Your Health - Emphysema

Emphysema

Pronounced: em-fiss-SEE-mah

Definition

Emphysema is a chronic obstructive disease of the lungs. The lungs contain millions of tiny air sacs called alveoli. In emphysema, the sacs lose their elasticity and air becomes trapped in the sacs. It becomes difficult to expel oxygen-depleted air from the lungs so the normal exchange of new and used air is diminished. Emphysema is classified as a chronic obstructive pulmonary disease (COPD).

Normal Lung vs Emphysemic Lung

Causes

Emphysema develops due to:

Smoking
Inhaling toxins or other irritants
Alpha1-antitrypsin deficiency (A1AD)—a genetic defect which can cause emphysema at an early age in nonsmokers

Risk Factors

These factors increase your chance of developing emphysema. Tell your doctor if you have any of these risk factors:

Smoking
Long-term secondhand or passive smoke exposure
Family members with emphysema
Exposure to pollutants at work
History of frequent childhood lung infections
Age: 50 or older
Connective tissue disorders
HIV infection

Symptoms

Early symptoms include:

Coughing in the morning
Coughing up clear sputum (mucus from deep in the lungs)
Wheezing
Shortness of breath with activity

As the disease progresses, you may experience:

Increased shortness of breath
Rapid breathing
Choking sensation when lying flat (may need to prop up with many pillows or even sleep in a chair)
Fatigue
Trouble concentrating
Increase in chest size (barrel chest)
Increased risk of serious lung infections
Enlargement of the right chamber of the heart
Heart failure
Coughing up thick and/or bloody mucus
Swelling in the legs
Weight loss
Breathing through pursed lips
Desire to lean forward to improve breathing
More frequent flare-ups (periods of more severe symptoms)

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be performed.

Tests may include:

Chest x-ray —a test that uses radiation to take pictures of structures inside the chest
CT Scan —a type of x-ray that uses a computer to make pictures of structures inside the chest
Arterial blood gas test—a blood test to assess the amount of oxygen and carbon dioxide in the blood
Lung function tests (spirometry)

Treatment

There is no treatment to cure emphysema. Treatment aims to ease symptoms and improve quality of life.

Treatment includes:

Smoking Cessation

Quitting smoking slows progression of the disease. Doctors consider it the most important aspect of treatment. Smoking cessation programs may include behavior modification and medications to help you gradually taper off cigarettes.

Environmental Management

Limiting the number of irritants in the air may help make breathing easier. Avoid smoke, dust, smog, extreme heat or cold, and high altitudes.

Medication

Although no medication will actually cure emphysema, a variety of drugs are available to help ease the symptoms and fight the complications. These include:

Bronchodilators—to relax the airways and open breathing passages (may be given as pills or inhaled)
Corticosteroids—to decrease inflammation and swelling in the breathing passages
Antibiotics—to fight bacterial infections
Expectorants—to loosen mucus and make it easier to cough up

Oxygen

Oxygen is given to supplement the air taken in by the body. It can increase energy levels and heart and brain function by increasing the amount of available oxygen.

Infection Prevention

Because emphysema makes you prone to flu and pneumonia :

Doctors recommend an annual flu shot .
Be sure to have a pneumococcal vaccine .

Avoid being around people who are sick. If you think you are getting the flu, call your doctor. You may need to take an antiviral medication.

Exercise/Pulmonary Rehabilitation Programs

Special exercises can strengthen chest muscles and make breathing easier. Physical activity builds endurance and improves quality of life. Follow your doctor's recommendations for activity levels and restrictions.

Breathing Techniques

Special methods of breathing and breathing exercises with and without an incentive spirometer can help bring more air into the lungs and force trapped air out of the lungs.

Percussion and Postural Drainage

This is a technique that uses special techniques of clapping on the back and chest to help loosen secretions and special positioning to help the lungs drain.

Nutrition and Fluids

Maintain a healthy weight . Excess weight causes the lungs and heart to work harder.
Eat a healthful diet , one that is low in saturated fat and rich in whole grains, fruits, and vegetables.
Eat several small meals during the day. It makes breathing easier.
Avoid gas-producing foods. An overly full stomach pushes up on the diaphragm, which encroaches on the lungs' space. This makes it harder to breathe.
Drink fluids to keep mucus thin.

Lifestyle Changes

Pace your activities.
Learn relaxation techniques and other methods to manage stress .
Seek emotional support from therapists , family, and friends. Anxiety can increase the rate of respiration, making breathing more strenuous.
Avoid situations which might expose you to a respiratory illnesses.
Be sure to get a yearly flu vaccine .
Avoid high altitudes and extremes of temperature.

Surgery

A small number of patients may benefit from surgery . Procedures used to treat emphysema include:

Bullectomy to remove a an area in the lung called bulla (sometimes done with laser)
Lung volume reduction surgery
Lung transplant

If you are diagnosed with emphysema, follow your doctor's instructions .

Prevention

You can reduce you chances of developing emphysema by:

Not smoking
Avoiding exposure to secondhand smoke
Avoiding exposure to air pollution or irritants
Wearing protective gear if exposed to irritants or toxins at work

RESOURCES:

American College of Chest Physicians
http://www.chestnet.org/

American Lung Association
http://www.lungusa.org/

CANADIAN RESOURCES:

The Canadian Lung Association
http://www.lung.ca/

Health Canada
http://www.hc-sc.gc.ca/index-eng.php/

References:

Chhabra SK, Gupta RK, Singh T. Cutis laxa and pulmonary emphysema. Indian J Chest Dis Allied Sci. 2001;43(4):235-237.

Chronic obstructive pulmonary disease. National clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care. National Guideline Clearinghouse website. Available at: http://www.guideline.gov/summary/summary.aspx?doc_id=5061&nbr=003545&string=Chronic+AND+obstructive+AND+pulmonary+AND+disease . Published February 2004. Accessed July 8, 2009.

COPD and asthma. National Lung Health Education Program website. Available at: http://www.nlhep.org/lung_copd.html . Accessed July 8, 2009.

Emphysema. American Lung Association website. Available at: http://www.lungusa.org/site/apps/nlnet/content3.aspx?c=dvLUK9O0E&b=2060053&content_id=%7B39330D56-C0E9-4D08-B98F-18EA7B3C410B%7D&notoc=1 . Accessed July 8, 2009.

Petrache I, Diab K, Knox KS, et al. HIV associated pulmonary emphysema: a review of the literature and inquiry into its mechanism. Thorax. 2008;63(5):463-469. Review.

What is COPD? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.html . March 2009. Accessed July 8, 2009.

Last reviewed September 2009 by Christine Colpitts, CRT, MA

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.