From the Guidelines
Pulmonary Emphysema Reversibility
Pulmonary emphysema is a chronic and progressive lung disease characterized by irreversible airflow limitation. Currently, there is no established treatment that can reverse the disease, and management is primarily focused on symptom relief and slowing disease progression 1.
Management Strategies
- Bronchodilators such as tiotropium bromide (18mcg, inhaled daily) and combination therapies like fluticasone-salmeterol (250-50mcg, inhaled twice daily) can help improve lung function and reduce symptoms, but do not alter the underlying disease pathology 1.
- Pulmonary rehabilitation programs, including exercise training and education, can also improve quality of life and functional capacity, but do not reverse emphysema 1.
- Surgical interventions such as lung volume reduction surgery (LVRS), bullectomy, and lung transplantation may be considered in selected patients, but these procedures have specific indications and do not reverse the disease 1.
Key Considerations
- The underlying damage in COPD is largely irreversible, but clinicians should maintain a positive approach to management, as symptoms and quality of life can be substantially improved 1.
- Primary prevention of the condition is of utmost importance, with smoking cessation being the most critical tactic, especially for younger subjects 1.
From the Research
Pulmonary Emphysema Reversibility
- Pulmonary emphysema is characterized by the destruction of alveolar septa and irreversible airflow limitation 2
- The disease is associated with chronic inflammation, accelerated ageing of the lungs, and an abnormal repair mechanism that might be driven by oxidative stress 3
- There is no effective treatment available for pulmonary emphysema, and challenges in this field involve the large complexity of lung pathophysiological processes and gaps in our knowledge on the mechanisms of emphysema progression 2
Current Understanding of COPD and Emphysema
- Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity worldwide, and is characterized by poorly reversible airway obstruction, which is confirmed by spirometry 4, 5, 3
- COPD includes obstruction of the small airways (chronic obstructive bronchiolitis) and emphysema, which lead to air trapping and shortness of breath in response to physical exertion 3
- Emphysema is a component of COPD, and is characterized by the destruction of alveolar septa and irreversible airflow limitation 2, 6
Treatment and Management of COPD and Emphysema
- The mainstay of the management of stable COPD is the use of inhaled long-acting bronchodilators, whereas corticosteroids are beneficial primarily in patients who have coexisting features of asthma, such as eosinophilic inflammation and more reversibility of airway obstruction 4, 3
- Apart from smoking cessation, no treatments reduce disease progression in COPD or emphysema 3, 2
- Pulmonary rehabilitation, which includes strength and endurance training and educational, nutritional, and psychosocial support, improves symptoms and exercise tolerance in COPD patients, but is underutilized 4