Are Emphysema and Bronchiectasis Reversible?

Both emphysema and bronchiectasis can significantly interfere with the lungs function, making it more difficult to breathe. Even in severe cases, they could be life-threatening. Some treatments are available. The treatment plan is highly variable, depending on several factors. A challenging question, are they reversible?

Emphysema

Emphysema, one of main types of COPD (chronic obstructive pulmonary disease), is quite common in some countries – including in North America and UK. This respiratory disease involves the enlargement of alveoli (air sacs) in the lung.

What are alveoli? Bronchi (main airways in the lungs) branch off into smaller passageways, and the smallest ones are called bronchioles. And at the end of each bronchiole, you have very tiny air sac called alveolus (the plural of alveolus is alveoli). See the following picture, image credit to Mayo!

Alveoli are essential part of the lung where oxygen begins to enter to the circulation (bloodstream) and carbon dioxide go away from the bloodstream.

In emphysema, the alveoli become enlarged due to the breakdown and damage of their walls. Over time, the air sacs lose their normal shape (there will be larger air sacs instead of tiny ones).

More damaged airs sacs means there’s a decreased surface area for gas exchange. As a result, you can have difficulty to catch your breath and get adequate oxygen for your body needs.

Shortness of breath is the main symptom, and it usually develops gradually. Even you may not notice any symptom for many years until the damaged alveoli becomes advanced. Feeling of breathlessness usually gets worse during exertion such as during exercise. But in severe case, it may also occur even while you’re at rest.

Emphysema is a progressive condition that will significantly ruin the lungs function over time, especially if the disease is poorly controlled and not treated as well. In most patients with COPD, emphysema is quite common to be found together with chronic obstructive bronchitis (a condition in which the linings of the airways thicken due to irritation and inflammation).

Excessive exposure to tobacco smoke (including for secondhand smoke) is the main risk factor of emphysema. If you smoke, quitting as soon as possible can help a lot to reduce your risk of developing the disease. If you’re already diagnosed with the disease, quitting can also plays a part to control and prevent it from getting worse.

Other risk factors include exposure to other air irritants (such as air pollutions), respiratory infections, age (the risk increases with age), and genetic factors.

Bronchiectasis

It is a chronic condition in which the walls of bronchi (the main, large airways of the lungs) get thickened and abnormally widened.

Symptoms

Persistent cough (difficult to improve) that comes up with a large amount of phlegm is the most common symptom. Sometimes there is only a mild phlegm (with a small amounts of phlegm), or none at all. But in general, the symptom will be more noticeable as bronchiectasis progresses and becomes advanced.

The color of phlegm can vary, too. It can be yellow-greenish, pale yellow, or colorless (clear). In some cases, the cough may come up with phlegm containing blood (blood-stained phlegm), depending on the severity of the disease.

Shortness of breath is another common symptom. People with bronchiectasis can have exacerbations (periodic flare-ups of difficulties in breathing). Other symptoms may include wheezing, joint pain, chest pain, and clubbing of the fingertips.

If the infection develops, the symptoms will worsen within a few days. You can cough up more phlegm which may smell more unpleasant, and your breathlessness worsens even more. The infection may also be followed with fatigue (tiredness), general feeling of sick, coughing blood, or sharp pain in the chest (especially when breathing).

Causes

Bronchiectasis starts to develop when the muscles and tissues surrounding the bronchi are destroyed or damaged. There are a number of causes why this may occur:

1. In some cases, the problem begins to develop in childhood after having a severe lung infection such as whooping cough and pneumonia, especially if the infection has damaged the main airways of the lungs.
2. Cystic fibrosis, a disorder that typically occurs in children and young adults. It can causes sticky, thick mucus in the lungs and other parts of the body.
3. If something goes awry with the body immune system that causes the main airways of the lungs to become more vulnerable to get damaged from an infection.
4. ABPA, allergic bronchopulmonary aspergillosis. It is a disorder in which you have excessive allergic reaction to particular type of fungi that may make the main airways of your lungs to easily get inflamed when you inhale spores from the fungi.
5. Genetic conditions such as immunodeficiency syndromes and primary ciliary dyskinesia.

Sometimes the cause is unidentifiable. If the cause is not known, this is called idiopathic bronchiectasis.

Are emphysema and bronchiectasis reversible?

Both respiratory diseases could be life-threatening, because they can lead to serious damage in the lungs. The bad news, the damage can be permanent.  Does this mean that they cannot be cured and irreversible?

… Continued …

Again the damaged area of the lungs due to emphysema and bronchiectasis can be permanent. Unfortunately, there is still no treatment to reverse or cure it.

Actually, the lungs have natural mechanism to repair themselves, though this ability is limited. At first, the disease may only cause a mild damage, reversible. But as the disease progresses and becomes advanced, there is greater chance for more serious damage to occur and permanent damage is inevitable.

Although there is still no cure, some effective treatments are available to help relieve the symptoms, control the disease and stop it getting worse so the lungs function can be preserved as much as possible.

Emphysema treatments

Currently, the treatments for emphysema are focused on improving the symptoms of the disease, especially such as shortness of breath. Some treatments are also aimed to help preserve the lung function and decrease the number of hospitalizations.

Medications for emphysema include:

1. The use of bronchodilators to help relax and open the airways. You can use it in several different ways, like as a solution and as inhalers. Based on how it works, it is available in two options; long-acting and short-acting.
2. Treating emphysema with steroids (corticosteroids) to help ease inflammation of the airways. It can be used as inhalers and oral. Intravenous (oral) corticosteroids are effective for exacerbations of emphysema, but it’s not recommended to use it frequently in long term since it poses the risk of serious effect effects.
3. Sometimes antibiotics are prescribed if you have emphysema with bacterial infection.

Besides those medications, the treatment plan may also include some of the following therapies:

1. Pulmonary rehabilitation therapy, an intensive program to help you learn how to breath more effectively and cope with the disease better. It usually involves the combination of nutrition, counseling, exercise, and medication management.
2. Oxygen therapy. Emphysema can make it more difficult to breathe, leading to oxygen deficiency in the body. For this reason, you may need oxygen therapy.

What else? Surgery may also be suggested to remove large areas of diseased /damaged lung so the remaining healthy areas of the lung will work better.

How about lung transplant? It is usually the last treatment option. It might be able to cure the disease, but it carries the risk of other medical problems.

Bronchiectasis treatments

Although the damage caused to the lungs by this respiratory disease can be permanent, but some treatments are available to help improve the symptoms and prevent the damage from getting worse.

In general, the treatment for bronchiectasis is focused on controlling sputum and infections, improving airway obstruction, and reducing the risk of complications from the disease. The main treatment options include:

1. Medication to help improve or relieve airflow within the lungs, such as with bronchodilators.
2. Daily drainage to remove sputum. This includes exercises, postural drainage, or with special (handheld) devices.
3. Antibiotics for treating the infection.

How about surgery? It is not the main treatment option for bronchiectasis. But sometimes it may be suggested with the following scenarios:

1. If the disease is only affecting a small area, single section of the lung.
2. If other treatments don’t work.
3. And if there is not underlying condition that could make the disease to return.

Lifestyle measures such as exercising regularly, quitting smoking, keeping hydrated, and eating right in a balanced diet may help too. You may also need to take pneumococcal vaccine in order to protect against pneumonia. Consult with your doctor for more advice!