DEAR DOCTOR K:
My mother has severe emphysema. Medication and oxygen therapy aren’t helping much anymore. Are there any good surgical options?
Emphysema is a long-term lung problem that makes it harder and harder to breathe as the disease progresses. It is often grouped together with chronic bronchitis under the label of chronic obstructive pulmonary disease (COPD).
Emphysema destroys the walls between tiny air sacs (alveoli) in the lungs. When this happens, the lungs cannot absorb oxygen and expel carbon dioxide normally. So they deliver less oxygen to the bloodstream. (I’ve put an illustration, below.) The lung tissue also loses its resilience, which makes it harder to expel air as forcefully. This leaves air trapped in the air sacs.
Lung damage in emphysema and chronic bronchitis
COPD encompasses two distinct diseases—emphysema and chronic bronchitis—both of which make breathing more difficult, albeit in different ways. Most people with COPD have components of both.
All of these changes result in shortness of breath. As the disease worsens, a person with emphysema may have trouble catching his or her breath even while sitting or lying down.
Medications that help open the airways are the cornerstone of treatment. Many people eventually also need supplemental oxygen therapy.
Surgery is an option only for people with severe emphysema who have trouble breathing despite medical treatment and pulmonary rehabilitation. (Pulmonary rehab is therapy that combines exercise breathing retraining, patient education and psychological support.)
The most common surgery is lung volume reduction surgery in which a surgeon removes damaged areas of the lung. The idea is to create space in which healthier lung tissue can expand and contract more easily. It also enables the diaphragm to return to a more normal position, so it can work more effectively to get air in and out of the lungs.
A newer, less invasive procedure called bronchoscopic lung volume reduction surgery sometimes can be done instead. It involves putting one-way valves into the airways leading to the diseased parts of the lung. The valves let air out but not in. This collapses the diseased parts of the lung. This procedure does not involve cutting open the chest, as traditional surgery does, but the result is similar: The space taken by an ineffective part of the lung is freed up.
In another procedure, bullectomy, the surgeon removes large, abnormal air pockets in the lungs. This procedure is done infrequently.
The final option is lung transplantation. It is a last resort for people whose lungs are failing because there is just not enough healthy lung left from the ravages of emphysema. This physically demanding procedure is usually done only on younger people, who are more likely to withstand the risks.
In other words, the few treatments available for end-stage emphysema are pretty drastic and only partially effective. But at least there is something to offer your mother that may have some benefit.
The vast majority of cases of emphysema are caused by smoking tobacco. That means there’s a way to never have to face those drastic choices: Quit, before it’s too late.