Emphysema

Increased shortness of breathRapid breathingChoking sensation when lying flat (may need to prop up with many pillows or even sleep in a chair)FatigueTrouble concentratingIncrease in chest size (barrel chest)Increased risk of serious lung infectionsEnlargement of the right chamber of the heartHeart failureCoughing up thick and/or bloody mucusSwelling in the legsWeight lossBreathing through pursed lipsDesire to lean forward to improve breathingMore frequent flare-ups (periods of more severe symptoms) DiagnosisThe 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) TreatmentThere is no treatment to cure emphysema. Treatment aims to ease symptoms and improve quality of life.Treatment includes: Smoking CessationQuitting 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 ManagementLimiting 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: Bronchodilatorsto relax the airways and open breathing passages (may be given as pills or inhaled)Corticosteroidsto decrease inflammation and swelling in the breathing passagesAntibioticsto fight bacterial infectionsExpectorantsto loosen mucus and make it easier to cough up OxygenOxygen 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 ProgramsSpecial 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 TechniquesSpecial 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 DrainageThis 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 FluidsMaintain 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 ChangesPace 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 surgeryLung transplant Prevention You can reduce you chances of developing emphysema by: Not smokingAvoiding exposure to second-hand smokeAvoiding exposure to air pollution or irritantsWearing protective gear if exposed to irritants or toxins at work RESOURCES: American College of Chest Physicianshttp://www.chestnet.org American Lung Associationhttp://www.lungusa.org CANADIAN RESOURCES: BC Health Guidehttp://www.bchealthguide.org/ The Canadian Lung Associationhttp://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. Last reviewed October 2007 by Rosalyn Carson-DeWitt, MDPlease 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.