Emphysema is a lung condition in which tiny air sacs in the lungs – alveoli – fill up with air. As the air continues to build up in these sacs, they expand, and may break or become damaged and form scar tissue. The patient becomes progressively short of breath. Emphysema is a type of COPD (chronic obstructive pulmonary disease). The main cause of emphysema is long-term regular smoking.
The alveoli turn into large, irregular pockets with holes in them. The surface area of the lungs is gradually reduced, resulting in less oxygen entering the bloodstream.
The small elastic fibers that hold open the small airways leading to the alveoli also become destroyed. When the patient breathes out they collapse, i.e. the patient has problems exhaling air.
Emphysema is not curable, the condition cannot be reversed. However, treatment may slow down its rate of progression and alleviate symptoms.
The alveoli are the grape-like sacs
According to Medilexicon’s medical dictionary, emphysema is:
1. Presence of air in the interstices of the connective tissue of a part.
2. A condition of the lung characterized by increase beyond the normal in the size of air spaces distal to the terminal bronchiole (those parts containing alveoli), with destructive changes in their walls and reduction in their number. Clinical manifestation is breathlessness on exertion, due to the combined effect (in varying degrees) of reduction of alveolar surface for gas exchange and collapse of smaller airways with trapping of alveolar gas in expiration; this causes the chest to be held in the position of inspiration (“barrel chest”), with prolonged expiration and increased residual volume. Symptoms of chronic bronchitis often, but not necessarily, coexist. Two structural varieties are panlobular (panacinar) emphysema and centrilobular (centriacinar) emphysema; paracicatricial, paraseptal, and bullous emphysema are also common.
What are the signs and symptoms of emphysema
A symptom is something the patient feels and describes, such as pain, while a sign is something everybody can detect, such as a rash.
A patient with emphysema may experience no symptoms for many years. Eventually, as the condition progresses, there is a shortness of breath (dyspnea), which starts off gradually. An individual with early stages of emphysema may avoid physical activity because it makes them pant too much. Eventually, the shortness of breath is present even when the person is resting.
What are the causes of emphysema?
The main cause of emphysema is long-term, regular tobacco smoking. It may also be caused by marijuana smoking (much less common), exposure to air pollutions, factory fumes, coal and silica dust.
In rare cases, a patient may have inherited a deficiency of Alpha-1 antitrypsin, a protein that protects the elastic tissue in the lungs.
What are the possible complications of emphysema?
Pneumothorax, also called collapsed lung. This can be fatal in patients with severe emphysema because the lungs have become so weak.
Cor pulmonale – a part of the heart expands and becomes weak. This happens when pressure in the arteries that connect the lungs and heart increases.
Giant bullae – empty spaces, called bullae develop in the lungs. Giant bullae are very large, sometimes half the size of the lung. Not only does the lung have a much smaller surface area, the bullae can become infected. Patients with giant bullae are more likely to develop pneumothorax.
Recurring infections – chest infections, pneumonia, influenza, cold and the common cold are like to occur more often in patients with emphysema.
Pulmonary hypertension – abnormally high blood pressure in the arteries of the lungs.
The doctor will carry out a physical examination and ask some questions, such as:
smoking status and history
whether he/she suffers from shortness of breath and how long for
what makes shortness of breath worse
whether there is a cough and if that cough brings up sputum
the patient’s medical history
whether his/her family have a history of lung disease
The doctor may order some tests, which may include:
Chest X-ray – this can help the doctor determine whether the emphysema is advanced, and also exclude any other reasons for the dyspnea.
CT (computerized tomography) scan – this may be ordered to help the doctor decide whether lung surgery is required.
Blood test – blood may be taken from an artery to determine how well the lungs are transferring oxygen into the blood, and removing CO2.
Lung function tests – these tests tell the doctor how well the patient’s lungs inhale and exhale air, as well as showing how much air the lungs can hold. The doctor will also have a better idea of how efficiently the lungs are transferring oxygen into the bloodstream. The patient will probably be asked to blow into a spirometer. Spirometry can be done at the doctor’s office or a nearby hospital or clinic. The patient has to blow as hard as possible into a small tube that is attached to a machine. The machine measures the time taken to blow all the air out of the lungs. If the patients airways are blocked it will take longer.
A modern USB PC-based spirometer [image from Wikimedia]
What are the treatment options for emphysema?
Emphysema is incurable; there is no treatment to reverse the condition. However, symptoms can be relieved and its progression can be slowed down with proper treatment.
Stop smoking – smoking is the main cause of emphysema in the first place. Stopping smoking will considerably slow down its progress.
Bronchodilators – types of medications that relax airways that have become constricted, thus relieving shortness of breath, breathing problems, and coughing. These drugs are more effective for the treatment of chronic bronchitis or asthma, but can help emphysema patients to some degree.
Steroid aerosol sprays – these are inhaled. Corticosteroids are effective for shortness of breath. However, they must be used under the careful monitoring of a doctor because long-term usage can result in weakened bones, elevated blood pressure and cataracts. Long-term steroid use also significantly raises the risk of developing diabetes.
Antibiotics – patients with emphysema generally get more infections, such as pneumonia or acute bronchitis than other people. Such conditions require antibiotic treatment.
Rehabilitation techniques – the patient can be taught certain breathing exercises that may help reduce shortness of breath and improve his/her ability to do exercise. Patients may undergo weight changes, which need to be addressed.
Oxygen – those with severe symptoms may require supplemental oxygen, which is usually administered through the nostril via a narrow tubing.
Surgery – a surgeon may surgically remove some of the damaged tissue, which helps the remaining lung tissue work better, this may help the patient breath better.
Lung transplant – when other options have not worked and symptoms are very severe, the doctor may recommend lung transplant
Original article date: 01 Jun 2004
Article updated: 22 Sept 2011