QUESTION FROM READER:EMPHYSEMA

My mother, who smokes, has been diagnosed as having emphysema. As far as I know, it is in the early stages, but what I have read about conventional treatment (oxygen therapy, drugs to dilate the bronchial passages, antibiotics, flu shots, even lung surgery or transplant) seems overwhelming and extreme. I would like to know what measures can be taken to halt the damage to her lungs. CZ, Shrewsbury………

Smoking is the major cause of emphysema. It’s also possible that emphysema is a type of end stage response to different kinds of assaults on the lungs (Ann Rev Med, 1989; 40: 411-29).

Studies have shown that significant deposits of cadmium are found in the lungs of emphysema patients (Lancet, 1988; i: 663-7), with cigarette smoke being the most obvious source (although air pollution also contributes). The amount of cadmium in the lungs relates directly to the severity of the emphysema (Ann Rev Med, 1989; 40: 411-29).

For anyone who smokes and has emphysema, there’s no substitute for quitting. However, several other factors will affect the course of your recovery. In looking for an effective treatment for emphysema, it’s helpful to view it as part of the spectrum of diseases which comes under the term Chronic Obstructive Pulmonary Disease (COPD). This includes asthma, chronic bronchitis and emphysema.

Treatments which are helpful for asthma and bronchitis, and even those used for lung cancer, are likely to be helpful for the emphysema patient.

According to a recent American study at Ohio State University, exercise may reduce anxiety and depression as well as improve endurance in those with COPD (Health Psychol, 1998; 17: 232-40). This is contrary to the usual advice given to COPD patients to limit their physical activity due to shortness of breath.

Other studies have shown a similar positive effect from exercise, which seems to strengthen the muscles supporting the lungs (Eur Respir J, 1996; 107: 2590-6).

The benefits of exercise can be greatly reduced if the emphysema sufferer has a poor diet (Chest, 1995; 107: 1206-12). Research into diet and lung function has been patchy and tends to focus on single nutrients. Antioxidants, such as vitamins A, C and E, are known to play a role in preventing damage due to free radicals (Bull Eur Physiopathol Respir, 1998; 279: 253s-255s). Of these, vitamin A and beta carotene (a pre cursor of vitamin A) are perhaps the most important, since they help build strong skin both inside and outside of the body. Smoking and high alcohol consumption will significantly reduce levels of carotenoids in the blood, and so elevate the risk of lung disease (Jpn J Cancer Res, 1987; 78: 1049-56).

One Japanese study of 265,000 people found that there was a significant association between low beta carotene intake and the incidence of lung cancer (Princess Takamatsu Symposium (US), 1985; 16: 41-53). In fact, the risk of developing lung cancer in the trial was the same between those who smoked and had a good daily intake of beta carotene and those who didn’t smoke but had a low intake of the nutrient.

One study by the National Cancer Institute, however, reported a 28 per cent increase in the incidence of lung cancer in smokers given beta carotene (New End J Med, 1996; 334: 1150-5). In both this and the Japanese study, however, the number of reported cases was small five and six cases per thousand, respectively. Perhaps more importantly, those who gave up smoking during the trial and took beta carotene were 20 per cent less likely to develop lung cancer. Although not directly concerning emphysema, the findings are relevant since the damage caused by other milder forms of lung disease, like emphysema, can increase the risk of later lung cancer (Am J Epidemiol, 1995; 141: 1023-32). (But see p11.)

In a recent study of 816 individuals, mostly smokers or ex smokers who were exposed to asbestos, beta carotene and retinol (a common form of vitamin A) were shown to protect against loss of breathing function (Am J Respir Crit Care Med, 1997; 155: 1066-71).

Two years ago, a small study reported that when rats with emphysema like lung damage were injected daily with the vitamin A derivative, retinoic acid, their respiratory function improved. Their lungs also returned to normal size and regained elasticity. Even new alveoli the lung’s air sacs that take up oxygen from each breath had grown (Nature Med, 1997; 3: 675-77). Although this research may not be applicable to humans, it does point the way towards possible effective nutritional treatment of emphysema.

Vitamin C has been shown to prevent bronchial constriction in asthmatic patients by reducing histamine and by normalising fatty acid metabolism, which in turn reduces free radical damage. It might be worth upping your intake of this vitamin and other antioxidants (Ann Allergy, 1990; 65: 311-4; Am J Epidemiol, 1990; 132: 67-76).

Omega-3 fish oils may also be beneficial, particularly eicosapentaenoic acid (EPA), which can be found in cold water fish. One study showed that the higher a person’s dietary intake of fish, the less likely he was to suffer from bronchitis or wheezing (Am J Epidemiol, 1990; 132: 67-76).

You may want to include more spicy foods in your diet. Anecdotally, foods like garlic, onion, chilli peppers, horseradish and mustards all play a role in helping to relieve wheezing and coughing. Onions have been shown to relieve bronchial obstruction (Int Arch Allergy Appl Immunol, 1987; 82: 535-6).

It’s also a good idea to rule out food sensitivities, which will reduce any further strain on your lungs if you tend to be asthmatic (Ann Allergy, 1987; 58: 164-72).

>From the herbal pharmacy, antioxidant herbs, especially grape seed extract, have been found to reduce coughing, wheezing, weakness, mucous and recurring respiratory infections usually associated with emphysema. Grape seed extract contains a powerful bioflavonoid complex known as a procyanidolic oligomer (PCO), an antioxidant thought to be 20 times more potent than vitamin C and 50 times more potent than vitamin E. PCOs help to conserve and regenerate vitamins C and E. In cases of lung disease, they appear to work by reducing inflammation and damage to the air sacs.

You can take it as a supplement (the standard therapeutic dose is 150 to 300 mg per day), as well as including PCO rich foods in your diet, such as grapes, blueberries, cherries and plums. Supplementing with immune boosting herbs such as echinacea, golden seal and liquorice root, particularly during changes in seasons, may help you stay well. Emphysema patients are particularly at risk if they contract colds. Their inability to breathe properly, and their already weakened immune systems, make viral infections harder to fight off.