Patients who require medical therapy take advantage of the Pulmonary Rehabilitation Network, which consists of 32 regional centers that follow rehabilitation program guidelines established by the University of Maryland and University of Maryland Rehabilitation & Orthopaedics Institute, formerly Kernan Hospital. If necessary, patients can also undergo lung volume reduction surgery or, in select cases, lung transplantation.
People with emphysema can expect to proceed through the steps listed below if they are evaluated by our team:
- Your first step is a consultation with members of our staff, to which you should bring your most recent medical records, chest X-rays, CT scans and pulmonary function tests.
- The physician and nurse will review these tests with you, take a complete medical history, perform a physical examination, and ask you several questions about your current exercise capacities and breathing difficulties.
- At the end of the consultation, the physician will make recommendations for further testing or medical management, almost invariably prescribing a pulmonary rehabilitation program.
- The office will contact you to schedule any additional tests or your rehabilitation.
You will undergo a series of tests that will help the staff define your illness and determine the extent of the problem. These tests typically include:
- Chest X-ray: Used to determine the areas where tissue has collapsed, as well as to detect other conditions that may accompany emphysema, such as pneumonia, heart problems or lung cancer.
- Pulmonary Function Tests: Breathing tests that measure how well your lungs are functioning, their volume, whether or not you respond to inhaler medications, and the strength of your respiratory muscles.
- Arterial Blood Gas: A blood test that measures levels of carbon dioxide and oxygen in your blood.
- Electrocardiogram (EKG): A test that measures the electrical activity of the heart.
- High Resolution CT Scan: Detailed pictures of the lung tissue, heart and diaphragm are taken to determine the location and severity of your emphysema.
- Oxygen Titration: While on a treadmill, oxygen levels are monitored to determine if your level of oxygen falls with exercise. This will help identify the amount of oxygen needed for the six-minute walk (see next item).
- Six-minute Walk: A test that requires you to walk on a designated path for six minutes while the distance you cover and your level of breathlessness are recorded.
- Cardiopulmonary Exercise Test: An exercise test that measures endurance and the ability of your lungs to compensate during physical activity. Your heart and oxygen levels are monitored while you ride an exercise bike.
- Right Heart Catheterization: This outpatient procedure will be performed only if the doctors feel you need further work-up. A catheter is inserted into a leg or neck vein and passed into the right side of your heart to measure the pressures in your heart.
Your test results will be presented at our weekly multi-disciplinary conference, which is attended by members of the thoracic team. Based on the information, the team may recommend nonsurgical medical management, which involves medication and rehabilitation; lung volume reduction surgery; or, in special cases, lung transplantation. You will be contacted by phone five to seven days after the conference.
You will attend pulmonary rehabilitation sessions two to three times per week for a minimum of eight weeks. These sessions may take place at University of Maryland Rehabilitation & Orthopaedics Institute, formerly Kernan Hospital, or a center closer to your home, and they typically involve an exercise regimen as well as education and counseling about the disease. The program is designed to help you retrain your breathing muscles, manage your shortness of breath, and conserve energy. If you attend faithfully and follow the therapist's recommendations, you can expect to improve by at least 25 to 50 percent, although many patients improve even more dramatically. While the program lasts for only eight weeks, it asks you to make a lifetime commitment to exercise. If you stop exercising, your symptoms are likely to return and gradually worsen. Moreover, if you go on to have surgery, the procedure is less likely to benefit you and your recovery will be much more difficult.
You will be scheduled to see the surgeon again shortly after you complete your formal rehabilitation. Before that visit, you will undergo some of the same tests that you had before. You also may need to have a VQ Scan, which shows how well the blood vessels and airways in the lungs communicate. You will be asked to breathe in a material which "highlights" the lungs when viewed by a special camera, and you will be injected with a drug that illuminates the blood vessels in the lungs. After these tests, the surgeon will re-evaluate you and decide on further treatment, which might include surgery, continued rehabilitation, or additional medical therapy.
If lung volume reduction surgery is recommended and you decide to go forward with it, you will be asked to sign a consent form and then schedule an appointment for pre-operative laboratory testing. The surgeon often will want to see you the week before your surgery is scheduled for an additional evaluation. During this time, you must stick to your prescribed exercise program and report any changes in your condition.
If you are interested in participating in the Emphysema Evaluation Program, we recommend that you first discuss it with your primary care or family physician. For more information, please call 410-328-6883.