Emphysema

What is emphysema?  

Emphysema is a chronic disease of the lungs characterized by thinning and over-expansion of the lung-like blisters (bullae) in the lung tissue. Because carbon dioxide is trapped in the bullae, fresh air flowing into the lungs, demanded by the body, pushes the walls of the lung further out with each new breath. This lack of air transfer causes the lungs to expand, lose their elasticity and tissue becomes destroyed. This causes more carbon dioxide to remain in the lungs leaving less space for fresh air and causing shortness of breath. Over time the muscles and ribs surrounding the lungs are forced to stretch to fit the over-expanded lungs. The diaphragms, the major muscles used for breathing, become flattened and lose their ability to function. 

What causes emphysema? 

Cigarette smoking, air pollution, work hazards, and lung infections cause emphysema. Cigarette smoking is the most important of these factors. Cigarette smoking alters the structure and function of the lungs causing them to increase in size and lose their elasticity.

Cigarette smoking increases the number of inflammatory cells in your lungs. These cells release enzymes and other products that destroy the lung tissue. As a result, the lungs develop bullae (holes) and lose elasticity. 

Alpha-1 antitrypsin deficiency is a disease caused by a genetic defect that leads to decreased levels of the protective protein, alpha-1 antitrypsin. Alpha-1 antitrypsin protects the lungs from the destructive effects of enzymes called elastates. Patients with alpha-1 antitrypsin deficiency may develop emphysema at an early age. 

How does emphysema cause shortness of breath? 

This is a very complicated question. The destruction of lung tissue seen with emphysema eventually results in dysfunction of virtually all the functions of the lung, as well as that of the respiratory muscles and chest wall. 

1. By losing elasticity, the lungs become more difficult to ventilate. The lungs rapidly become progressively more impaired and air becomes trapped within the lung. This is why emphysema is termed an “obstructive” lung disease. This impairment increases the work of breathing. Patients first experience symptoms with exercise but as the disease progresses shortness of breath can occur with all activities and even at rest. 

2. In addition, as the lung loses its elasticity, the chest wall and ribs begin to expand and become overinflated. This results in a flattening of the major inspiratory muscle, the diaphragm, and causes the muscle to work less efficiently. This further adds to the increased work of breathing and diminishes the ability of the diaphragm to cope with even a normal workload. As a result, shortness of breath worsens. 

3. The main function of the lungs is to add oxygen and remove carbon dioxide from the blood. As emphysema progresses, patients may have an inadequate amount of oxygen in the blood. As the disease worsens, the amount of carbon dioxide in the blood increases. If the oxygen in the blood is not supplemented, the entire body suffers, including the heart and the brain. 

4. The patient with emphysema becomes “out of shape” (deconditioned) because the disease does not allow sufficient exercise to stay in shape. 

What is the medical treatments for patients who suffer from emphysema? 

Medical treatments for emphysema includes bronchodilators, steroids, antibiotics, and oxygen. All patients with emphysema should stop smoking to prevent further damage tothe lungs and airways. Air pollution and exposure to passive smoke should be avoided as much as possible. A regular exercise program should be maintained and usual activity such as walking and stair climbing continued. Emphysema patients should be vaccinated in the early fall with a flu vaccine. They should obtain prompt treatment of any lung infections. They should drink 10-12 cups of liquid a day, eat small meals and snacks several times a day, and if overweight, lose weight in an effort to reduce the shortness of breath. 

Medical treatment 

1. Bronchodilators (pills and inhalers) open up airways to relieve wheezing or shortness of breath. Steroids such as prednisone are usually used when the disease is severe but can have side effects. People can respond differently to the same medication so you should discuss your medical therapy with your doctor. 

2. Pulmonary rehabilitation and exercise may increase your endurance. It is extremely important when doing pulmonary rehabilitation that you exercise in a monitored safe atmosphere where your oxygen status can be monitored. 

3. Supplemental oxygen may help to decrease the feeling of shortness of breath. The oxygen requirement is usually increased during exercise and decreased at rest. Once your physician has determined that you need oxygen it is very important to use it as prescribed. 

What are the surgical option for emphysema? 

Lung transplantation and lung volume reduction surgery are surgical options that are available. Surgical options for emphysema are only used when the use of all medical treatments (medication, pulmonary rehabilitations) have been tried and symptoms still persist.

Categories: Emphysema, medical treatments for Emphysema, What causes emphysema