November 19, 2010

Dear Mayo Clinic:

Can methylprednisolone relieve shortness of breath for a person with emphysema?

Answer:

Methylprednisolone is a corticosteroid medication used to reduce inflammation in people with various lung conditions. It can help relieve shortness of breath in some cases. But it's not effective for the treatment of emphysema. Many people who have emphysema also have chronic bronchitis, though, and methylprednisolone is often used to treat that disorder.

To understand how this medication works, it's helpful to know how your lungs function. When you breathe in, air travels down your windpipe (trachea) and into your lungs through two large tubes (bronchi). Inside your lungs, these tubes divide into many smaller tubes that end in clusters of air sacs (alveoli). The air sacs have thin walls full of tiny blood vessels. The oxygen in the air you inhale passes into these blood vessels and enters your bloodstream. Carbon dioxide is removed from your bloodstream through these blood vessels at the same time.

Emphysema is a progressive lung disease that causes shortness of breath, wheezing, chest tightness and chronic coughing. People who have emphysema rarely, if ever, have emphysema alone. Emphysema is part of a spectrum of lung conditions that make up chronic obstructive pulmonary disease (COPD). People who have COPD usually have a combination of emphysema and chronic bronchitis. But the two conditions affect different parts of the lungs.

Emphysema affects the lungs' air sacs, and is usually caused by cigarette smoking. Chemicals in tobacco smoke can cause — among many other health problems — inflammation and damage to the air sacs. This decreases the elasticity of the air sacs, making it difficult for air to get in and out of the lungs.

In contrast, chronic bronchitis affects the lungs' bronchial tubes. Also caused mainly by smoking, chronic bronchitis is a persistent irritation and inflammation of the lining of the bronchial tubes that may lead to narrowing and, eventually, scarring of the tubes. Symptoms of chronic bronchitis are similar to those of emphysema, including shortness of breath.

Methylprednisolone works to reduce shortness of breath by decreasing inflammation in the bronchial tubes. It doesn't have any effect on the air sacs. People who have COPD are often given methylprednisolone when they are hospitalized for worsening shortness of breath. But the medication is given to counteract the effects of chronic bronchitis on the lungs, rather than emphysema.

Because it's a disease that gets worse over time and no cure is currently available, emphysema can be challenging to treat. That said, there are steps you can take that may help you feel better, stay active and slow the progression of the disease. The most important is to quit smoking. If you need help, ask your doctor about medications designed to help people quit smoking, such as nicotine gum, nicotine patches and the prescription medications bupropion hydrochloride and varenicline.

For people with emphysema, quitting smoking is often part of a larger treatment plan that includes an exercise program to help slow the decline of lung function, as well as simple techniques you can use to improve your breathing.

For a person with COPD that includes both emphysema and chronic bronchitis, methylprednisolone and other medications, such as bronchodilators, can help control symptoms, including shortness of breath. These medications affect only the chronic bronchitis component of the disease. The emphysema component of COPD, however, responds only to supplemental oxygen. If all other treatment options fail, a lung transplant may be appropriate for some people with severe emphysema.

If you have emphysema, talk to your doctor about developing a comprehensive treatment plan that will most effectively control your symptoms.

— Eric Edell, M.D., Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn.

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