Emphysema Overview

What happens when you have emphysema?

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Emphysema is a chronic lung disease caused by damage to the alveoli, the tiny air sacs in the lung where the exchange of oxygen and carbon dioxide takes place. With emphysema, damage to the alveoli results in air becoming trapped, causing them to expand and rupture. Damage to alveoli, and the resultant compromise in air exchange results in a decreased level of oxygen in the blood (hypoxemia) combined with an increased level of carbon dioxide in the blood (hypercapnia).

Emphysema is one type of chronic obstructive pulmonary disease (COPD), a category of lung diseases that also includes chronic bronchitis and bronchiectasis. COPD is now considered to be the fourth leading cause of death in the United States.

Symptoms

Symptoms of emphysema may include:

  • Shortness of breath: The most common symptom of emphysema is shortness of breath. It often comes on gradually, occurring at first only with activity and later at rest as well.
  • Cough: A persistent cough is very common and is sometimes difficult to distinguish from a smoker's cough.
  • Production of sputum or phlegm
  • Wheezing
  • Frequent respiratory infections such as bronchitis or pneumonia
  • Chest pain
  • Cyanosis: Blueness of the fingers and lips
  • Exercise intolerance: Some people do not notice shortness of breath directly, but instead note that they are unable to as physically active as they once were, for example, it becomes difficult to walk as far or to climb as many flights of steps.
  • Muscle atrophy: The combination of decreased exercise along with other effects of the disease can result in muscle wasting and atrophy.

Causes

Smoking is the most common cause of emphysema, thought to be responsible for 85 percent to 90 percent of the cases. But there are many other causes which can act alone, or in conjunction with smoking, to cause emphysema.

We aren't certain exactly what causes COPD, but several risk factors have been identified including:

  • Secondhand smoke
  • Occupational exposures to fumes, dust, and vapors, such as ciliates, cadmium, coal dust, and grain and flour dust
  • Air pollution
  • Alpha-1-anti-trypsin deficiency: This inherited disorder may cause emphysema which appears in patients who are much younger in general.
  • Asthma: Asthma refers to reversible lung diseases whereas emphysema is irreversible, but in some cases, asthma may lead to emphysema.

Treatments

Emphysema is irreversible and progressive over time, so the goals of emphysema treatments are slowing the progression of the disease and improving symptoms. Some treatments include:

  • MedicationsThere are no drug treatments that have proven successful in slowing the rate of decline of lung function with emphysema. Instead, the medications are used to help increase exercise tolerance, reduce COPD exacerbations, and improve overall health status. Medications used for stable COPD include bronchodilatorsglucocorticoids, and antibiotics for infections.
  • Oxygen therapy: This can be given continuously, during activity, or for the relief of sudden episodes of shortness of breath. Long-term oxygen therapy of over 15 hours per day is given when a patient has low oxygen saturation levels during Stage IV COPD.
  • Quitting smoking: This is very important for individuals living with this condition and can help to slow the progression of the disease.
  • Pulmonary rehabilitation: There are many benefits of pulmonary rehabilitation, which is physical therapy for the lungs. It is an interdisciplinary program that should last at least six weeks. Pulmonary therapy can make a big difference for some people living with emphysema in improving exercise tolerance, reducing symptoms, and decreasing hospitalizations and lengths of stay.
  • Immunizations: Staying up to date with immunizations, especially the flu vaccine and the pneumonia vaccine, helps prevent infections which can result in worsening the disease.
  • Regular exercise routine: Emphysema creates a vicious circle. The disease itself makes it difficult to exercise, and the atrophy of muscles can, in turn, make the disease worse. The best exercises for COPD include a combination of endurance, flexibility, and strength training.
  • Surgery: Lung volume reduction surgery to remove severely damaged tissue may be useful for some people with severe emphysema, especially for those who have disease predominantly involving the upper lobes. Bullectomy may be done in patients who have giant bullae. Lung transplant is another consideration.

Exacerbations

Emphysema is characterized by what is known as COPD exacerbations—periods in which the symptoms become worse, often requiring hospital admission. These exacerbations are often precipitated by infections but may be set off by other conditions such as exposure to air pollution, wood smoke, or even perfumes in a mall.

Increased Risk of Lung Cancer

People with emphysema are also at increased risk of developing lung cancer. Lung cancer screening is available for those who are between the ages of 55 and 80 and have smoked for at least 30 pack-years. That said, emphysema is an independent risk factor for lung cancer and some people may wish to be screened even if they have not smoked, or have smoked less than 30 pack years.

Coping and Support

Emphysema can be a frustrating disease all the way around. Not only do you have to cope with symptoms and treatments, but those symptoms and treatments can affect nearly every other area of your life. Many people with COPD receive inadequate support. You need to seek out information on how to live and cope with COPD.

The Future of the Disease

At the current time, emphysema remains an irreversible disease and treatment is aimed at slowing the progression and complications related to the disease. Using recent advances in the understanding of stem and progenitor cells in the lung, laboratory studies have offered hope that lung regeneration therapy may be a way to reverse this progression in the future. Clinical trials, however, have failed to show any benefit of this approach to date.

Sources

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