Lymphangioleiomyomatosis (LAM) is a rare lung condition that almost exclusively affects women of childbearing age.

It is estimated that three to five in every one million women will develop LAM.

LAM is characterised by lung cysts (air-filled sacs which gradually destroy the lung), changes to the lymphatic system and, in some people, benign tumours in the kidney.

It is a progressive condition, which means that symptoms will generally get worse over time.

LAM develops differently in each person. In some women, it can be quite mild so they stay very well for decades and do not need any treatment. However, for others, their lung function will decline more quickly over time. There is not a cure for LAM but breakthroughs in research mean that effective treatments are available.

You can develop LAM without any other condition. This is known as sporadic LAM. Or you can develop it together with a condition called tuberous sclerosis. The causes of LAM are not fully understood.

• Sporadic LAM
  Sporadic LAM is not inherited and it is not passed on to children. One of two proteins (called tuberin and hamartin) are abnormal in LAM tissue. This is due to mutations (changes) in the genes responsible for these proteins. The proteins act as a brake on the growth of LAM cells and when they are abnormal there is excessive growth of these cells. Why this should happen is not clear, but stopping the growth of these cells is the main focus of research at the moment.
• Tuberous sclerosis and LAM
  Tuberous sclerosis is a hereditary condition. Individuals with tuberous sclerosis have the same gene mutation in all or most of their cells and so they are very likely to get LAM. By the age of 40 years, about 80% of women with tuberous sclerosis have LAM, although they may not go on to have lots of symptoms.

Oestrogen plays some part in LAM; although it does not appear to be the direct cause of LAM, higher levels of oestrogen, for example during pregnancy or hormone replacement therapy (HRT), can speed up the disease.

The average age at which people start to have symptoms of LAM is around 35 years, but now that healthcare professionals are getting better at recognising the condition it is being diagnosed earlier. LAM very seldomly affects children.

Symptoms vary, but the most common are breathlessness and pneumothorax (lung collapse).

A pneumothorax refers to a collapse of one or both of the lungs, caused by air entering the pleural cavity. The pleural cavity is the space between your lungs and the chest wall.

Less common symptoms are cough, coughing up blood, benign kidney tumours (angiomyolipomas), which occur in about half of cases, and chylous effusions (when lymph that forms in the digestive system, called chyle, builds up in the thin cavity around your lungs and stops them expanding properly when you breathe). Fatigue is also very common in women with LAM.

The course of LAM varies between individuals, but there are ways to manage the symptoms.

It can be difficult to diagnose LAM, as many symptoms are similar to other lung conditions (such as asthma, chronic obstructive pulmonary disease (COPD) and bronchitis).

It is very important that a proper diagnosis is made. European Respiratory Society (ERS) guidelines state that to diagnose LAM you need to have:

• a computerised tomography (CT) scan (where your body is X-rayed at a number of angles before a computer puts together a detailed image) showing lung cysts, plus
• another piece of evidence, e.g. tuberous sclerosis, kidney tumour, chylous effusion

A blood test showing a high level of a protein called vascular endothelial growth factor D (VEGF-D) in the blood can also help in diagnosing LAM.

In very rare cases, where a diagnosis cannot be made from a combination of the above symptoms, a biopsy may be needed. This is where some samples of the tissue from your lungs are taken and tested.

As LAM is such a rare condition, it is important to get a specialist opinion as early as possible and to discuss your individual case with an expert on the condition.

Although there have been some major advances in LAM research, there is currently no cure.

Women with LAM tend to get increasing loss of lung function. This is usually slow, but it can happen more quickly for some people.

Most women with LAM live for decades from the start of their symptoms, but it can vary. Therefore, it is important to discuss your own case with a specialist.

Usually you will be monitored to see if your condition is stable or progressing, so that the best treatment and management can be offered to you.

• Treating symptoms

  You may receive supportive treatment at first. This could include the use of inhalers (bronchodilators), which make breathing easier. This may be the only treatment that some women need. Some women benefit from supplementary oxygen, which helps with breathlessness.

• Pleurodesis or pleurectomy (for collapsed lung)

  Some women with LAM will have more than one pneumothorax (lung collapse) during their lives, and the following procedures may be recommended to prevent this happening again. This can significantly improve the quality of life for women with LAM.

  • Pleurodesis is a procedure that aims to stick the pleura together to prevent your lung from collapsing again.
  • Pleurodectomy is a procedure during which the surgeon strips the lining between the lung and the chest wall so that the lung sticks to the chest wall, preventing further lung collapse.

• Medication

  The main treatment for LAM is a drug called sirolimus (also called rapamycin). This drug helps to stop loss of lung function for many women. However, treatment with sirolimus may not be appropriate for every woman with LAM. Some may not benefit from the drug and others can experience side-effects that outweigh the benefits.

• Lung transplant

  A lung transplant may be an option for some women with advanced LAM, where there are no other treatment options. Many women with LAM have had successful lung transplants and improved quality of life as a result.

You can help manage common symptoms of LAM by:

• Keeping a healthy weight
• Not smoking
• Keeping active (supplementary oxygen, if required, may help you exercise more effectively)
• Doing a pulmonary rehabilitation programme to help with breathlessness
• Using inhalers, if your airways are narrowed
• Having vaccinations against influenza an pneumococcus
• Not taking the combined oral contraceptive pill (which contains oestrogen and progesterone)
• Discussing pregnancy with your specialist, as symptoms can get worse during pregnancy due to higher oestrogen levels
• Not having hormone replacement therapy (HRT) after the menopause

Your lung function should be monitored regularly for changes. If your lung function is decreasing, your physician may recommend other treatment.

There is a lot of research going on and the most significant areas of research are focusing on:

• Better tools to predict how LAM will develop - so healthcare professionals can know whether an individual is likely to remain stable or need treatment sooner rather than later. Various studies are looking for biomarkers (a biological marker in the blood that suggests that a person has a particular condition), to give information on how the condition is developing.
• Finding a cure - sirolimus prevents LAM from getting worse, but only works while you are taking the drug. If you stop taking it, your lung function will decline again. New treatments are currently being evaluated which include new drugs as well as research into combining sirolimus with other drugs to see if LAM cells can be killed, rather than just stopped from growing.
• Regenerative treatments - studies into regenerative treatments aim to mend the damaged lung tissue. This is still at a very early stage, and significant results are a long way off.

Due to advances in LAM research, living with the condition is very different to how it used to be.

As living with LAM is very different for every woman, you should not compare yourself with others.

Many women feel desperate and anxious when they first get their diagnosis. It can be helpful to make contact with others diagnosed with LAM to talk and share information and practical tips on what helps.

Find support organisations in your country.

Advanced information

You can find more in-depth medical information about LAM in the European Respiratory Society publications below.

This information is designed for healthcare professionals but will be of interest to some individuals in search of more advanced information.

Please note that some of the links below may contain detailed medical information and survival rates for people with LAM.

• LAM Guidelines

  European Respiratory Society guidelines for the diagnosis and management of lymphangioleiomyomatosis (2010)

  Official American Thoracic Society/Japanese Respiratory Society Clinical Practice Guidelines: Lymphangioleiomyomatosis Diagnosis and Managementwere were published in 2016. This followed rapid research advances since the ERS guidelines were published. The purpose of these new guidelines is to provide recommendations for the diagnosis and treatment of LAM that reflect the progress that has been made during the years since the ERS LAM Guidelines were published
  

  
  

  
  

• Journals

  JOURNALS

  These journals contain articles related to LAM research.
  
  Search the resources below and see our Latest news for most recent articles.

  EUROPEAN RESPIRATORY JOURNAL (ERJ)

  The official scientific journal of ERS is the most highly regarded, peer-reviewed, respiratory journal in Europe. It is a non-open access journal.
  Search ERJ archive for article abstracts about LAM

  EUROPEAN RESPIRATORY REVIEW (ERR)

  State-of-the-art reviews, updates, meeting proceedings, editorials and correspondence on current topical issues in respiratory medicine, science and surgery. Published by ERS, articles are free to access online.
  Search ERR archive for LAM articles.

  BREATHE

  The clinical educational publication from ERS. Published quarterly it is free to access for all bringing high-quality educational material to a wide audience.
  Search Breathe archive for LAM information.
  

  ERJ OPEN RESEARCH

  A fully open access original research journal published online by ERS. It aims to publish high quality work in all fields of respiratory science and medicine.
  

  Search ERJ Open Research for LAM articles.