Here is some understandig about Emphysema and COPD
In patients with emphysema, normal lung tissue is often replaced by large
"bullae," large balloon-like structures that press on normal lung tissue and
reduce the person's lung capacity even further. If the lungs are full of
bullae, the lungs become too large for the chest cavity and cannot expand
properly. Bullae can be surgically removed in a procedure called bullectomy
if they are large or localized, or the lungs can be surgically reduced in
size to make them fit better in the chest cavity. Some patients have noted
significant improvement in symptoms after lung volume reduction surgery, but
the procedure carries high risks, including death. The National Emphysema
Treatment Trial is a five-year study currently underway to evaluate the
effectiveness of lung volume reduction surgery. So far, results seem to
indicate that there is a higher risk of mortality for emphysema patients
with a low forced expiratory volume in one second (FEV1) and either
homogeneous emphysema--evenly distributed bullae all over the lungs--or a
very low carbon monoxide diffusing capacity. "Low," in this case, means
under 20% of the normal capacity. Patients with this profile should probably
consider medical treatment and pulmonary rehabilitation instead of surgery.
Emphysema is a pulmonary deficiency usually caused by years of free-radical
damage that results in degenerative changes in the air sacs of the lung.
Free radicals and changes of antioxidant enzymes are also thought to play a
role in chronic obstructive pulmonary disease.
Pulmonary oxygen radical injury and the protective role of antioxidant
enzymes in COPD were measured in one study. The results suggest that the
increased free-radical toxicity and decreased glutathione peroxidase and
catalase activities in red blood cells are involved in chronic obstructive
pulmonary disease (Misso et al. 1996; Tekin et al. 2000).
In another study, an imbalance between oxidants and antioxidants in smokers
and in patients with airway diseases such as asthma was proposed.
Antioxidants were measured in a group of chronic obstructive pulmonary
disease patients. The results showed that smoking, acute COPD attacks, and
asthma are associated with a marked oxidant/antioxidant imbalance in the
blood, associated with evidence of increased oxidative stress (Rahman et al.
1996).
In more recent research on the effects of smoking, it was concluded that
antioxidants that have good bioavailability or molecules that have
antioxidant enzyme activity are therapies that not only protect against the
direct injurious effects of oxidants, but also may fundamentally alter the
inflammatory events that have a central role in the pathogenesis of COPD
(MacNee 2001).
The suggested daily dose of antioxidant nutrients for patients with these
lung diseases is 3 tablets 3 times a day of Life Extension Mix and 1 capsule
a day of Life Extension Booster. In order to help break up the thick mucus,
600 mg of N-acetyl-cysteine should be taken 3 times a day, along with 2
grams of vitamin C.
If the combination of these nutrients does not sufficiently break up the
mucus, Pulmozyme, a drug used to treat cystic fibrosis, can be prescribed by
your doctor. Pulmozyme is the most effective mucus-eradicating drug
available. However, it is approved only for cystic fibrosis and, as a
result, physicians often fail to prescribe it for acute mucus problems.
To restore energy production to damaged cells in the lungs and relax
bronchial airways, the following nutrients are suggested:
Coenzyme Q10: assists in cellular respiration and acts as an antioxidant
Alpha-lipoic acid: functions as a cofactor in energy production, acts as a
free radical scavenger, and helps regenerate the effects of other
antioxidants
Acetyl-L-carnitine: transports lipids into the mitochondria to be used in
the production of cellular energy
NADH: a reduced form of vitamin B3 essential for energy production
Taurine: may improve breathlessness and increase cardiac blood flow
Magnesium: is a cofactor in over 300 enzymatic reactions in the body and
relaxes bronchial muscles
Potassium: weakness and fatigue are symptoms of deficiency. Consult your
physician for blood testing.
Vitamin A Status Is Important
Epidemiologic studies have shown the severity of COPD correlates with low
vitamin A intake. Other reports indicate that serum levels of vitamin A
(retinol) are below normal in patients with COPD. In emphysema, the alveoli
and bronchiole tubes of the lungs are destroyed, and the lungs become
enlarged and less efficient. Although treatments exist, such as antibiotics
and inhalers, none of these are curative. The vitamin A derivatives work by
actually helping the lung regrow in areas destroyed by the disease.
Retinoids are able to do this by turning on the genes that signal the growth
of lung tissue. This process was originally observed by studying fetuses,
whose lungs have high concentrations of certain retinoids.
The relationship between vitamin A status and COPD was further explored in a
two-part study by researchers at the Faculty of Medicine of Botucatu UNESP
in Sao Paulo, Brazil (Pavia et al. 1996). In the first part of the study, 36
men, age 43-74 years, were divided into five groups: healthy nonsmokers,
healthy smokers, smokers with mild COPD, former smokers with moderate-severe
COPD, and former smokers with severe, complicated COPD. All subjects
underwent pulmonary function testing, and dietary intake of vitamin A was
estimated from a food-frequency questionnaire. In addition, serum levels of
retinol and other vitamin A-related compounds were determined from fasting
blood samples. The results of this part of the study showed that serum
levels of vitamin A were significantly lower in the two groups with moderate
or severe COPD, although no group exhibited overt vitamin A deficiency.
In the second part of the study, 12 male smokers (45-61 years) with mild
COPD were randomly assigned to receive either a placebo or a vitamin A
supplement for 30 days. A comparison of pulmonary function tests performed
at baseline and at the end of the study showed a significant improvement in
forced expiratory volume in the vitamin A-supplemented group but only modest
improvement in the group receiving the placebo. Interestingly, pulmonary
function tests performed 30 days after the end of vitamin A supplementation
were similar to baseline values (Paiva et al. 1996).
These results support earlier findings of an association between low vitamin
A status and COPD. In addition, Pavia et al. (1996) conclude that the
improvement in pulmonary function observed following vitamin A
supplementation suggests "the existence of a local vitamin A deficiency" in
persons with COPD. Those with COPD may consider supplementation with
25,000-50,000 IU of vitamin A a day.
A pilot study performed at the UCLA School of Medicine, March 2002, using a
vitamin A derivative, all-trans-retinoic acid (ATRA), indicated that ATRA
was shown to reverse anatomic and physiologic signs of emphysema in a rat
model. Researchers conclude that ATRA is well tolerated in patients with
emphysema and trials evaluating higher doses, longer treatment, or different
dosing schedules are feasible (Mao et al. 2002). ATRA is sold under the
tradename Vesanoid.
The benefit of vitamin A derivatives--ATRA and 13 cis-retinoic acid--against
emphysema is the subject of a study funded by the National Heart, Lung, and
Blood Institute known as the FORTE study (Feasibility of Retinoid Therapy
for Emphysema). Research will be conducted at five universities throughout
the United States. Adult patients with mild to moderate emphysema will
randomly receive 1 or 2 strengths of ATRA, 13 cis-retinoic acid, or a
placebo for 6 months. The placebo group will then receive the retinoids and
the retinoid group will receive the placebo for the remaining 3 months of
the study. The study seeks to confirm the benefits of retinoids against the
disease observed in previous human and animal studies. The trade name for
13-cis-retinoic acid is Accutane. For more information or status of this
study, please visit the website www.clinicaltrials. gov, and search for the
key word: FORTE.
Relieving Breathlessness
Most emphysema treatment is based on the concept that it can be treated but
not cured. The administration to emphysema sufferers of theophylline and
ipratropium bromide in combination has produced improvements in maximal
oxygen consumption and maximal minute ventilation, and it has reduced
several measures of breathlessness. British patients who had not responded
to oral administration of corticosteroid (prednisone) were given budesonide
(by inhalation). Researchers concluded that inhaled corticosteroids were of
no benefit to patients with advanced COPD (Bourbeau et al. 1998). Inhaled
corticosteroids, while less dangerous than oral steroids, can still increase
the risk of high blood pressure and diabetes. Other undesirable side effects
reported by patients include edema, cataract development, bone brittleness,
and premature skin aging sometimes known as "onion skin" (Covar et al. 2000;
Jick et al. 2001).
Researchers in New Zealand found that nebulized saline solution relieved
breathlessness in patients at rest with COPD (Poole et al. 1998). Other
conventional therapies include breathing techniques, aromatherapy, and
oxygen therapy. Recent developments in lung reduction are very promising.
Such surgery is called volume reduction surgery or lung shaving (Matsuzawa
et al. 1998; Meyers et al. 1998; Norman et al. 1998). Other experimental
procedures showing some promise are the surgical removal of damaged alveoli,
which reduces lung size, and laser removal of damaged lung tissue. Laser
surgery has not been as effective as volume reduction therapy (Sabanathan et
al. 1998). Lung transplantation becomes more successful with each passing
year, though there is a real shortage of donors (Geertsma et al. 1998).
Nondrug Therapies
An old folk remedy that works well to loosen the phlegm in the lungs of
those with damaged cilia is to inhale steam. Use of a steam or a hot mist
vaporizer in a room can also be very helpful. (Avoid the use of cold water
humidifiers as they often introduce mold, mildew, and harmful bacteria into
the air, actually increasing the risk of lung infection.) Using a steam
vaporizer in a small, enclosed space such as a bathroom can raise the level
of humidity significantly and can be very useful. Adequate liquid intake
enhances thinning and removal of lung secretions.
Postural drainage is a technique in which the lung segment to be drained is
placed in the uppermost position relative to the rest of the body. There is
also a very useful "clapping" technique in which someone "claps" the back or
chest of the patient to loosen the built-up phlegm. Also known as
"percussion," the technique uses cupped hands clapping the chest wall in
rapid succession, producing a series of hollow sounds. Both percussion and
chest vibration (using a vibrator) can be used in combination with postural
drainage as appropriate. Pillows are used to support the patient in the
designated position. (Consult your medical caregiver for detailed
instructions on the use of these techniques.)
Exercise and Nutrition
Though exercise before the onset of emphysema can increase lung capacity, it
has not been demonstrated to have that effect in those suffering from the
disease. Regular aerobic exercise does, however, help the patient to use
available oxygen more efficiently and also strengthens the heart.
Proper nutrition includes the increase of unprocessed foods such as fruits
and vegetables and high-quality protein and the decrease of fried foods,
alcohol, refined carbohydrates, and processed foods. Also, it is wise to
eliminate the use of all mucous producing foods like dairy and
gluten-containing grains. If sound nutrition is important in preventing
emphysema, it is crucial once the disease has been diagnosed. Malnutrition
may increase the risk of respiratory failure in patients with COPD. French
scientists found that the primary goal of a successful nutritional program
for those with COPD should be to improve diaphragm strength by correcting
mineral and electrolyte disturbances at the muscular level.
Pulmonary rehabilitation in emphysema patients has resulted in reduced
hospitalization, improved well-being and exercise tolerance, and reduced
shortness of breath. Such programs usually require physician referral, a
cardiopulmonary stress test, and evaluation by an RRT. Substantial benefits
are reported for those suffering from emphysema, asthma, bronchiectasis,
chronic bronchitis, and sarcoidosis. It is also recommended for those
planning to undergo lung reduction therapy as well as for those who have
just completed that surgery. Residential programs last about 8 weeks and
include smoking cessation and education on breathing exercises, nutrition,
energy conservation, stress reduction, and the management of medication.
Exercise includes such activities as walking on a treadmill, walking,
stationary bicycling, stretching, and working out with light weights.
Exercise programs are always tailored to individual needs. Regular exercise
has been proven to improve the condition of the cardiopulmonary system.
Regenerating Alveoli
Scientists funded by the National Heart, Lung, and Blood Institute have
demonstrated a remarkable regeneration of alveoli, which returned to their
normal size and number. In research using rats at the Georgetown University
School of Medicine, treatment with ATRA, a metabolite of vitamin A, resulted
in nonsurgical reversal of damage caused by emphysema the first time
(Massaro et al. 1996). Not only was the number of alveoli increased in
normal rats, but alveoli in rats with emphysema were repaired, and lung
elasticity recoil was significantly improved (DeLuca et al. 1997). Though
these studies have so far been conducted only in animals, results are very
promising, leading a number of physicians to put their emphysema patients on
retinoic acid therapy.
As human research studies are reported, many caregivers are confident that
this remarkable therapy will be more widely adopted. In fact, the FDA has
now approved the drug ATRA for emphysema therapy. Vesanoid--a trade name for
ATRA--must be prescribed by a physician. If the high cost of retinoic acid
makes its cost prohibitive, consider taking 4 drops a day (100,000 IU) of
emulsified liquid vitamin A (refer to vitamin A precautions in Appendix A).
Summary
Emphysema is one of the diseases known collectively as COPD. Although
emphysema can be brought on by a number of situations and conditions that
damage the lungs, the primary causative factor is smoking. Exposure to fine
particulate matter, aerosol sprays, industrial chemicals, or air pollution
can damage the lungs, leading to emphysema or making the condition worse in
those already suffering from the disease. Vitamin A and antioxidant
supplementation, regular exercise, postural drainage and percussion, the use
of steam and hot mist vaporizers, and lung reduction and transplant surgery
are all useful therapies for emphysema.
Do not smoke, because smoking leads to emphysema and also makes emphysema
worse.
Get regular exercise and eat a balanced, nutritious diet.
If you (or anyone in your family) are alpha-1-antitrypsin deficient, see
your doctor about AAT supplementation.
Avoid industrial pollutants, second-hand tobacco smoke, grain dust, and
other air pollutants. This applies to everyone, but is especially important
for emphysema patients.
The suggested dose of high-potency vitamins for COPD patients is 3 tablets 3
times a day of Life Extension Mix and 1 capsule a day of Life Extension
Booster.
To help break up thick mucus in the lungs, drink plenty of fluids and take
600 mg a day of N-Acetyl-Cysteine and 2 grams of vitamin C 3 times a day.
In patients for whom N-Acetyl-Cysteine and vitamin C do not provide
sufficient relief from thick mucus, Pulmozyme, a drug used to treat cystic
fibrosis, can be prescribed by their doctor. Because it is approved only for
cystic fibrosis, Pulmozyme is unlikely to be prescribed for emphysema unless
requested by the patient.
Low vitamin A levels are often seen in COPD patients. Pulmonary function may
improve with supplementation of 25,000-50,000 IU of vitamin A daily.
To restore energy to damaged lung cells and keep airways relaxed, the
following nutrients are suggested:
Coenzyme Q10, 100 mg 3 times a day.
Alpha-lipoic acid, 250 mg twice a day.
Acetyl-L-carnitine, 1000 mg twice a day.
NADH, 5 mg twice a day.
Taurine, 1000 mg twice a day.
Elemental magnesium, 500 mg twice a day.
Potassium, if needed.
N-Dimethylglycine (DMG) can be taken at the rate of 1 or 2 tablets (125-250
mg) under the tongue immediately before exercise. It has been demonstrated
to help in oxygenation.
For More Information
Contact the American Lung Association at (800)586-4872