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
	© 2008 Nucleus Medical Art, Inc.

Causes

Emphysema develops due to:

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

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

• Smoking cigarettes
• Long-term second-hand or passive smoke exposure
• Family members with emphysema
• Exposure to pollutants at work
• History of frequent childhood lung infections
• Age: 50 or older

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, patients 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, and perform a physical exam.

Tests may include:

• Chest x-ray —a test that uses radiation to take pictures of structures inside the body
• CT Scan —a type of x-ray that uses a computer to make pictures of structures inside the chest
• Blood tests assessing the amount of oxygen and carbon dioxide in the blood (arterial blood gas test)
• 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, contact your physician. 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 utilizes 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 normal weight. Excess weight causes the lungs and heart to work harder.
• Eat a healthy diet that is low in saturated fat and rich in fruits, vegetables, and whole grain foods.
• 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, making 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 professionals, family, and friends. Anxiety can increase the rate of respiration, making breathing more strenuous.
• Avoid situations which might expose you to contagious respiratory illnesses.
• Be sure to get an influenzae vaccine yearly.
• 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 blebs on the lungs (sometimes done with laser)
• Lung volume reduction surgery
• Lung transplant

Prevention

You can reduce you chances of developing emphysema by:

• Not smoking
• Avoiding exposure to second-hand 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:

BC Health Guide
http://www.bchealthguide.org/

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

References:

American Lung Association website. Available at: http://www.lungusa.org . Accessed October 11, 2005.

Chronic obstructive pulmonary disease. National Guideline Clearinghouse website. Available at: http://www.guideline.gov . Accessed October 11, 2005.

National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ . Accessed October 11, 2005.

National Lung Health Education Program website. Available at: http://www.nlhep.org/ . Accessed October 11, 2005.

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