What is the treatment for Panlobular Emphysema (PLE), a type of Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

Panlobular emphysema treatment should focus on managing symptoms and slowing disease progression with a combination of pharmacologic and nonpharmacologic interventions, prioritizing long-acting muscarinic antagonists (LAMA) and/or long-acting β2-agonists (LABA) with or without inhaled corticosteroids (ICS), as recommended by the 2023 Canadian Thoracic Society guideline 1.

Treatment Overview

The treatment of panlobular emphysema, a type of Chronic Obstructive Pulmonary Disease (COPD), involves a multifaceted approach to manage symptoms, slow disease progression, and improve quality of life. This includes:

• Smoking cessation as the most critical intervention
• Bronchodilators such as short-acting beta-agonists (e.g., albuterol) and long-acting medications like tiotropium or salmeterol
• Combination therapy with inhaled corticosteroids (e.g., fluticasone, budesonide) for patients with moderate to severe disease
• Pulmonary rehabilitation programs including exercise training, breathing techniques, and education
• Oxygen therapy for patients with low blood oxygen levels
• Vaccinations against influenza and pneumococcal pneumonia
• Antibiotics for acute exacerbations
• Lifestyle modifications such as maintaining a healthy weight, staying physically active, and avoiding respiratory irritants

Pharmacologic Interventions

The 2023 Canadian Thoracic Society guideline recommends LABA/LAMA maintenance therapy in all symptomatic patients with COPD confirmed by spirometry, with a step up to single-inhaler triple therapy in those with persistent moderate to severe dyspnea and/or poor health status despite treatment with single inhaler dual therapy with LAMA/LABA or ICS/LABA 1.

• Long-acting muscarinic antagonists (LAMA) and/or long-acting β2-agonists (LABA) with or without inhaled corticosteroids (ICS) are the cornerstone of pharmacologic treatment.
• Inhaled corticosteroid (ICS) mono-therapy should NOT be used in COPD management, as per the guideline.

Nonpharmacologic Interventions

Nonpharmacologic interventions play a crucial role in managing panlobular emphysema:

• Pulmonary rehabilitation is essential and includes exercise training, breathing techniques, and education.
• Oxygen therapy is recommended for patients with low blood oxygen levels.
• Vaccinations against influenza and pneumococcal pneumonia are important preventive measures.
• Lifestyle modifications, including maintaining a healthy weight, staying physically active within limitations, and avoiding respiratory irritants, are also crucial components of managing panlobular emphysema effectively.

Recent Guidelines and Recommendations

The 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD provides updated recommendations focused on symptoms, exacerbations, and mortality 1. These guidelines emphasize the importance of targeted case-finding strategies for patients to benefit from therapeutic options and highlight the need for a paradigm shift in COPD management, focusing not only on alleviating symptoms and preventing exacerbations but also on reducing mortality.

From the FDA Drug Label

Tiotropium bromide inhalation powder is indicated for the long-term, once-daily, maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. The efficacy and safety of roflumilast in COPD was evaluated in 8 randomized, double-blind, controlled, parallel-group clinical trials in 9394 adult patients

The treatment for Panlobular Emphysema (PLE), a type of Chronic Obstructive Pulmonary Disease (COPD), may include:

• Tiotropium bromide (INH) for the long-term, once-daily, maintenance treatment of bronchospasm associated with COPD, including emphysema 2
• Roflumilast (PO) to reduce exacerbations in COPD patients, particularly those with severe COPD associated with chronic bronchitis and a history of exacerbations 3 Key points:
• These medications are used for the treatment of COPD, including emphysema
• The specific type of emphysema, Panlobular Emphysema (PLE), is not explicitly mentioned in the provided drug labels
• The treatment should be individualized and based on the patient's specific condition and medical history

From the Research

Treatment Options for Panlobular Emphysema (PLE)

The treatment for Panlobular Emphysema (PLE), a type of Chronic Obstructive Pulmonary Disease (COPD), includes:

• Medical treatment, which is the mainstay of therapy and consists of:
  • Smoking cessation
  • Pulmonary rehabilitation
  • Administration of bronchodilators
  • Steroids and supplemental oxygen when indicated 4
• Surgical procedures, such as lung volume reduction surgery (LVRS), which has been shown to be beneficial to selected patients with end-stage emphysema when medical therapy has failed 4, 5
• Bronchoscopic alternatives to surgical approach, including:
  • Airway bypass
  • Bronchoscopic lung volume reduction with one-way valves 4
  • Endobronchial valves, which can improve lung function and quality of life, and may also provide a survival benefit 6
• Augmentation therapy, which is the only FDA-approved treatment for Alpha-1 Antitrypsin Deficiency (AATD), a condition that can increase the risk of developing emphysema and COPD 7
• Pulmonary rehabilitation, which can significantly affect the decline of forced expiratory volume in 1 second (FEV1) over time, and improve exercise tolerance, symptoms, and quality of life 8

Non-Pharmacological Treatments

Non-pharmacological treatments for COPD include:

• Long-term oxygen therapy (LTOT), which is the only treatment that has been shown to modify survival rates in severe cases 5
• Nasal positive pressure ventilation (nPPV)
• Pulmonary rehabilitation
• Lung-volume-reduction surgery (LVRS) 5