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Treatment options expanding for emphysema patients.


Persons with emphysema, or chronic obstructive pulmonary disease (COPD), are having increased, if somewhat limited, options for the treatment of the disease process.

Avoiding or eliminating smoking is still considered the best way to reduce or eliminate the possibility of acquiring COPD. There are a relatively small number of people, however, who get severe emphysema due to a deficiency of alpha-1-antitrypsin, a substance normally found in the blood and lungs. Good news in the form of FDA approval for Miles Inc./Cutter Biological of West Haven, Conn., to market the alpha-1 by prescription occurred last year following studies under the auspices of the federal government. Although research to date has not demonstrated that replacement therapy prevents emphysema in persons with a genetic deficiency of the alpha-1-antitrypsin, the treatment is available. Studies have demonstrated that monthly administration of the substance significantly increases the level of alpha-1-antitrypsin in the blood and lungs. Unfortunately, it has no effect on individuals with emphysema who do not have the genetic defect.

Another treatment modality of COPD is getting increased attention due to reports of its success. Recently, two-lung transplantation was reported by researchers in Toronto, Ontario, Canada. Although still considered experimental, this strategy is considered a hopeful alternative to the progressive respiratory failure anticipated in individuals with advanced emphysema. The limited number of lungs available for transplants, the large number of individuals with advanced COPD, and the dangers of transplant failure associated with inadequate means for long-term oxygenation using external machines if the transplant fails are creating serious ethical and medical problems.

Single-lung transplants have been available since 1963. Problems associated with tissue rejection and breakdown of the sites of anastomosis (points where transplant tissues are joined to the patient's own tissue) limited the opportunity for successful transplants until the early 1980s. Even with improved surgical techniques and better antirejection drugs, the single-lung replacement has not been beneficial to many individuals with advanced COPD because the person's remaining lung often steals too much of the blood needed for aeration of the lungs, and also serves as a haven for disease-causing microorganisms.

Despite the drawbacks, single- and bilateral-lung transplants and the alpha-1-antitrypsin substance are providing new hope for persons with COPD after careful dialogue between patients, families and their physicians.
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Publication:Medical Update
Date:Aug 1, 1989
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