Emphysema and Chronic Obstructive Pulmonary Disease (COPD)

Emphysema is a progressive, destructive lung disease in which the walls between the tiny air sacs in the lungs are damaged. As a result, the lungs lose their elasticity and exhaling becomes more and more difficult. Air remains trapped in the overinflated lungs.

Emphysema patients report increasing shortness of breath, especially with activity, as well as variable degrees of coughing and wheezing, and irreversible airflow obstruction. Heredity may play a part in the tendency to develop emphysema, but the disease is clearly worsened by smoking, air pollution, exposure to dust and fumes, and lung infections.

Together with asthma and chronic bronchitis, emphysema is part of a group of diseases that share a common feature – difficulty in expelling air from the lungs. We refer to this group as Chronic Obstructive Pulmonary Disease (COPD). COPD is the most common form of pulmonary dysfunction today.

The fourth leading cause of death in United States, COPD is also the second major cause of disability (behind coronary artery disease). Over 15 million adult Americans have COPD. While hereditary and environmental factors can play a role in causing or aggravating COPD, smoking is responsible for 82% of cases.

Lung Volume Reduction Surgery for COPD

Lung Volume Reduction Surgery (LVRS), the removal of sections of damaged lung tissue, has shown promising results for patients with end-stage emphysema. By removing the most diseased tissue (up to 30% of the lung volume), the goal is to improve the residual lung function and respiratory mechanics. LVRS can be performed through either median sternotomy (open chest) or video-assisted minimally invasive technique.

NewYork-Presbyterian/Columbia University Medical Center is the only medical center in the tri-state area designated by the National Institutes of Health as a center of excellence in LVRS for the treatment of emphysema. If you are interested in being evaluated for lung volume reduction surgery, please call the Center for Lung Failure at 212.305.1158 to obtain a patient questionnaire. You will need to discuss your interest in LVRS with your primary physician, who will be asked to provide your medical information to us including history, pulmonary function, and x-ray studies.

Our staff will review that information to determine whether you're a candidate for an on-site evaluation. If you qualify, you will be invited to the center for 2 days of outpatient testing, including:

  • Chest X-ray
  • Chest CT scan
  • Perfusion scan of lungs
  • Blood tests (alpha1 antitrypsin; Cotinine level)
  • Complete pulmonary function test with lung volumes by plethysmography
  • Room air arterial blood gas
  • Dobutamine stress test of heart
  • Cardiopulmonary exercise test

After these tests are done, you will be examined by a pulmonologist and surgeon who make final decisions about your eligibility for lung volume reduction surgery. All patients, whether surgical candidates or not, are evaluated for and prescribed a pulmonary rehabilitation program by the rehabilitation medical physician during their evaluation at the Center.

Patients accepted for surgery are referred to a 6-week program of outpatient pulmonary rehabilitation prior to surgery as well as a preoperative checkup in the final week of the program. At this time surgical consent is obtained, surgery scheduled and preoperative testing including an evaluation by an anesthesiologist is performed. All arrangements are made with the patient and his or her family and the staff at the Center for Lung Failure.

Most private insurance plans cover the procedure, while Medicare covers lung volume reduction surgery with condition.

Learn more about Lung Volume Reduction Surgery here.

Lung transplantation offers a return to improved breathing and an excellent quality of life for patients suffering from advanced emphysema. NYP/Columbia is a leading center in the field of lung transplantation.

Not all patients with advanced emphysema are candidates for LVRS or lung transplantation, however. For such patients, we provide other treatment options, including redirection of airflow by means of bronchoscopically implanted stents and valves. These endobronchial stents enable trapped air to escape and improve overall lung function.

For information about current clinical trials, click here.

Medical Treatments for COPD

There are many medical options for treating emphysema/COPD.

Smoking Cessation

The primary recommendation for preventing and treating COPD is to smoking cessation.

Bronchodilators

Bronchodilators relax the muscles of the bronchus, allowing air to get in and out easier. These medications are available in pill or liquid form (taken orally), or as an aerosol spray (inhaled).

Steroids

Steroids dilate the bronchial tubes and decrease the swelling of the lining and inflammation of the cells. Up to 20% of COPD patients, mostly those with asthma or asthmatic bronchitis, benefit from steroid therapy. The potential side effects of systemic steroids are osteoporosis, diabetes, weight gain, cataracts, and hypertension. (Steroid treatment has little to offer emphysema patients.)

Anti-Infective Agents

Antibiotics are frequently used during acute bronchitis to fight bacterial infections. Flu and pneumonia vaccinations are recommended for all patients with COPD. The influenza shot is administered yearly while the pneumonia shot is administered every five years.

Oxygen Therapy

Oxygen therapy has proven beneficial in improving the quality and length of life in selected emphysema patients. 

Nutrition

Proper nutrition is critical for emphysema patients. Weight loss, which is common in patients with advanced emphysema, can be caused by inadequate food intake in individuals too short of breath to eat. However, most weight loss in COPD patients is due to the increased metabolic demand of respiratory muscles that are overworked because of emphysema damage.

Emphysema sufferers who lose weight are sicker and face increased mortality risks. Long-term benefits have not been demonstrated from the use of oral or IV supplements to improve nutritional health. Researchers have recently begun investigating using anabolic steroid to treat these patients.

Pulmonary Rehabilitation for COPD

Pulmonary rehabilitation has clear benefits for patients with COPD. Exercise increases endurance, improves shortness of breath, increases maximal oxygen consumption, and improves quality of life. Numerous studies have documented improvement in symptoms, maximum oxygen consumption, and quality-of-life measures. A decrease in the number of hospitalizations has also been shown in patients who participate in pulmonary rehabilitation programs.

Benefits do vary among individuals, however, and consistent participation in an exercise regimen is necessary to maintain improvements. In addition, it has not been shown that pulmonary rehabilitation produces any change in pulmonary functions tests (PFTs) or overall oxygen requirements for individuals.

Pulmonary Rehabilitation Program

The NYP/Columbia Pulmonary Rehabilitation program is specifically designed for individuals with chronic lung disease. The program offers exercise training, education, nutrition counseling, and a monthly support group.

Our team of health care providers assists individuals in designing a comprehensive, personalized program. Our goal is to help you achieve optimal physical functioning and improved quality of life, with an emphasis on collaborative self-management of your disease. Potential benefits include:

  • maximization of strength, endurance, and flexibility
  • decreased symptoms of breathlessness
  • decreased effort for the activities of daily living
  • increased energy to partake in hobbies, and social/family activities

Our education programs provide you with information on:

  • medications
  • signs and symptoms of infection
  • pathology of lung disease
  • proper nutrition
  • energy conservation
  • relaxation training
  • breathing retraining and secretions management
  • oxygen delivery systems
  • travel and environmental issues

In addition, individual and group support sessions offer a forum to discuss and share the frustrations and limitations of lung disease, while helping you to increase self confidence, independence, and overall emotional well being. Family and significant others are encouraged to participate.

Exercise Program for COPD

It is important to consult your doctor before beginning any new exercise program.

Stretches

Stretching exercises are designed to gently lengthen large muscle groups to improve overall flexibility and muscle efficiency. Stretching on a daily basis will make you feel more agile and will improve your ability to exercise. It is often uncomfortable but becomes easier with time. Stretching should always be done slowly and gently. A sustained prolonged stretch will provide the best benefit. Do not use bouncing or jerking motions when stretching. Stretching may be done daily without harm, but it is important to consult a health professional about a stretching program if you experience any persistent discomfort or joint pain with these activities.

Strength Training

Strength exercises are designed specifically to strengthen certain muscle groups. Always do exercises slowly and use the appropriate amount of weight. Weight should be increased only when you can easily do 3 sets of 8-10 repetitions without fatigue. You should increase weights in small increments to avoid injury and undue soreness. Certain types of antibiotic medications as well as corticosteroids (prednisone) may increase your risk of muskuloskeletal injury (i.e. sprains or strains) with heavy weight lifting. If you are currently on medications of this sort, consult your physician before beginning or increasing your activity.

Lower Extremity Endurance Training

Endurance training makes your muscles (including your heart) more efficient and better able to work. You will be able to do more activity for longer periods of time with greater ease. Endurance training includes aerobic activities such as treadmill walking, stationary bicycling, or free walking.

The American College of Sports Medicine recommends 20-30 minutes of continuous exercise 3-5 times a week for optimal cardiovascular and pulmonary benefits. Interval training or exercising for shorter times may be necessary initially until tolerance is achieved. Four 5-minute intervals with rest periods may be a more realistic goal to start. Intensity (speed, resistance, and incline) should be determined by a physician using a controlled graded exercise test.

Upper Extremity Endurance Training

Arm endurance training may be done supported (using an arm ergometer, "UBE", or arm crank) or unsupported (arm calisthenics). It should also be continuous for at least 15 minutes, 3 times a week. Initially interval training or exercising for shorter times may be necessary until tolerance is achieved.

Three 5-minute intervals with rest periods may be a more realistic goal to start. General recommendations for supported arm endurance are to begin with little or no resistance. When you can tolerate 15 minutes of continuous exercise, you may progress further by adding small increments of resistance in the middle portion of the exercise.

Always include a warm up and cool down period at a lower resistance for all endurance types of training. When doing calisthenics unsupported, build up to 15 minutes and then add small hand weights (1/2-1 pound) in each hand. You may find it necessary to return to interval training in order to tolerate the increased challenge.

Oxygen Therapy for COPD

If I use oxygen will I be confined to my home?

There are many types of portable oxygen systems including several light weight portable units. Consult your doctor or local medical supplier for more information.

Can I get addicted to oxygen?

Oxygen is not addictive. When your lungs are unable to supply adequate oxygen, supplemental oxygen may be required. Your need for supplemental oxygen may vary throughout the day and may also depend upon your activity level. When you are active (walking, showering, dressing, working), your body requires more energy (oxygen). By depriving your body of adequate oxygen you run the risk of putting undue stress on your heart and potentially developing heart failure.

How do I know if I need oxygen?

Your doctor will assess your need for supplemental oxygen using two methods:

    • Arterial Blood Gases (ABGs): This test is considered the gold standard. A sample of arterial blood is taken, usually from your arm, and tested for direct levels of oxygen. A level of 80-100 mm Hg is considered the normal range. Patients with chronic obstructive pulmonary disease (COPD) may tolerate lower levels of oxygen.
    • Pulse Oximetry: This is a non-invasive test that indirectly measures the level of oxygen in the blood. A probe is placed usually on your finger (ear, nose, and forehead probes may also be used) to measure oxygen levels. Normal levels are 90-100%.

A complete assessment of oxygen requirement should include these measurements both at rest and with exercise or activity.

How much oxygen should I be using?

Your doctor will prescribe the appropriate amount of oxygen for you to use based upon the results of your ABG and pulse oximetry tests. You may require a higher dose when exercising or performing difficult activities than when you are at rest or sleeping. Typically a prescription will be between 1-6 l/m of oxygen by flow meter.

If I feel short of breath, does that mean I need oxygen?

No, feeling short of breath does not necessarily mean that your body is lacking adequate oxygen. Only by testing your blood oxygen level (ABGs or pulse oximetry) will you know if you need oxygen and how much. Shortness of breath is part of lung disease. Often a regular program of exercise and conditioning combined with optimal medical management (medications and oxygen) may help to decrease the symptoms of shortness of breath.

Research Studies for COPD

We are a major research and treatment center for endobronchial stent procedures and are currently offering several clinical trials. We also are investigating bronchoscopic treatments of advanced emphysema in ongoing clinical trials through the Program in Interventional Bronchoscopy and Endobronchial Therapy.

In addition to services and treatment available through the Department of Surgery, Columbia's Division of Pulmonary, Allergy & Critical Care provides additional options for clinical trials and treatment for COPD.