What Is Emphysema?

What Happens When You Have Emphysema?

diagram of alveoli showing emphysema
What is emphysema?. A.D.A.M. Medical Encyclopedia

Definition: Emphysema

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 and COPD

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 4th leading cause of death in the United States.

Symptoms of Emphysema

Symptoms of emphysema may include:

  • Shortness of breath - The most common symptom of emphysema is shortness of breath. Shortness of breath 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 referred to as cyanosis may occur.
  • 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, 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:

  • Smoking - Smoking is thought to be responsible for 85 to 90 percent of cases of emphysema.
  • Secondhand smoke
  • Occupational exposures to fumes, dust, and vapors, such as cilicates, cadmium, coal dust, and grain and flour dust.
  • Air pollution.
  • Alpha-1-antitrypsin deficiency - The inherited disorder alpha-1-anti-trypsin deficiency 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.

Emphysema Treatments

Emphysema is irreversible and progressive over time, so the goals of emphysema treatments are too slow the progression of the disease and to improve symptoms. Some treatments include:

  • Medications - Medications such as bronchodilators, steroids, and antibiotics to treat infections are primary treatments for emphysema.
  • Quitting smoking 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 or physical therapy for the lungs." Pulmonary therapy can make a big difference for some people living with emphysema both in improving exercise tolerance.
  • Immunizations - It is important for people to stay up to date with immunizations, especially the flu vaccine and the pneumonia vaccine to help prevent infections which can result in worsening of the disease. 
  • Regular exercise routine - A significant problem with emphysema is that it 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.
  • Lung volume reduction surgery - Surgery to remove severely damaged tissue (lung volume reduction surgery) may be useful for some people with severe emphysema, especially for those who have disease predominantly involving the upper lobes.

Complications

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 and Screening

People with emphysema are also at increased risk of developing lung cancer. We now have lung cancer screening 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. Learn about lung cancer screening.

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 our life. Recent studies have found that many people with COPD receive inadequate support and that in general inadequate measures are currently available to properly support the number of people dealing with COPD.

Check out these tips on how to live and cope with COPD.

The Future of Emphysema

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:

Kasper, Dennis L.., Anthony S. Fauci, and Stephen L.. Hauser. Harrison's principles of internal medicine. New York: Mc Graw Hill education, 2015. Print.

Oh, D., Kim, Y., and Y. Oh. Lung Regeneration Therapy for Chronic Obstructive Pulmonary Disease. Tuberculosis and Respiratory Disease. 2017. 80(1):1-10.

Rzadkiewicz, M., Bratas, O., and G. Espnes. What Else Should We Know About Experiencing COPD? A Narrative Review in Search of Patients’ Psychological Burden Alleviation. International Journal of Chronic Obstructive Pulmonary Disease. 2016. 11:1195-2304.

van Agteren, J., Carson, K., Tiong, L., and B. Smith. Lung Volume Reduction Surgery for Diffuse Emphysema. Cochrane Database of Systematic Reviews. 2016. 10:CD001001.

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