RiteFlo™ Can Be Combined With Rescue and Controller Inhalers Prescribed For Asthma, Bronchitis, Emphysema, and COPD.

Definition

• Emphysema is a progressive respiratory disease. It is characterized by shortness of breath due to the enlargement or over-inflation of the small, but vital air sacs, called alveoli, in the lungs.

What is Emphysema?

• Emphysema is the most common cause of death from respiratory illness in the United States. Doctors often refer to areas where alveoli are destroyed as blebs and larger destroyed segments as bullae.
• Emphysema, secondary to smoking, involves the progressive destruction of the bronchioles that connect to the alveoli (small air sacs in the lung) of the lung. These bronchioles lose their elasticity, which is crucial in supporting alveoli. Alveoli are crucial in the exchange of oxygen and carbon dioxide.
• Emphysema commonly occurs in people age 50 or greater. Emphysema often coexists with chronic bronchitis and doctors usually refer to these two conditions as COPD or Chronic Obstructive Pulmonary Disease.
• Less than 1% of patients with emphysema have the inherited disease called Alpha-1 Antitrypsin Deficiency. These patients begin to have symptoms of shortness of breath by the age of 30-40. The current therapy for this disease is plasma based replacement therapy with alpha-1 antitrypsin (Prolastin®, Aralast® Zemaira™). It is estimated that 50,000 to 100,000 people may have this condition, but many of these patients have yet to be identified. Most of these patients may present with symptoms of chronic bronchitis or even asthma.
• The symptoms of emphysema are initially insidious. Patients may present with mild shortness of breath only with exertion or a mild cough or even weight loss. The cough may only be productive of clear mucus at the onset of disease. However, as the disease progresses patients develop: profound symptoms of shortness of breath without exertion, copious amounts of sputum production and patients may even develop a barrel-shaped chest. These patients are at risk for developing pneumonia, pulmonary hypertension, cor pulmonale and chronic respiratory failure.
• Although emphysema is an irreversible lung process, it can be medically managed by both the patient and doctor. The first step is to stop smoking and the second step is to see a physician who will prescribe medications that will help you breathe better. Additionally, better nutrition and an active lifestyle with exercise can only help your condition.
• The current thinking is that emphysema is caused by an imbalance of proteins, called proteases and antiproteases, in the lung. It is the antiproteases that help to protect the lung. Smoking inhibits the ability of antiproteases and other helpful proteins from protecting the lung and keeping the lung elastic.
• A significant portion of the lung (greater than 50%) is damaged by the time a patient notices that he or she has difficulty breathing. Only in the later stages of the disease is it difficult to inhale.
• Many patients develop acute exacerbations or flares of the disease resulting in significant infections that need the immediate attention of a physician.
• Emphysema is manageable if you stop smoking, improve your nutrition, become more active and take your medications as prescribed.

How is a Diagnosis of Emphysema Made?

• A careful medical history (looking for a history of smoking, quality of cough) and physical exam is the first step in the process of making a diagnosis. One of the first clues that may be elicited from a physical exam is the hollow sound a physician makes when tapping a patient’s chest. This hollow sound is the result of enlargement of the lung or rupture of the lung’s alveoli.
• Laboratory tests are the next step in the diagnostic workup. A chest x-ray is often ordered. In the early phases of emphysema, the x-ray may be normal. However, as the disease progresses, the x-ray may reveal “over inflation of the lung” which looks like increased chest diameter and a flattening of the diaphragm. The heart may appear smaller or have a more vertical appearance on the x-ray. On careful review, the x-ray may reveal blebs or bullae.
• The next phase and probably the most important laboratory test is to perform a pulmonary function test with a spirometer. This computer will measure the air flow in your lungs over a period of a few seconds. This is a non-invasive safe test. Based on the percentage of flow, your health professional will be able to assess the severity of your lung disease. If your predicted lung test value is below 80% of normal, you most likely have an obstructive lung disease. Your doctor or health professional will be able to stage your disease and give you appropriate therapy based on the published guidelines for treatment of emphysema.
• Later in the disease process, an EKG will show signs of cor pulmonale or right ventricular heart failure. Many patients will have increased levels of hemoglobin due to the lower concentration of oxygen in the patients blood stream.

How to Treat Emphysema?

What is the Role of Oxygen Therapy in Emphysema?

• Once emphysema progresses to where oxygen levels in the blood are low, supplemental oxygen therapy is required. At this point, a patient is entering the final stages of emphysema.
• Supplemental oxygen therapy aids in breathing, but its primary purpose is to support heart function. Many patients only want to take their oxygen at night and do not want to be seen taking their oxygen during the day. However, clinical trials have shown that supplemental oxygen is most effective when used for 24 hours a day.
• Most patients prefer not using supplemental oxygen. Yet, survival rates with patients with COPD (Chronic Obstructive Pulmonary Disease) is significantly longer in proportion to the time a patient is on supplemental oxygen.
• Medicare and most insurance companies cover the cost of home oxygen therapy once it is prescribed by your doctor or health professional.

What is Volume Reduction Surgery?

Is Lung Transplantation an Option for Patients with Severe Emphysema?