-antitrypsin deficiency. While damaged airways don’t regenerate and there is no cure, emphysema is preventable and treatable.

Symptoms of emphysema

The symptoms of emphysema include: 

• breathlessness with exertion, and eventually breathlessness most of the time in advanced disease
• susceptibility to chest infections
• cough with phlegm production
• fatigue
• barrel-shaped chest (from expansion of the ribcage in order to accommodate enlarged lungs)
• cyanosis (a blue tinge to the skin) due to lack of oxygen.

Structure of the lungs

The lungs are sponge-like structures that lie within the chest, protected by the ribcage. They are made up of progressively branching air passages. The largest of these is the windpipe (trachea), which divides into the two bronchi, which divide into the smaller bronchioles.

Bronchioles end in minute air sacs (alveoli), where inhaled oxygen is transferred to the blood stream and carbon dioxide is transferred from the blood into the exhaled breath. This exchange of oxygen and carbon dioxide takes place via a fine mesh of capillaries.

Damaged airways and lungs

After repeated exposure to chemical irritants, such as cigarette smoke, the air passages and air sacs of the lungs become inflamed and damaged. 

The airways of healthy lungs have elastic properties, but in lungs that are repeatedly exposed to irritants, the airways lose their elasticity and become thickened and swollen. This swelling means that the passageway for air becomes narrower.

If the same person also has chronic bronchitis (ongoing inflammation of the lining of the bronchial tubes), the mucus present can further contribute to narrowing of the air passages and clogging of the air sacs, further reducing their ability to function. As the number of functional air sacs reduces, the number of capillaries servicing the damaged alveoli also gradually reduces. 

These changes result in:

• partial blockage of the passages carrying inhaled and exhaled breath
• reduced capacity for the lungs to extract the oxygen from inhaled air.

This means that the person has to breathe harder to get enough oxygen. 

Complications of emphysema

Complications of emphysema can include: 

• pneumonia – this is an infection of the alveoli and bronchioles. People with emphysema are more prone to pneumonia
• collapsed lung – some lungs develop large air pockets (bullae), which may burst, resulting in lung deflation (also called pneumothorax)
• heart problems – damaged alveoli, reduced number of capillaries and lower oxygen levels in the blood stream may mean that the heart has to pump harder to move blood through the lungs. Over time, this can place considerable strain on the heart.

Diagnosis of emphysema

Chronic obstructive pulmonary disease, including emphysema, is diagnosed mainly using a lung function test called spirometry. Other tests that may help in diagnosis of emphysema include: 

• other lung function (or breathing) tests
• chest x-rays
• CT scans.

Treatment for emphysema

There is no cure for emphysema, although it is treatable. Appropriate management can reduce symptoms, improve your quality of life and help you stay out of hospital.

Management includes: 

• stopping smoking immediately and completely – this is the most effective treatment for COPD and emphysema
• avoiding other air pollutants
• respiratory (pulmonary) rehabilitation programs
• oxygen treatment, in advanced cases
• medications such as
  • anti-inflammatory medications
  • medicine to widen the airways (bronchodilators) and loosen the phlegm
  • antibiotics
• stress management techniques
• gentle, regular exercise to improve overall fitness
• influenza vaccination (yearly) and pneumococcal vaccination to protect against certain types of respiratory infection.

Respiratory rehabilitation programs

A person with emphysema can take part in a respiratory rehabilitation program, commonly known as ‘pulmonary rehab’. These programs: 

• provide information and education on emphysema
• introduce people to a supervised exercise program proven to improve emphysema symptoms 
• improve lung function through specific breathing exercises
• teach stress management techniques
• offer advice on adapting to life with emphysema
• provide emotional support through shared experiences.

To find out about a program near you, call Lung Foundation Australia on 1800 654 301.

Oxygen treatment for emphysema

If a person with emphysema is found to have exceptionally low levels of oxygen in their blood, they will be given oxygen to use at home. The oxygen is usually breathed through the nose via nasal prongs (cannulae). The person will need to use the oxygen treatment for at least 16 hours every day.

Where to get help

Chronic Obstructive Pulmonary Disease (COPD)

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Overview

Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease that gets worse over time. The disease has three traits that must be present to be diagnosed:

• Emphysema: A condition that causes the air spaces inside the lungs to become permanently larger. This happens because the disease destroys the walls of the tiny air sacs inside the lungs.
• Chronic bronchitis: A cough that does not go away, creates mucus or phlegm, and lasts at least three months in two consecutive years. To be considered bronchitis, tests must rule out infections or diseases such as tuberculosis, lung cancer or chronic heart failure.
• Blocked airflow in and out of the lungs, such as with asthma. This symptom generally gets worse over time.

COPD can be managed with treatment and treatment should be started early on to ensure the best quality of life possible.

Symptoms

Most patients won’t notice symptoms of COPD until the condition has caused major lung damage. Symptoms will usually get worse over time, especially if the patient continues to be exposed to smoking or other lung irritants.

Generally, the first symptom a patient with COPD will have is coughing and difficulties breathing typical of bronchitis, emphysema and asthma.

Other signs of COPD include:

• Redness of the skin because the capillaries are congested
• Fluid in the lungs and airways and linings of the throat
• Production of a great deal of mucous and other secretions, sometimes including pus
• Enlarged glands
• Changes in the cells of the lungs and airways that can be seen with a microscope
• Blue tint to skin around the lips or fingernails
• Frequent respiratory infections

People who have smoked more than 20 cigarettes a day for more than 20 years may begin to cough up mucus in their 40s or early 50s. Breathlessness during exercise or exertion usually doesn’t become bad enough to see to a doctor until the COPD patient is in their 50s or mid-60s.

Gradually, patients may produce more and more fluid or mucus in their lungs or airways.

Severe chest conditions (coughs, production of pus-filled fluid or mucus, wheezing, breathlessness and sometimes fever) may happen from time to time. As the disease gets worse, the time between severe fits gets shorter.

Late in the disease, these fits may be so severe that the blood doesn’t get enough oxygen and the person’s skin turns bluish. The patient may develop a morning headache that indicates too much carbon dioxide in their blood. There may also be a loss of weight.

Causes and Risk Factors

COPD is most commonly caused by tobacco smoke. It mostly affects adults, with symptoms appearing between the ages of 30 and 40 years old. Age and cigarette smoking account for more than 85% of the risk of developing COPD.

In rare cases, the condition can develop in younger patients when it is associated with Alpha-1 Antitrypsin Deficiency (A1AD).

COPD affects more men than women and is most frequently diagnosed in Caucasian people.

It is not yet understood what the role of air pollution is in causing COPD. But working around large amounts of various chemical fumes, such as welding fumes, or various dusts, such as mineral dust, may put you at greater higher risk of developing COPD.

Diagnosis

Diagnosis of COPD usually begins with a review of medical history and symptoms, as well as a physical exam. In the early stages of COPD, a physical exam may show very little except wheezing when breathing out. As the disease develops, the lungs begin to show signs of overinflating with air. The size of the chest gets larger.

The doctor may notice that the diaphragm moves less than that of a healthy person. The sounds of the heart become distant. Crackles may be heard at the base of the lungs. The veins of the neck may stick out, mostly when a person is breathing out, showing increased pressure inside the chest.

The patient may also have jerky movements because of buildup of carbon dioxide in the blood.

After the physical exam, the doctor will do tests to rule out other conditions, such as cancer, tuberculosis or chronic heart failure, which may cause similar symptoms. The doctor will also determine whether the patient has COPD rather than bronchitis, emphysema or asthma alone.

Chest x-rays, computed tomography (CT) scans or a bronchoscopy may be used to rule out tuberculosis or other conditions if a person is coughing up blood. Two-dimensional echocardiography and Doppler techniques may be used to find out whether there is high blood pressure in the lungs.

Other tests such as blood oxygen tests, as well as lung function and exercise testing may be conducted to find out how much damage has been done and how well the lungs are working.

Treatment

There is no cure for COPD. Current treatments focus on managing symptoms or underlying conditions and improving the patient’s quality of life. Treatment approaches, including lifestyle changes, medication, rehabilitation and therapy, as well as surgery, vary depending on how severe the COPD is and what has caused it.

Patients with COPD may need to make lifestyle changes once they have been diagnosed with the condition. The single most important lifestyle change a patient can make is to stop smoking . This is extremely important for patients who have mild or moderate COPD. It can improve some symptoms of COPD and delay others.

Other lifestyle changes may include removing lung irritants from the home and workplace, as well as learning how to save energy during daily activities.

Maintaining proper nutrition is also very important for patients with COPD because their daily activities often require more energy than normal. The extra challenge of breathing with COPD causes the patient’s resting use of energy to rise. Without food to balance this energy usage, someone with a chronic condition such as COPD will begin to lose weight.

Medications may be prescribed to improve airflow, reduce inflammation and muscle spasms inside the lungs, and cut or thin down mucus and fluid buildup. Antibiotics may be helpful in taking care of infections that may contribute to COPD. Staying current on flu and pneumonia shots can reduce the chances of infection that can cause COPD symptoms to become worse.

Physical or occupational therapy can help manage the symptoms of COPD. Oxygen therapy may be used if the amount of oxygen in the blood is low. This therapy may help with shortness of breath and extend the patient’s ability to stay active. Many doctors will recommend pulmonary rehabilitation, which provides information and counseling to patients to help them manage the condition.

For some, surgery may be a treatment option. Lung volume reduction surgery or a lung transplant may be the best option, particularly those younger than 65 with no other medical problems who aren’t responding to medications.

The multidisciplinary team at the Chronic Obstructive Pulmonary Disease Program can determine the best treatment option for each patient.

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

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COPD & Emphysema | Michigan Medicine

What is COPD?

COPD (chronic obstructive pulmonary disease) is a common preventable and treatable disease of the lungs. Patients with COPD have airflow obstruction that is caused either by destruction of the air sacs that exchange gas in the lungs (emphysema) and/or inflammation of the airways (chronic bronchitis). The most common cause of COPD is smoking, but other risk factors include second-hand smoke exposure, working in a dusty environment and genetic factors. It is currently the fourth leading cause of death in the U.S.

Symptoms of COPD

• Chronic cough, often with mucus
• Shortness of breath that worsens with activity
• Wheezing
• Chest tightness
• Fatigue

Diagnosing and Treating COPD

During your first visit, we will collect a thorough history and conduct a comprehensive exam. A breathing test (spirometry) where we measure your lung capacity as you blow through a tube attached to a machine will also be performed. Spirometry is required to make a diagnosis of COPD. Other tests, such as a chest x-ray or CT exam, may also be needed to confirm diagnosis or rule out other medical conditions.

While there is currently no cure for COPD, a combination of drugs and lifestyle changes can help manage the symptoms. Treatments include:

• A smoking cessation program can help smokers quit.
• Our Pulmonary Rehabilitation Program provides education and methods to improve breathing.
• Bronchodilators and inhaled corticosteroids are inhaled medicines that can open the airways, ease shortness of breath, and can reduce the frequency of “flare-ups” of breathing trouble that patients with COPD frequently experience.
• A yearly flu vaccine helps to prevent lung infections, and a pneumococcal vaccine (pneumonia shot) can help prevent pneumonia/menigitis caused by strep.
• Oxygen may be helpful for some patients if your oxygen levels are low.
• A small proportion of patients can be treated with surgical procedures, including lung volume reduction surgery or even lung transplantation.

Zephyr® Valve: A New Treatment

For patients with severe COPD or emphysema, a new treatment option known as the Zephyr® Endobrachial Valve System has proved successful in improving lung function, exercise capacity and quality of life. During this minimally invasive procedure, a doctor uses a bronchoscope (a thin tube with a camera), to place tiny valves in the airways of the lungs. These valves allow healthy portions of the lungs to expand, lifting pressure off the diaphragm to enhance breathing. 

Candidates for the Zephyr Valve are patients who have a diagnosis of emphysema confirmed by a CT scan and who have not smoked for at least four months.

Patients not eligible for the Zephyr Valve include those who:

• Are unable to have a brochoscopic procedure.
• Have an active lung infection.
• Are allergic to nitinol, nickel, titanium or silicone.
• Have not stopped smoking.
• Have an air pocket greater than 1/3 of the size of the lung.

Michigan Medicine is one of only a few hospitals in Michigan to offer this treatment option for patients with COPD or emphysema. For more information about the Zephyr Valve, view or download the Zephyr Endobronchial Valve System PDF.

COPD Research and Clinical Trials

Investigators at the University of Michigan are actively involved in helping to understand, diagnose, and develop new treatments for COPD. Cutting-edge research studies and clinical trials are regularly available to patients who qualify. View current COPD studies on UMHealthResearch.org or search for other studies on the UMHealthResearch.org home page.

Make an Appointment

To schedule an appointment to discuss COPD, emphysema or any other lung or breathing condition, call us at 734-763-7668, or 888-284-LUNG.

Chronic obstructive pulmonary disease | Nature Reviews Disease Primers

90,000 Emphysema of the lungs. New treatments.

Emphysema is a condition in which the air sacs in the lungs (alveoli) are partially destroyed, which leads to a decrease in the total surface of the lung tissue and is manifested by progressive shortness of breath.

Causes of emphysema:

• tobacco smoking and / or smoking marijuana
• air pollution, including tobacco smoke (the so-called “passive smoking”)
• occupational hazards (inhalation of dust and harmful substances in production: miners, grinders, welders, etc.)etc.)
• deficiency of alpha-1-antitrypsin (this substance “protects” the alveoli from destruction). In this case, emphysema usually occurs before the age of 40.

Emphysema most commonly occurs in smokers as part of chronic obstructive pulmonary disease (COPD).

What happens with emphysema?

Lungs in a healthy person consist of airways (trachea, bronchi and bronchioles) and air sacs (alveoli). The easiest way to imagine the structure of the lungs in the form of a tree with large branches (trachea and bronchi), which continuously branch and turn into small branches (bronchioles).At the ends of the bronchioles there are hollow air sacs – alveoli (like bunches of grapes).

Alveoli have a very thin wall (0.5 micrometers) and are enveloped in a network of small vessels (capillaries). It is through the thin wall of the alveoli that oxygen enters the bloodstream, and carbon dioxide enters the bronchioles and is removed from the body. Even the lungs can be thought of as a very finely porous sponge. So, the total number of alveoli in both lungs of a person is 600-700 million. The diameter of one alveolus is 280 micrometers (for comparison, the thickness of a human hair is about 100 micrometers).The total surface area of ​​the alveoli varies from 40 m² when exhaling to 120 m² when inhaling. This is a huge area! It is this feature that helps the lungs to easily “extract” oxygen from the air and deliver it to the blood.

With the progression of emphysema, a fine-pored sponge turns into a large-pore one. The walls of adjacent alveoli are destroyed, the alveolar sacs become larger. Thus, the diameter of one alveoli increases, but as a result, the total number of alveoli decreases, due to which the total surface area of ​​the lung tissue decreases.

The lungs can no longer effectively “extract” oxygen from the air, therefore, shortness of breath appears and progresses. None of the existing drugs can restore the normal structure of the alveoli and increase the total surface area of ​​the lungs, which is why the dyspnea associated with emphysema is so difficult to treat. One of the effective ways to reduce shortness of breath is to increase the concentration of oxygen in the inhaled air from 21% to 90%, then it will be easier for the lungs to “extract” it from the air.

Symptoms of emphysema.

The main symptom of emphysema is shortness of breath. The biggest problem with early diagnosis is that shortness of breath increases gradually, very slowly. Even when you already have emphysema, you will not feel short of breath and do not consult a doctor in a timely manner. At first, shortness of breath worries only with severe physical exertion, and with the progression of the disease, it occurs with minimal effort (talking, washing, dressing, etc.) or even at rest. Many patients unconsciously limit their physical activity, adapt to shortness of breath until it completely disrupts their lifestyle.Unfortunately, only then there is an incentive to go to the doctor.

Later, other signs may join:

• weight loss
• change in the shape of the chest (“barrel chest”)
• cyanosis (bluish staining of the skin and mucous membranes)
• edema on the lower extremities (not all appear)

Since emphysema most often occurs within the framework of a certain disease, in parallel with the progression of shortness of breath, symptoms of the underlying disease are observed.For example, in COPD, it is a cough.

Complications of emphysema.

In the presence of emphysema, often occur:

• giant bulls. Bulls are areas of the lung that are filled with air, but do not participate in gas exchange. Essentially large but useless air sacs in the lungs
• pneumothorax (collapse of the lung, most often due to ruptured bullae)
• chronic cor pulmonale (thickening of the wall and expansion of the cavity of the right half of the heart).

Diagnosis of emphysema.

If you experience shortness of breath, be sure to see a doctor. Not a single experienced and competent doctor will explain your shortness of breath with age features or overweight until a complete examination is carried out.

Minimum survey plan:

• patient examination
• general blood test (to exclude anemia as a cause of shortness of breath)
• spirometry (lung function test)
• electrocardiography (ECG, to exclude shortness of breath associated with heart disease)
• chest x-ray.

In many cases, additional examination is required to confirm the diagnosis:

• bodyplethysmography (very precise examination of lung function)
• echocardiography (to rule out or confirm a complication of emphysema, such as chronic cor pulmonale, or to rule out other heart diseases causing dyspnea)
• computed tomography of the lungs. Computed tomography of the lungs is the most accurate method for diagnosing pulmonary emphysema.Because this study allows you to very accurately assess the structure of the lung tissue, measure its density and identify complications of emphysema (bulla).
• pulse oximetry (to determine blood oxygen saturation, with emphysema it may decrease)
• blood gas analysis (to detect hypoxemia – low oxygen content in the blood).

Treatment of emphysema.

Treatment of emphysema consists of two components – conservative and surgical.

Conservative treatment:

• Smoking cessation will stop lung damage. This is the most effective treatment. If you are regularly treated with drugs, but continue to smoke, the effect of the treatment will be so insignificant that you will not even feel it. In the presence of occupational hazards, rational employment is very important in order to exclude contact with harmful vapors, gases, and dust.
• Treatment of the underlying disease.Emphysema is an essential component of COPD. COPD treatment is discussed in a separate article. In case of alpha-1-antitrypsin deficiency, injections of a drug containing this substance are prescribed (not registered in Russia).
• Long-term oxygen therapy. Many people with severe emphysema have hypoxemia (low oxygen in the blood) due to ineffective lung function. The only way to eliminate it is long-term oxygen therapy using an oxygen concentrator. Treatment should be carried out indefinitely, daily at least 15-18 hours a day.Long-term oxygen therapy for emphysema in the context of COPD can reduce shortness of breath, increase physical activity, improve sleep, and most importantly, prolong life by 5-10 years or wait for lung transplantation.

Surgical treatment:

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Emphysema of the lungs | University Hospital Freiburg

Description

Pulmonary emphysema is a chronic disease, which is based on an imbalance of enzymes (proteases – antiproteases or protective proteins) in the lungs.In this case, the alveoli, which make up the lung tissue, expand and lose the ability to sufficiently contract, as a result of which the flow of oxygen into the blood and the removal of carbon dioxide from it is disrupted. With emphysema, there is a pathological increase (swelling) of the lung tissue. Currently, there are three main types of the disease:

• centrilobular emphysema, which mainly affects the upper part of the lungs,
• panlobular, caused by a deficiency of the enzyme alpha-1 protease (it affects the lower parts of the lungs, forming scars and scars on the lung tissue ),
• and senile emphysema caused by natural age-related changes in the vessels of the lungs and impaired elasticity of the alveoli.

Symptoms

In the initial stages of the disease, signs of emphysema can appear with significant physical exertion in the form of shortness of breath, and at a later stage, respiratory failure occurs even at rest. Then dry cough with phlegm is added to shortness of breath. At the same time, the supply of oxygen to the body is disrupted due to stretching of the tissues of the alveoli, which, increasing in volume, cannot fully contract, therefore air accumulates in them.The patient experiences in this case:

• fatigue,
• rapid fatigability,
• general deterioration of health,
• his working capacity decreases.

Causes and risks

The main reasons leading to the development of pulmonary emphysema are:

• penetration into the respiratory tract of dust particles, vehicle exhaust gases, other pollutants, the inhalation of which is often associated with professional activities (miners, construction workers, etc.)
• tobacco smoke when smoking also aggressively affects the alveoli, gradually destroying them with toxins,
• frequent respiratory infections,
• hereditary predisposition to the disease.

Pulmonary emphysema often occurs on the basis of excessive smoking in the course of chronic obstructive bronchitis, which is currently included in the diagnosis of COPD (Chronic Obstructive Pulmonary Disease).

Examination and diagnosis

The standard examination procedures include, first of all:

• general medical examination of the patient
• and study of the medical history.

Further diagnostics in case of suspected emphysema includes a study of the function of external respiration using, first of all, spirometry and bodyplethysmography. These procedures also measure the volume of air in the lungs remaining after exhalation. In order to clarify the diagnosis of emphysema, an analysis of the so-called diffusion capacity of the lungs can be carried out. To perform this test, the patient must inhale a mixture with a low content of CO2 gas and hold his breath for 10 seconds, during which the gas enters the blood.In this case, the amount of CO2 in the alveoli is measured before and after holding the breath. Changes in lung tissue are determined using computed tomography (CT), and chest x-ray or magnetic resonance imaging, along with other methods, serve to increase the information content of the diagnosis. Based on a general blood test, it is possible to identify the presence of an inflammatory process, as well as a deficiency of the enzyme alpha-1 protease as a possible cause of pulmonary emphysema.By examining the gas composition of arterial blood (quantitative content of oxygen, carbon dioxide, pH value), it is possible to determine the degree of impairment of the patient’s respiratory capacity.

Treatment

Therapy of emphysema should be aimed mainly at improving the patient’s quality of life and slowing the progression of the disease. Treatment includes many different methods used depending on the severity and individual parameters of the disease.

• Unconditional smoking cessation is of prime importance here.
• Inhalation of dust, exhaust gases, etc. should be avoided, if possible.
• As medicinal therapy, drugs (bronchodilators) are prescribed to help widen the airways to improve the supply of oxygen to the body, as well as cortisone drugs as anti-inflammatory drugs.
• Physiotherapy procedures, breathing exercises, also help to increase the functionality of the lungs and improve the patient’s well-being.
• In case of a progressive stage of the disease, a long course of oxygen therapy is recommended
• or, in extreme cases, surgery to reduce the volume or even a lung transplant.

Forecast

Emphysema is an incurable disease. However, a timely visit to a doctor and a quick start of the course of treatment counteract the development of the disease.

Comments

Along with pulmonary emphysema, it is often necessary to treat such concomitant diseases as chronic bronchitis, diabetes mellitus, heart failure.Complex therapy of pulmonary emphysema should also include additional preventive measures to prevent infectious respiratory diseases. This includes the annual vaccination against influenza and pneumococcal viruses.

Treatment of chronic obstructive pulmonary disease (COPD) in Moscow

Chronic obstructive pulmonary disease, or COPD, is a common disease of the respiratory system in adults, which is based on a pronounced chronic inflammatory response of the lungs to the action of pathological particles and gases (primarily tobacco smoke).At the same time, chronic inflammation develops in the walls of the bronchi, the process of excretion of sputum is disrupted, subsequently the air flow rate in the bronchi during exhalation progressively decreases, the lungs are filled with air, which can cause the development of emphysema.

With COPD, the normal function of the immune system, the structure and function of the lining of the bronchi changes. As a result, there is a violation of the patency of the bronchi, emphysema of the lungs, pneumosclerosis develops, and respiratory failure increases.

The production of a large volume of mucus, an increase in its viscosity lead to the creation of a favorable environment for the reproduction of pathogenic microorganisms. As a result, there is a violation of the patency of the bronchi, emphysema of the lungs, pneumosclerosis develops, and respiratory failure increases.

Causes and mechanisms of development of COPD

There are several causes of chronic obstructive pulmonary disease:

• active and passive smoking – this factor is in the first place;

• some environmental and ecological conditions;

• professional harm;

• hereditary predisposition.

An exacerbation of a chronic disease can be triggered by a bacterial or viral infection. The severity of the course and the characteristics of treatment depend on the causative agent of an infectious disease. Frequent SARS lead to a decrease in local defenses, and bacterial complications can develop against their background. Therefore, it is important for people with COPD to see a doctor urgently if symptoms of worsening appear.

Manifestations of COPD

The symptoms of COPD depend on how impaired the patency of the bronchi.This indicator can be determined by evaluating the function of external respiration – spirometry.

The main manifestations of the disease are productive cough and shortness of breath. Symptoms vary in severity, from mild shortness of breath with intense physical activity to severe at rest. In severe cases, other symptoms are added to the signs, which can indicate the development of not only respiratory, but also heart failure (edema of the lower extremities, enlarged liver, weakness, accumulation of fluid in the pleural and abdominal cavity)

In some people, purulent inflammation in the bronchi predominates, which is manifested by a cough with a large amount of sputum and symptoms of general intoxication.In others, the leading symptoms are the development of emphysema and respiratory failure, and shortness of breath predominates.

Features of treatment

Treatment for COPD in adults is always comprehensive. The basis of therapy is bronchodilators – agents that promote the expansion of the bronchi, have an anti-inflammatory effect, as well as drugs to reduce the formation of mucus. It is important to eliminate risk factors that can make the disease worse. Smoking, work in hazardous work is strictly prohibited.The doctor will definitely recommend getting vaccinated against influenza, pneumococcal infection in order to prevent viral and bacterial diseases and minimize the likelihood of complications.

Get qualified help for COPD at the Family Doctor clinic. We have everything you need for accurate diagnosis and effective treatment.

You can make an appointment with a pulmonologist at a time convenient for you by calling the single contact center of the Family Doctor clinic in Moscow +7 (495) 775 75 66, through the on-line registration form and at the clinic’s registry.

Cost

general practitioner, pulmonologist, functional diagnostics physician

90,000 Chronic Obstructive Pulmonary Disease (COPD) – New therapies

Drug Therapy

The growing awareness of the role of inflammation in the genesis of COPD has led to speculations about medications that target various elements of the inflammatory response cascade. Many broad spectrum anti-inflammatory drugs are currently in phase 3 trials for COPD and may enter the market within the next decade.Nitric oxide inhibitors, phosphodiesterase-4 inhibitors, leukotriene modifiers and tumor necrosis factor alpha antagonists are present among these new drugs. [117] Brindicci C, Ito K, Torre O, et al. Effects of aminoguanidine, an inhibitor of inducible nitric oxide synthase, on nitric oxide production and its metabolites in healthy control subjects, healthy smokers, and COPD patients. Chest. 2009 Feb; 135 (2): 353-67.
http://www.ncbi.nlm.nih.gov/pubmed/18719059?tool=bestpractice.com
Long-term (≥6 months) treatment with acetylcysteine ​​may reduce the prevalence of exacerbations but probably does not affect the frequency of exacerbations, lung volumes, or FEV1.[118] Fowdar K, Chen H, He Z, et al. The effect of N-acetylcysteine ​​on exacerbations of chronic obstructive pulmonary disease: a meta-analysis and systematic review. Heart Lung. 2017 Mar-Apr; 46 (2): 120-8.
http://www.ncbi.nlm.nih.gov/pubmed/28109565?tool=bestpractice.com
Antiplatelet therapy is associated with a reduction in all-cause mortality in patients with COPD, regardless of cardiovascular risk. [119] Pavasini R, Biscaglia S, d’Ascenzo F, et al. Antiplatelet treatment reduces all-cause mortality in COPD patients: a systematic review and meta-analysis.COPD. 2016 Aug; 13 (4): 509-14.
http://www.ncbi.nlm.nih.gov/pubmed/26678708?tool=bestpractice.com
Epidermal growth factor receptor kinase has the potential to combat mucus overproduction. A therapy aimed at suppressing fibrosis is now being developed. The search also continues for inhibitors of serine proteinases and matrix metalloproteinases to prevent lung destruction and further development of emphysema, and drugs such as retinoids that may even cause regression of this process.[120] Malhotra S, Man SF, Sin DD. Emerging drugs for the treatment of chronic obstructive pulmonary disease. Expert Opin Emerg Drugs. 2006 May; 11 (2): 275-91.
http://www.ncbi.nlm.nih.gov/pubmed/16634702?tool=bestpractice.com
Inhibitors of HMG-CoA reductase and phosphodiesterase-4 are emergency treatments for COPD, and show improvement in some patients, with some improvement in pulmonary function in patients with moderate to severe COPD. [121] Janda S, Park K, FitzGerald JM, et al.Statins in COPD: a systematic review. Chest. 2009 Sep; 136 (3): 734-43.
http://www.ncbi.nlm.nih.gov/pubmed/19376844?tool=bestpractice.com
Although retrospective studies show a reduction in the number and severity of exacerbations, hospitalizations and mortality rates among patients taking statins, especially in patients with cardiovascular disease (CVD) or hyperlipidemia, a prospective study was unable to prove this beneficial effect. [122] Criner GJ , Connett JE, Aaron SD, et al; COPD Clinical Research Network; Canadian Institutes of Health Research.Simvastatin for the prevention of exacerbations in moderate-to-severe COPD. N Engl J Med. 2014 Jun 5; 370 (23): 2201-10.
https://www.nejm.org/doi/full/10.1056/NEJMoa1403086

http://www.ncbi.nlm.nih.gov/pubmed/24836125?tool=bestpractice.com
In a meta-analysis of randomized controlled trials in patients with COPD who take statins, clinical outcomes were better than those in patients with concomitant CVD, elevated baseline C-reactive protein levels, or high cholesterol levels.[123] Zhang W, Zhang Y, Li CW, et al. Effect of statins on COPD: a meta-analysis of randomized controlled trials. Chest. 2017 Dec; 152 (6): 1159-68.
http://www.ncbi.nlm.nih.gov/pubmed/28847550?tool=bestpractice.com
The efficacy and safety of synthetic hormone ghrelin therapy in patients with COPD with a sharp decrease in physical performance and cachexia is being investigated and has some promising results. [124] Levinson B, Gertner J. Randomized study of the efficacy and safety of SUN11031 (synthetic human ghrelin) in cachexia associated with chronic obstructive pulmonary disease.e-SPEN J. 2012 Oct; 7 (5): e171-5.
https://www.sciencedirect.com/science/article/abs/pii/S2212826312000401
Palovarotene is a selective agonist of gamma-receptors for retinoic acid and is in the research phase for the treatment of emphysema. It is hypothesized that retinoic acid signaling affects alveologenesis. This has shown promising results in animal studies. [125] Hind M, Stinchcombe S. Palovarotene, a novel retinoic acid receptor gamma agonist for the treatment of emphysema.Curr Opin Investig Drugs. 2009 Nov; 10 (11): 1243-50.
http://www.ncbi.nlm.nih.gov/pubmed/19876792?tool=bestpractice.com
Many inhalation drug combinations have been proposed for the treatment of COPD. Aclidinium / formoterol is a long-acting muscarinic receptor antagonist / long-acting beta-2 agonist (LABA / LAMA) combination that is available in some countries but is pending FDA approval in the United States.[]
How does combined aclidinium / formoterol compare with aclidinium or formoterol monotherapy for people with chronic obstructive pulmonary disease (COPD)? /Cca.html? TargetUrl = https: //www.cochranelibrary.com/cca/doi/10.1002/cca.2397/ fullShow answer

Interventional therapy

Targeted volume reduction and a new technique for selective bronchoscopic lung volume reduction are now possible. In this technique, a one-way valve is placed in an overly dilated and emphysematous segment, causing the non-functioning pulmonary segment to collapse.Promising reports have been made from the case series of patients undergoing this therapy. For patients with COPD requiring surgery, this approach is an alternative approach to surgical lung volume reduction. [126] Fishman A, Martinez F, Naunheim K, et al; National Emphysema Treatment Trial Research Group. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med. 2003 May 22; 348 (21): 2059-73.
https: // www.nejm.org/doi/full/10.1056/NEJMoa030287

http://www.ncbi.nlm.nih.gov/pubmed/12759479?tool=bestpractice.com
[127] Valipour A, Herth FJ, Burghuber OC, et al. Target lobe volume reduction and COPD outcome measures after endobronchial valve therapy. Eur Respir J. 2014 Feb; 43 (2): 387-96.
http://www.ncbi.nlm.nih.gov/pubmed/23845721?tool=bestpractice.com

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How does lung volume reduction surgery compare with usual medical care in people with diffuse emphysema? /Cca.html? TargetUrl = https: // cochranelibrary.com / cca / doi / 10.1002 / cca.1510 / fullShow Answer

Pharmacogenic Therapy

Pharmacogenic Therapy may be important in COPD. It is important to identify the genetic factors that determine why certain heavy smokers develop COPD and others do not. The identification of genes that predispose to COPD may form new therapeutic targets. [128] Barnes PJ, Stockley RA. COPD: current therapeutic interventions and future approaches. Eur Respir J. 2005 Jun; 25 (6): 1084-106.http://erj.ersjournals.com/content/25/6/1084.full

http://www.ncbi.nlm.nih.gov/pubmed/15929966?tool=bestpractice.com
[129] Sandford AJ, Silverman EK. Chronic obstructive pulmonary disease. 1: Susceptibility factors for COPD the genotype-environment interaction. Thorax. 2002 Aug; 57 (8): 736-41.
http://www.ncbi.nlm.nih.gov/pubmed/12149538?tool=bestpractice.com

Protein augmentation of Clara 16 cells

The protein of Clara 16 (CC16) cells is produced mainly by Clara cells, which are located in the epithelium of the respiratory tract.CC16 has anti-inflammatory properties in lungs that have been exposed to tobacco smoke, and COPD is associated with CC16 deficiency. Experimental augmentation of CC16 levels reduces inflammation and cell damage, and thus CC16 augmentation may be a new disease-modifying treatment for COPD [130] Laucho-Contreras ME, Polverino F, Tesfaigzi Y, et al. Club cell protein 16 (CC16) augmentation: a potential disease-modifying approach for chronic obstructive pulmonary disease (COPD).