What are the drugs for treating emphysema? What should we pay attention to in our daily life?

Author: Wang Guangfa, Chief Physician, Peking University First Hospital

Reviewer: Wu Xueyan, Chief Physician, Peking Union Medical College Hospital

In fact, strictly speaking, there is currently no particularly effective drug treatment for emphysema.

Because emphysema is often caused by COPD, the progression of emphysema will be alleviated if COPD is cured. Therefore, the drugs used to treat emphysema are often also the drugs used to treat COPD.

Commonly used maintenance drugs, such as anticholinergic drugs. Long-acting anticholinergic drugs are preferred. The earliest developed one is tiotropium bromide. The working principle of tiotropium bromide is to block cholinergic receptors and block the activation of the vagus nerve. Like long-acting vagus nerve blockers, there are now glycopyrrolate and umeclidinium bromide. These are relatively new drugs with better efficacy and longer maintenance time. The effect of a single use of the drug can last for 24 hours, so it can be used once a day.

There are also some long-acting beta-2 receptor agonists, such as salmeterol, which appeared earlier and is taken once every 12 hours, and indacaterol and vilanterol, which are taken once every 24 hours. The function of these drugs is to activate beta-2 receptors and block vagus nerve receptors to relax muscles.

The vagus nerve and the sympathetic nerve are a bit like the yin and yang in traditional culture, and the two have opposite effects. So in terms of medication, one is a blocker and the other is an agonist, and the therapeutic effect is the same.

The combined use of these two bronchodilators is the basis of COPD treatment. Inhaled corticosteroids can also be added, which is more effective for patients with high eosinophil levels.

So now some new triple drugs are gradually emerging, and these treatments are still worth looking forward to in the future.

Patients with emphysema must take the disease seriously. Nowadays, everyone pays more attention to hypertension. Patients with hypertension take medicine every day. Patients with emphysema also need to take medicine every day. What kind of medicine do they take? Inhaled medicine.

During the medication process, the first thing to do is to quit smoking. Not quitting smoking is like putting out a fire while adding fuel to the fire. The patient's condition will not improve.

The mainstream treatment now is drug inhalation, which has its advantages: first, it has a local effect, so the systemic adverse reactions caused by the drug are less; second, the local drug concentration is high, so the effect is better. Therefore, under the same dosage, the effect is better than systemic medication.

Some patients said that they still had breath holding after taking the medicine, for example, when exercising, their exercise tolerance would increase. Some of these medicines could reduce acute attacks, and some could even prolong life.

So everyone should realize this problem. It is not like asthma. When asthma strikes, the breath is very short, but it can be relieved quickly after inhaling the medicine, so the awareness and feeling of this medicine are relatively strong. But the feeling of COPD and emphysema patients is not so obvious, but in the long run, it is good for patients, so this is very important.

Patients with emphysema also have some precautions in their daily lives. For example, acute exacerbations of emphysema are common in patients, so special attention should be paid to the prevention of acute exacerbations.

For example, try not to go out on smoggy days. Normally, the room should be ventilated, but on smoggy days, don't ventilate. If you have an air purifier at home, turn it on to reduce the impact of these pollutants on the human body.

Before the flu season arrives, you should get a flu shot and a pneumococcal vaccine to reduce infection. Because this group of patients is very vulnerable, their condition will be more severe after a respiratory infection, so you should pay attention to prevention.

Figure 1 Original copyright image, no permission to reprint

Another thing is that these people often pant when they move, so they are particularly reluctant to move. The result is muscle atrophy in the upper and lower limbs. These muscle atrophy may seem like just a weakening of strength, but in fact it is not, because these muscles are very helpful in maintaining their nutritional status and improving immune function.

Therefore, patients should pay attention to persisting in rehabilitation exercises, just like normal people. Everyone may hold their breath when climbing a mountain, but normal people don’t stop climbing mountains because of holding their breath. In fact, this is also a kind of fun and a form of exercise.

These patients with emphysema should also insist on exercising. Of course, this does not require them to go hiking. Maybe everyone has different ways of exercising. They can go to the hospital for an assessment of what kind of exercise they can do and what kind of exercise they should do in this condition. The doctor will give them correct guidance.

Of course, if these patients are still smoking, they must quit. It is never too late to quit smoking. Don't say that I have emphysema, which is already very serious, why should I quit smoking? Just keep smoking. Smoking one more cigarette is actually burning your life.

Once they quit smoking, many patients will say that they cough and expectorate less immediately. This means that the inflammatory response is lighter, and lung function is still declining, but it is declining more slowly than before quitting smoking. This is also something that patients with emphysema should pay attention to.

Figure 2 Original copyright image, no permission to reprint

Of course, there are some special industries with a lot of dust, so try not to do them. In some rural areas, if you cook with firewood, you must pay attention to ventilation, or change to coal stoves. If the conditions are good, it is better to burn natural gas. So changing some lifestyles is also good for patients with emphysema.