Emphysema
What is it?
Emphysema is a respiratory disease in which the alveoli, the tiny air sacs in the lungs, become enlarged. This enlargement causes the alveoli walls to break down, or rupture, narrowing the airways. The narrowed airways make it difficult to breathe in oxygen and exhale carbon dioxide. Emphysema gradually destroys the lung tissue. Emphysema and chronic bronchitis, which often occur together, cause a condition known as chronic obstructive pulmonary disease
(COPD)
Who gets it?
Emphysema is most common among people age 50 and older. It is the most common cause of death from respiratory disease in the United States, and usually occurs in heavy cigarette smokers. However, pipe, cigar, and marijuana smoking can also damage the lungs. Some people have an inherited condition called Òearly onset emphysemaÓ because it can appear as early as 30 to 40 years of age. This type of emphysema is caused by low levels of an enzyme inhibitor called alpha-1-antitrypsin (AAT). Approximately 75,000 to 150,000 Americans have an AAT-deficiency, but not all develop emphysema. Smokers with AAT-deficiency are at a greater risk of developing
COPD.
What causes it?
Emphysema is almost always caused by cigarette smoking. In normal lungs, tiny air sacs called alveoli support the small airways, called the bronchioles, and hold the airways open. With emphysema, smoke causes an overproduction of an enzyme that destroys the walls of the alveoli, so the bronchioles no longer have any support. When the bronchioles collapse, the airway becomes permanently
narrowed.
What are the symptoms?
The first symptom of emphysema is usually shortness of breath during exertion. As the disease progresses, and with age, the shortness of breath occurs more often, until it even occurs when you are at rest. You also develop a heavy cough that produces thick phlegm, also called sputum. As the the millions of alveoli in the lungs expand and enlarge, so does the chest. This causes the chest to take on an enlarged, barrel-shaped appearance. The strain of breathing can lead to other complications, such as heart failure and acute respiratory failure. Acute respiratory failure occurs when there are low levels of oxygen or high levels of carbon dioxide in the
blood.
How is it diagnosed?
To diagnose emphysema, the doctor will perform a complete physical exam and take a medical history. He or she will ask about your smoking habits and any family history of emphysema or COPD. An examination of the hands and feet can show whether your body is getting enough oxygen. When emphysema is in the early stages, the doctor may only hear some wheezes upon listening to your chest with a stethoscope. As the disease progresses, tapping on the chest while listening to your breathing with a stethoscope will reveal a hollow sound that is caused by the enlargement or rupture of the lungs' alveoli. Doctors commonly use an instrument called a spirometer to measure the air taken into and exhaled from the lungs. If your lung capacity is lowered, this test will show a reduced amount of airflow when you exhale forcefully. To determine the exact cause of your symptoms, the doctor may give you an asthma medication, then repeat the test. If your breathing does not improve greatly, then the cause of the symptoms is emphysema, not asthma.
Other diagnostic tests for emphysema include an arterial blood gas, which measures the amounts of oxygen and carbon dioxide levels in the blood; blood tests to measure the amount of red blood cells; and an electrocardiogram (ECG), which measures the electrical activity of the heart to determine whether the lung disease has caused any heart problems. A chest x-ray may be ordered to diagnose emphysema or to look for signs of pneumonia. Because early-onset emphysema can be caused by low levels of the alpha-1-antitrypsin protein, the doctor may also order a blood test to check for this condition, especially if you have emphysema at a young age and no other risk
factors.
What is the treatment?
Emphysema cannot be cured. The goal of treatment is to slow the progression of the disease, relieve symptoms, and help prevent complications. It is most important to remove the irritation that is causing the damage. That means the patient must stop smoking. Commonly used medications include bronchodilators, which relax the bronchial muscles so the airways are widened and it's easier to breathe. This drug is available in inhaled, injected, and oral forms. Steroids called corticosteroids also can help relax the airways so breathing is easier. However, these types of drugs usually aren't prescribed for long-term use because of their side effects. Controlled coughing techniques are often taught to help remove excess mucus from the lungs. Too much mucus in the lungs can cause infection. Drinking plenty of fluids can help prevent thick mucus, as well as taking a drug to help reduce secretions. As emphysema progresses, you will find that you need to breathe oxygen from a portable cylinder 24 hours a day to keep the blood oxygen at normal levels.
Yearly flu vaccinations and a one-time pneumonia vaccine are recommended to prevent pulmonary infections for all patients with emphysema, and antibiotics are given at the first sign of any infection. Patients showing signs of heart failure are given diuretics to prevent fluid retention. In cases of early-onset emphysema, patients receive augmentation therapy in which replacement alpha-1-antitrypsin protein is injected every one to two weeks for life. Mild exercise, as well as special breathing techniques, can often help improve breathing. While surgery is rarely used, available surgical techniques include lung transplants and removal of diseased lung tissue, called lung volume reduction. Alternative treatments include diet and nutritional supplements; herbal medicines; water, or hydrotherapy; acupressure and acupuncture; aromatherapy; and yoga. Consult your doctor before using any alternative
therapies.
Self-care tips
You can prevent emphysema by never smoking. However, if you quit smoking at the first sign of emphysema, you can significantly improve your long-term outlook. If you have emphysema, follow your doctor's recommendations for treatment and use supplemental oxygen to help with breathing. Heart problems occur when the heart does not receive enough oxygen from the blood and the body must labor to breathe. Also, see your doctor at the first sign of any illness and avoid exposure to air pollutants and people with respiratory illnesses such as colds. Ask your doctor about flu and pneumonia shots because these illnesses can become life-threatening to someone with existing respiratory problems.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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