Emphysema therapy

A It s impossible to tell how long improvements from peroxide therapy will last. As with any therapy, it depends on the condition, the person, and a lot of unknown factors. You can t get a 50,000 mile, 5-year guarantee with any therapy. In any chronic condition, such as emphysema, therapy will undoubtedly have to be continued on an intermittent basis indefinitely. 

The mucolytic acetylcysteine may be used as part of the treatment of bronchopulmonary diseases such as emphysema It is primarily given by nebulization but also may be directiy instilled into a tracheostomy to liquefy (thin) secretions. The mucolytic drugs are effective as adjunctive therapy in chronic bronchopulmonary diseases, such as chronic emphysema, emphysema with... 

Improvement in symptoms should occur within 48 to 72 hours after initiation of therapy for most patients with CAP. Response to therapy could be slowed in patients with underlying pulmonary disease such as moderate to severe asthma, COPD, or emphysema. In patients not responding to therapy with no underlying factors that would suggest a slowed response to therapy, then other infectious and noninfectious reasons must be considered. The infection could be caused by a pathogen not covered by the initial therapy, a drug-resistant isolate could be present, or more severe infection could be present (nonpulmonary), and the patient should be... 

Gene engineering is the basis of gene therapy where genes are removed, replaced, or altered producing new proteins for the treatment of diseases such as muscular dystrophy, some cancers, adenosine deaminase deficiency, cystic fibrosis, and emphysema. 

Mucolytic Adjuvant therapy for abnormal, viscid, or inspissated mucus secretions in chronic bronchopulmonary disease (chronic emphysema, emphysema with bronchitis, chronic asthmatic bronchitis, tuberculosis, bronchiectasis, primary amyloidosis of lung) acute bronchopulmonary disease (pneumonia, bronchitis, tracheobronchitis) pulmonary complications of cystic fibrosis tracheostomy care pulmonary complications associated with surgery use during anesthesia posttraumatic chest conditions atelectasis due to mucus obstruction diagnostic bronchial studies (bronchograms, bronchospirometry, bronchial wedge catheterization). 

One should consider infiuenza- and pneumococcal-vaccination in patients with increased risk for lower RTI including patients with chronic obstructive pulmonary disease like chronic bronchitis or emphysema and cystic fibrosis patients. It should be considered for the elderly population in general. There is no role for prophylactic antibiotic therapy in patients with frequent RTI. Attempts should be made to have those patients that smoke stop doing so. 

O 1-Antitrypsin augmentation therapy is appropriate in non-smoking, younger patients with severe ofi-antitrypsin (AAT) deficiency and associated emphysema. Such therapy is not indicated in the common form of COPD. 

Indications Replacement therapy in patients with congenital alpha-1 antitrypsin deficiency who have panacinar emphysema... 

Crystal, R. G. (1990). Alpha 1 -antitrypsin deficiency, emphysema, and liver disease Genetic basis and strategies for therapy. J. Clin. Invest. 85, 1343-1352. 

Pulmonary gene therapy is attractive for the treatmment of chronic bronchitis, cystic fibrosis, a-1 antitrypsin deficiency, familial emphysema, asthma, pulmonary infections, surfactant deficiency, pulmonary hypertension, lung cancer, and malignant mesothelioma. The pulmonary endothelium may act as a bioreactor for the production and secretion of therapeutic proteins, such as clotting factors and erythropoietin into the blood circulation. There is a potential benefit for acquired lung diseases, as well as cancers, to be controlled and possibly treated by expression of cytokines, surfactant, antioxidant enzymes, or mucoproteins within lung cells. 

The use of recombinantly produced (X,-antitrypsin would reduce the risk of transfusion-related viral disease however, its half-life is too short to produce adequate serum levels without daily infusion. Studies have shown that the recombinant product can be administered as an aerosol. It diffuses across the respiratory epithelium, enters the lung lymph, and eventually reaches the systemic circulation. Unfortunately, it is not known whether this therapy has any influence on the development or progression of emphysema. Further carefully controlled, multicenter trials are necessary. 

More broadly, timolol therapy should be considered with caution in patients with any significant sign, symptom, or history for which systemic beta-blockade would be medically imwise.This includes disorders of cardiovascular or respiratory origin (e g., asthma, chronic bronchitis, and emphysema) as well as many other conditions. Spirometric evaluation after institution of timolol therapy may help to identify patients in whom bronchospasm develops after commencement of therapy. In general, however, patients with asthma and other obstructive pulmonary diseases should avoid this drug. Sympathetic stimulation may be essential to support the circulation in individuals with diminished myocardial contractility, and its inhibition by P-adrenoceptor antagonists may precipitate more severe cardiac feilure. 

Opioid-naive patients with severe pain who require high doses of opioids are at highest risk for respiratory depression, whereas patients receiving chronic opioid therapy rarely experience this problem (20). Fortunately, the occurrence of respiratory depression can often be circumvented with appropriate titration of opioid dose (22)unless there is underlying pulmonary dysfunction such as emphysema or severe obesity (23). 

Aerosol preparations of drugs are most commonly used for the treatment of diseases involving airway obstruction, namely bronchodilators and antiinflammatory agents in asthma, bronchitis, and emphysema. Other uses of aerosol therapies include mucolytics (for decreasing the thickness or viscosity of mucus in diseases involving abnormal mucus secretion, e.g., pneumonia,... 

Medical Research Council Working Party. Long-term domiciliary oxygen therapy in chronic hypoxic cor pulmonale comphcating chronic bronchitis and emphysema. Lancet 1981 1 681-685. 

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