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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