What is emphysema?
Emphysema is a disease of the lungs that usually develops after many years of smoking. Both chronic bronchitis and emphysema belong to a group of lung diseases known as chronic obstructive pulmonary disease (COPD). Once it develops, emphysema can’t be reversed. This is why not smoking or stopping smoking is very important.
Emphysema is a condition that involves damage to the walls of the air sacs (alveoli) of the lung. Alveoli are small, thin-walled, very fragile air sacs located in clusters at the end of the bronchial tubes deep inside the lungs. There are about 300 million alveoli in normal lungs. As you breathe in air, the alveoli stretch, drawing oxygen in and transporting it to the blood. When you exhale, the alveoli shrink, forcing carbon dioxide out of the body.
When emphysema develops, the alveoli and lung tissue are destroyed. With this damage, the alveoli cannot support the bronchial tubes. The tubes collapse and cause an “obstruction” (a blockage), which traps air inside the lungs. Too much air trapped in the lungs can give some patients a barrel-chested appearance. Also, because there are fewer alveoli, less oxygen will be able to move into the bloodstream.
Who gets emphysema?
Over 3 million people in the United States have been diagnosed with emphysema. Over 11 million Americans have COPD. Emphysema is most common in men between the ages of 50 and 70.
Symptoms and Causes
What causes emphysema?
Smoking is the number one factor. Because of this, emphysema is one of the most preventable types of respiratory diseases. Air pollutants in the home and workplace, genetic (inherited) factors (alpha-1 antitrypsin deficiency), and respiratory infections can also play a role in causing emphysema.
Cigarette smoking not only destroys lung tissue, it also irritates the airways. This causes inflammation and damage to cilia that line the bronchial tubes. This results in swollen airways, mucus production, and difficulty clearing the airways. All of these changes can lead to shortness of breath.
What are symptoms of emphysema?
Symptoms of emphysema may include coughing, wheezing, shortness of breath, chest tightness, and an increased production of mucus. Often times, symptoms may not be noticed until 50 percent or more of the lung tissue has been destroyed. Until then, the only symptoms may be a gradual development of shortness of breath and tiredness (fatigue), which can be mistaken for other illnesses. People who develop emphysema have an increased risk of pneumonia, bronchitis, and other lung infections. See your doctor if any of these symptoms arise:
- Shortness of breath, especially during light exercise or climbing steps
- Ongoing feeling of not being able to get enough air
- Long-term cough or “smoker’s cough”
- Long-term mucus production
- Ongoing fatigue
Diagnosis and Tests
How is emphysema diagnosed?
The diagnosis of emphysema cannot be made solely on symptoms. Several tests are used to make the diagnosis. One simple test is to tap on your chest and listen with a stethoscope for a hollow sound. This means that air is being trapped in your lungs. Other tests include:
- X-rays: X-rays are generally not useful for detecting early stages of emphysema. However,
X-rays can help diagnose moderate or severe cases. Either a plain chest X-ray or a CAT (computer-aided tomography) scan can be used. Once the test is completed, the readings are compared to X-rays of healthy or normal lungs.
- Pulse oximetry: This test is also known as an oxygen saturation test. Pulse oximetry is used to measure the oxygen content of the blood. This is done by attaching the monitor to a person’s finger, forehead, or earlobe.
- Spirometry and pulmonary function tests (PFT): This is one of the most useful tests to determine airway blockage. A spirometry or PFT tests the lungs’ volume by measuring airflow while a patient inhales and exhales. This test is done by taking a deep breath and then blowing into a tube that is hooked up to a specialized machine. These tests are compared to normal results from people of similar gender, age, height, weight and ethnic background.
- Arterial blood gas: This test measures the amount of oxygen and carbon dioxide in blood from an artery. It is a test often used as emphysema worsens. It is especially helpful in determining if a patient needs extra oxygen.
- Electrocardiogram (ECG): ECGs check heart function and are used to rule out heart disease as a cause of shortness of breath.
You might also talk to your doctor about whether testing for alpha-1 antitrypsin deficiency is appropriate for you.
Management and Treatment
How is emphysema treated?
Because emphysema can worsen over time and there is no known cure, treatment is focused on slowing the speed of decline. The type of treatment will depend on the severity of the disease.
Quitting smoking: If you smoke, quit. This is the most important step you can take to protect your lungs. It is never too late to quit. Your doctor can help you find the best smoking quitting method for you.
Bronchodilator medications: These medicines relax the muscles around the airways. They are often used to treat asthma. Bronchodilators, given through hand-held inhalants, produce more immediate results and have fewer side effects than oral medications.
Anti-inflammatory medication: These medications reduce inflammation in the airways. However, long-term side effects of these drugs include osteoporosis, hypertension, high blood sugar, and fat redistribution.
Oxygen therapy: Oxygen therapy is prescribed for patients whose lungs are not getting enough oxygen to the blood (hypoxemia). These patients can’t absorb enough oxygen from the outside air and need to get more oxygen through a machine (a nasal catheter or a facemask).
Lung volume reduction surgery: Lung volume reduction surgery involves removing a portion of diseased lung tissue, then joining together the remaining tissue. Doing this may relieve pressure on the breathing muscles and help improve lung elasticity (or stretch). The results of the surgery have been very promising. Not all patients with emphysema are candidates for this surgery.
What are some tips for managing emphysema?
The best way to prevent or reduce further problems is to prevent respiratory infections by:
- Practicing good handwashing methods
- Brushing and flossing teeth daily, and using an antibacterial mouth rinse after meals
- Keeping breathing equipment clean
- Keeping your house clean and free of dust
- Getting a flu shot every year
- Following a doctor-prescribed exercise program
- Avoiding irritants such as:
- Cigarette smoke
- Exhaust fumes
- Strong perfumes
- Cleaning products
- Pet dander