Struggling for every breath you take
For over 2.4 million people, the very act of breathing requires major effort. Emphysema is a chronic condition that affects the lungs and refers to a decreasing ability to take oxygen out of the air and to eliminate carbon dioxide from the body. Because lung capacity is limited, shortness of breath, wheezing, coughing, and fatigue are all recognized features of this condition. Smoking is the most common cause of emphysema. Medication can help alleviate some symptoms and the speed of deterioration, but emphysema has no cure.
Emphysema is a chronic obstructive pulmonary disease (COPD), as is asthma and chronic bronchitis. Emphysema is a degenerative condition in which the body becomes starved for proper oxygen because of the problem of transferring oxygen from the air to the body. These problems start in the lungs, in the tiny air sacs called alveoli. As many as 300 million alveoli in the lungs absorb oxygen out of the inhaled air, transfer it to the blood stream, and remove carbon dioxide from the blood to be expelled with the outgoing air.
When a person has emphysema, the thin, elastic tissues that make up the alveoli walls are destroyed by exposure to air pollutants like tobacco smoke, ozone, and carbon monoxide. This results in fewer, larger air sacs that have less surface area to exchange oxygen and carbon dioxide. The walls of the small bronchial tubes lose their elasticity, become weak and may collapse during exhalation. This further obstructs the airflow and traps stale air inside the lungs. As a result the lungs are not sufficiently emptied, resulting in shallow breaths. Both of these factors contribute to a shortage of oxygen and a surplus of carbon dioxide in the body.
As emphysema develops, the struggle to breathe increases. Physical activity is difficult, and eventually, supplemental oxygen has to be administered at all times. There is no cure for emphysema, but treatment can help slow its advancement and alleviate some symptoms, so that many people live for years with the condition. Without treatment, however, the progression of emphysema can be fatal.
How Common Is Emphysema?
Statistics show that over 2.4 million adults suffer from emphysema. COPDs (chronic obstructive pulmonary diseases) account for 60,000 to 90,000 deaths per year. Classical late-onset emphysema usually develops in people over age 55, while early-onset forms of the disorder can begin at age 30. Men are more likely to develop emphysema than women because in the past, more men smoked than women. The male to female ratio is approximately two to one.
Goals of Treatment
Irreversible damage to the heart and lungs cannot be cured. The main focus of treatment revolves around improving breathing, preventing infections of the already fragile lung tissue, and control of coughing and mucus production. Related conditions are treated as they arise.
Medication can provide some measure of relief from the symptoms of emphysema. Bacterial infections can be suppressed and breathing can be eased (often through antibiotics and bronchodilator therapy). Supplemental oxygen is very important if the blood oxygen is low. Cessation of smoking and a rehabilitation program should be a main consideration for anyone suffering from emphysema. Usually inpatient care is not necessary unless respiratory failure occurs or an infection develops.
The stepped care approach is a common way to manage emphysema. The steps involve the use of specific drugs as symptoms develop and are best discussed with your doctor or medical professional.
|Drugs most commonly prescribed|
Several prescription drugs are available to reduce serious respiratory problems by opening the airways:
Inhalers containing corticosteroids to reduce lung inflammation. Recent studies show that there is no indication that inhaled steroids will help someone who does not have reactive airway disease. It is oral steroids that appear to help the person breathe better.
Alternative drugs can help reduce discomfort and the risk of secondary infections.
Lung Volume Reduction Surgery (LVRS) has brought dramatic improvement to some people with advanced emphysema, helping to reduce the need for supplemental oxygen and enabling an increased level of activity. The operation, which removes 20% to 30% of the damaged lung tissue, reduces the size of the distended lungs and allows more room for the remaining tissue to inflate when inhaling. Though this improves lung mechanics, it does not stop the progression of the disease.
In some severe cases, a lung transplant may be considered a viable surgical option, in which case one or both lungs may be transplanted.
It has been proposed that giving emphysema patients anabolic steroids may help bulk up lung muscle tissue; however, much more research must be performed in order to determine if anabolic steroids are beneficial to respiratory diseases.
Gene therapy involving alpha-1-antitrypsin may be on the horizon to help emphysema patients with this rare form of the disease.
It is common for chronic bronchitis, pneumonia and other infections to accompany emphysema. Antibiotics should be administered accordingly. Because several drugs must be used in order to maintain a reasonable quality of life, drug interactions may occur. You should check with your doctor to determine the possibility of any dangerous drug interactions.
Quality of Life
The loss of independence and severe functional impairment eventually occurs as emphysema progresses and can have a significant effect on those who suffer from this condition. Anxiety, lowered self-esteem, and depression are all feelings that need to be considered and dealt with through appropriate counseling, family support, and education. Exercise programs, good nutrition, avoidance of infections, and intelligent use of medications can help in the rehabilitation process.
Considerations for Older People
The long-term effects of smoking or pollutant exposure are often seen in the elderly, who suffer in their later years from a lifetime of tobacco use. Often the breathing difficulties that older people experience can be due to a variety of causes asthma, bronchitis, or emphysema. It is important to determine the source of breathing difficulty so it can be properly treated. Stress from such things as worry, fear, or loneliness is common in older people and can affect the severity of their illness as well as all aspects of their lives.
Self care & Prevention
The primary way to prevent emphysema is to completely stop smoking. Dust, fumes, and other air pollutants that lead to lung irritation should also be avoided.
Promptly treating lung infections is one way to stop this condition from accelerating quickly. Maintaining ideal body weight and consistently eating nutritionally complete meals are also important. Appropriate exercise is also a vital part of a treatment plan. Additionally, the following elements can play a vital role in improving your quality of life:
- If you smoke, stop. Quitting halts the progression of emphysema, although it cannot reverse it.
- Don't overdo it. Instead of bursts of activity, maintain a slow, steady pace. Eat slowly. Chew slowly. Schedule rest periods frequently during the day.
- Take it easy. Rethink your life to eliminate needless effort. Invest in such labor-saving devices as a TV remote, a cordless phone, and so on. Do as much as possible while sitting.
- The American Lung Association (ALA) suggests breathing through pursed lips. Keep your lips shut tight except for a tiny opening at the center. Inhale and exhale slowly, with steady pressure, making a "sssss" sound. Try to exhale for twice as long as you inhale. Pursed-lip breathing prevents gasping for air.
- Stay away from respiratory irritants, including smoke, dust, fire, and chemical vapors.
- Cold air can be hard to breathe. During the winter, cover your nose and mouth with a soft scarf when outdoors. During the summer, avoid cold air conditioning or cover your nose and mouth with a handkerchief to help warm up the air you inhale.
- Emphysema makes exercise difficult, but exercise helps preserve remaining lung function. The American Lung Association recommends daily walks or other non-strenuous activities for example, gardening or swimming.
Last updated 25 May 2012
- Chronic obstructive pulmonary disease (COPD)
- Classic emphysema
- Alpha-1-antitrypsin (ATT) deficiency emphysema
Any long-term exposure to airborne pollutants such as coal dust can irritate the delicate lung tissues, but by far the most common source of lung tissue irritation is tobacco smoke. A history of cigarette smoking, which is responsible for 82% of all lung diseases, has been established as the primary cause of classic emphysema. The chemicals and tar in cigarette smoke not only destroy the thin air sacs and damage the tissue of the bronchial tubes, they also injure the small hair-like cilia that line these tubes and the windpipe. Cilium work to eliminate foreign particles and mucus from the lungs, but when their effectiveness is diminished more pollutants reach the alveoli.
Early-onset emphysema, a rare form of the disease found in only 2% of all cases, is inherited. Trypsin is a bacteria-killing enzyme that breaks down lung tissue when present in large quantities. It is normally neutralized by the presence of a protein called alpha1-antitrypsin (AAT). In some people the gene which encodes AAT is missing, causing tissue erosion similar to the destruction of lung tissue caused by smoking and other toxins. Smoking also increases the severity of emphysema in patients with AAT deficiency.
While alpha-1-antitrypsin deficiency is an established hereditary factor for early-onset emphysema, recent studies have shown that there may be other, as of yet unidentified, genetic links to emphysema. However, much more research must be performed in order to solidify these theories.
Engaging in any activity that increases lung toxin exposure contributes to emphysema development. These include:
- Exposure to secondhand smoke
- Living in areas with dense pollution
- Occupations that have lengthy smoke exposure periods (such as firefighters), or other long-term airborne chemical and particle exposures.
- Long-term bronchitis
Symptoms & Diagnosis
Symptoms develop later in life (usually after age 40). Initially the symptoms will not be terribly obvious and most serious problems with emphysema will not arise until 10 years after the initial development of the disease.
The main feature of emphysema is a struggle for breath. In the early stages of this condition there may be no apparent symptoms. As the disease progresses the difficulty with breathing becomes increasingly problematic until it is noticed even when resting. Other symptoms include a chronic cough that produces a small amount of phlegm or spit from the accumulation of excess mucus in the airways, recurring pneumonia or bronchitis, and wheezing sounds.
As emphysema progresses, the lack of oxygen may cause the nail beds and lips to take on a bluish color (cyanosis) and the restricted ability to eliminate carbon dioxide may cause morning headaches. Chronic fatigue will be noticed due to the deterioration of the blood vessels in the lungs restricting the flow of blood and decreasing blood circulation. Over time the inability to sufficiently exhale can cause the chest to become distended, giving a barrel chest appearance.
Conditions That May Be Mistaken for Emphysema
Diagnosis of emphysema is often made difficult by the coexistence of several other pulmonary disorders. The following are conditions that may make a correct diagnosis difficult or may actually be present with emphysema:
- Chronic bronchitis
- Bronchial asthma
- Cystic fibrosis
- Central airway obstruction
- Acute viral infections
- Chronic sinusitis
How Emphysema is Diagnosed
To diagnose emphysema, the following tests are important:
- A physical exam will include taking a history of the symptoms mentioned above
- The doctor will listen to your lungs for any wheezing or rasping sounds as you breathe
- Pulmonary function tests to measure rate of exhalation, lung capacity and diffusion of oxygen into the blood.
- Alpha-1-antytrypsin levels in the blood serum of young patients (under age 30).
- Arterial blood gas tests to detect the level of oxygen in the blood. This is the only way to ascertain oxygen levels, because mild hypoxia (inadequate oxygen at cellular level) may not show any symptoms.
- Hemoglobin levels may be tested.
- Chest X-rays will show hyperinflation with a flattened diaphragm and in later stages the increase of the right side of the heart due to pulmonary hypertension, an increase in arteroposterior diameter.
- A computed tomography (CT) scan of the lung may be taken. If emphysema is present, destruction of the lung air sacs will be shown.
Vitamin C: in addition to helping treat the common cold, vitamin C may also ease breathing for people with asthma and other respiratory conditions. Clinical nutritionists often suggest it for emphysema.
- Yoga, tai chi, qi-gong: These gentle, non-strenuous exercise programs are good for people with emphysema. While non-taxing, they help improve lung function.
- Breathing exercises: Deep breathing exercises can train you to use your diaphragm muscles instead of your chest muscles, and teach you to avoid a shallow breathing pattern.
- Walking: In cases of less severe emphysema, regular exercises such as walking can help to maintain physical stamina. Lung capacity will not be increased, but maintaining fitness as much as possible will help the body use the available oxygen more efficiently.