Emphysema is a type of lung disease characterized by shortness of breath. Many people with emphysema also have chronic bronchitis (characterized by a chronic and productive cough). A combination of the two lung diseases is commonly called chronic obstructive pulmonary disease (COPD).
The exchange of oxygen and carbon dioxide takes place in the small air sacs of the lungs (alveoli). In a person with emphysema, the alveoli are damaged. The main tubes leading into the lungs (the bronchi) are also damaged and narrowed.
Emphysema is generally caused by cigarette smoking or long-term exposure to certain industrial pollutants or dust. A small percentage of cases are caused by the inherited disorder alpha-1- antitrypsin deficiency. The damaged airways don’t regenerate and there is no cure, however COPD is preventable and treatable.
• Breathlessness upon exertion, eventually breathlessness all the time
• Susceptibility to chest infections
• Sputum produced with chronic bronchitis
• Expansion of the ribcage, due to expansion of the lungs
• Cyanosis, or a blue tinge to the skin due to lack of oxygen.
Diagnosis is by spirometry (lung function testing), including diffusion testing. Findings will often demonstrate a decrease in FEV1 but an increase in Total Lung Capacity (TLC). Diffusion tests such as DLCO will show a decreased diffusion capacity. Other investigations might include X-rays, high resolution spiral chest CT-scan, bronchoscopy (when other lung disease is suspected, including malignancy), blood tests, and pulse. It might also be under the category of Alpha-1 Antitrypsin Deficiency, AAT. A way to help AAT is to put more into the blood flow and eat more protein.
Structure of the lungs
The lungs are sponge-like structures that lie within the chest, protected by the ribcage. They are made up of progressively branching air passages. The largest of these is the windpipe (trachea), which divides into the two bronchi, which divide into the smaller bronchioles. Bronchioles end in minute air sacs (alveoli), where inhaled oxygen is transferred to the blood stream and carbon dioxide is transferred from the blood into the exhaled breath. This exchange of oxygen and carbon dioxide takes place via a fine mesh of capillaries.
Damaged airways and lungs
After repeated exposure to chemical irritants, such as cigarette smoke, the air passages and air sacs of the lungs become inflamed and damaged. The airways of healthy lungs have elastic properties, but in lungs that are repeatedly exposed to irritants, the airways lose their elasticity and become thickened and swollen. This swelling means that the passageway for air becomes narrower.
If the same person also has chronic bronchitis (ongoing inflammation of the lining of the bronchial tubes), the mucus present can further contribute to narrowing of the air passages and clogging of the air sacs, further reducing their ability to function. As the number of functional air sacs reduces, the number of capillaries servicing the damaged alveoli also gradually reduces. The person has to breathe in a more exaggerated fashion to get sufficient amounts of oxygen.
• Pneumonia – an infection of the alveoli and bronchioles. A person with emphysema is prone to repeated bouts of pneumonia.
• Collapsed lung – some lungs develop large air pockets (bullae), which can burst during a coughing fit. The lung may deflate if the air escapes into the chest cavity.
• Heart problems – the damaged alveoli and reduced number of capillaries mean that the heart has to pump hard to move blood through the lungs. Over time, this can place considerable strain on the heart.
There is no cure for emphysema, however it is treatable. Appropriate management has been shown to improve quality of life and help people stay out of hospital.
• Stop smoking immediately – there are many successful programs to help people quit.
• Medications such as anti-inflammatory drugs, corticosteroids and decongestants.
• Medications to widen the airways (bronchodilators) – in puffer or tablet form.
• Antibiotics to clear up bronchitis infection, if present.
• Respiratory (pulmonary) rehabilitation programs.
• Stress management techniques.
• Gentle, regular exercise to improve overall fitness.
• Avoidance of air pollutants.
• Yearly vaccination against influenza to protect against respiratory infection.
• Oxygen treatment, in severe cases.
Respiratory (pulmonary) rehabilitation programs
A person with emphysema can take part in a respiratory rehabilitation program. These programs:
• Provide information and education on this lung disease
• Introduce patients to an exercise program proven to improve symptoms of COPD
• Improve lung function through specific breathing exercises
• Teach stress management techniques
• Offer advice on adapting to life with emphysema
• Provide emotional support through shared experiences.
If a person with emphysema is found to have exceptionally low levels of oxygen in their blood, they will be given oxygen to use at home. The oxygen is usually breathed through the nose via nasal prongs (cannulae). The person will need to use the oxygen treatment for at least 15 hours every day.