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My mother has had a hiatal hernia for many years and now has been diagnosed with emphysema although she never smoked. Could the hernia or the medication she takes for it cause the lung trouble?

Neither your mother's hiatal hernia nor her medication could have brought on the problems with her lungs. Emphysema is a progressive disease caused by damage to the small air sacs in the lungs, which causes them to lose their elasticity. As a result, air gets trapped in the sacs making it difficult to exhale and leading to shortness of breath. Cigarette smoking is the most common cause, but exposure to secondhand smoke, chemical fumes, indoor and outdoor pollution can also be to blame. Sometimes a rare genetic enzyme deficiency is responsible, but this usually is associated with cases diagnosed before age 50 (and earlier for smokers).

Emphysema typically is treated with bronchodilators and corticosteroids to improve breathing. Physicians may also recommend using low-flow oxygen during exercise or for those who have night-time breathing problems. Pulmonary rehabilitation may help improve tolerance for exercise. Beyond that, treatment options are few. Here are some suggestions to protect the lungs from further damage:

Take 60 mg twice a day of Coenzyme Q10 (CoQ 10), which can improve use of oxygen at the cellular level. Get the softgel form. CoQ10 is best absorbed when taken with a meal containing some fat.
Take the Chinese medicinal mushroom cordyceps, which is nontoxic and may be useful in chronic lung disease. Look for capsules of cordyceps extract and follow the dosage directions on the label.
Increase your dietary sources of carotenes, such as carrots, sweet potatoes, yellow squash and leafy green vegetables.
Exercise to build stamina but get your doctor's approval first.
Maintain normal weight. If you're overweight, your heart has to work harder, and you're more likely to experience shortness of breath. If you're underweight, you will have lower energy stores to draw from.
Try to avoid exposure to air pollution, which can worsen emphysema symptoms. Stay indoors when ozone levels are unhealthy and pollution levels are high.
See your doctor promptly if you develop a cold or the flu, both of which can worsen symptoms. Be sure to get flu shots annually and ask your physician about being vaccinated against pneumococcal pneumonia.
Practice my 4-7-8 breathing exercise. It can improve efficiency of breathing and allay anxiety associated with "air hunger" that is a common symptom of emphysema.
Andrew Weil, M.D.

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