Emphysema is one of the common lung diseases that form part of the chronic obstructive pulmonary disease (COPD). The management of this condition includes lifestyle changes, exercises, pulmonary rehabilitation as well as pharmacotherapy and surgery.

Cessation of smoking

Smoking (as well as passive exposure to cigarette smoke) remains one of the best known and most closely associated causes of emphysema. The first step to treating emphysema is to quit smoking.

Nicotine replacement therapy and other smoking cessation aids and medications may be used to stop smoking.

Studies like the Lung Health Study have shown that stopping smoking at any time even after diagnosis of emphysema may help reduce the risk of progression of lung damage.

Lifestyle changes

Healthy lifestyle habits include a healthy balanced diet as well as regular physical exercise. Patients are encouraged to avoid dust, air pollutants, exposure to second hand smoke etc.

Regular immunizations

Some regular immunizations are necessary for emphysema patients. These include immunization against influenza with annual influenza vaccination and immunizations against pneumococcal infections at least once and repeated in 5-10 years. This is particularly important for people over the age of 50.

Pulmonary rehabilitation program

A pulmonary rehabilitation program may be suggested in patients living in areas where community respiratory services are available.

Oxygen therapy is administered to maintain the normal blood levels of oxygen. The goal of oxygen therapy is to maintain PaO2 ≥ 60 mmHg or SpO2 ≥ 90% at rest. Oxygen therapy may be a useful addition to pulmonary rehabilitation

Medication in management of emphysema

The management of emphysema is similar to management of COPD. The main treatment is with the use of bronchodilators. These help in opening up of the narrowed airways and thus provide relief from breathlessness by increasing fresh air flow into the lungs.

• Bronchodilators – these may be a short-acting inhaled beta2 agonist like Salbutamol or antimuscarinic inhaled agent like ipratropium. In mild cases they are to be used as needed. Ipratropium is the first step in therapy. For moderate to severe cases regular use of ipratropium or a long-acting antimuscarinic agent tiotropium or long-acting beta2 agonist (LABA) like Salmeterol, Formoterol etc. are advised. Concurrent use of tiotropium and ipratropium is not recommended.
• Mucolytic medicine is given as tablets or syrup and makes sputum thinner and runnier, making it easier to cough up.
• Corticosteroids – these reduce the inflammation within the lungs. For patients with moderate to severe COPD with a history of exacerbations that occur more than one per year on average, for two consecutive years, inhaled corticosteroids (e.g. budesonide, fluticasone etc.) may be advised. These can be used regularly in combination with tiotropium and LABA therapy to reduce exacerbations. For flare ups and exacerbations, oral or injectable steroids may be used
• Theophylline is another group of bronchodilator that is taken as pills. These are advised in patients with persistent symptoms despite optimal inhaled therapy.
• Antibiotics – these are prescribed for the lung infections that are common in patients with emphysema. The common microbes that affect these patients include H. influenzae, S. pneumonia, C. pneumoniae, and M. pneumoniae. These agents are effectively treated with macrolides, fluoroquinolones, second generation cephalosporins, cotrimoxazole, or doxycycline for five to seven days.