Emphysema

Emphysema

Definition:

Emphysema occurs when the air sacs in your lungs are gradually destroyed, making you progressively more short of breath. Emphysema is one of several diseases known collectively as chronic obstructive pulmonary disease (COPD). Smoking is the leading cause of emphysema.

As it worsens, emphysema turns the spherical air sacs — clustered like bunches of grapes — into large, irregular pockets with gaping holes in their inner walls. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.

Emphysema also slowly destroys the elastic fibers that hold open the small airways leading to the air sacs. This allows these airways to collapse when you breathe out, so the air in your lungs can't escape. Treatment may slow the progression of emphysema, but it can't reverse the damage.

Symptoms:

You can have emphysema for many years without noticing any signs or symptoms. The main symptom of emphysema is shortness of breath, which usually begins gradually. You may start avoiding activities that cause you to be short of breath, so the symptom doesn't become a problem until it starts interfering with daily tasks. Emphysema eventually causes shortness of breath even while you're at rest.

When to see a doctor
See your doctor if you've had shortness of breath for several months, especially if it's getting worse or it's interfering with your daily activities. Don't try to attribute it to your deconditioning or age or weight. Seek immediate medical attention if:

• You're so short of breath, you can't talk
• Your lips or fingernails turn blue or gray
• You're not mentally alert
• Your heartbeat is very fast

Causes:

The main cause of emphysema is long-term exposure to airborne irritants, including:

• Tobacco smoke
• Marijuana smoke
• Air pollution
• Manufacturing fumes
• Coal and silica dust

Rarely, emphysema is caused by an inherited deficiency of a protein that protects the elastic structures in the lungs. It is called Alpha-1 antitrypsin deficiency emphysema.

 Complications:

People who have emphysema are also more likely to develop:

• Collapsed lung (pneumothorax). A collapsed lung can be life-threatening in people who have severe emphysema, because the function of their lungs is already so compromised.
  
• Heart problems. Emphysema can increase the pressure in the arteries that connect the heart and lungs. This can cause a condition called cor pulmonale, in which a section of the heart expands and weakens.
  
• Large holes in the lungs (giant bullae). Some people with emphysema develop empty spaces in the lungs called bullae. Giant bullae can be as large as half the lung. In addition to reducing the amount of space available for the lung to expand, giant bullae can become infected and are more prone to causing a collapsed lung (pneumothorax).

Treatments and drugs:

Emphysema can't be cured, but treatments can help relieve symptoms and slow the progression of the disease.
Medications

• Smoking cessation drugs. Prescription medications, such as bupropion hydrochloride (Zyban) and varenicline (Chantix), can help you quit smoking.
  
• Bronchodilators. These drugs can help relieve coughing, shortness of breath and trouble breathing by relaxing constricted airways, but they're not as effective in treating emphysema as they are in treating asthma or chronic bronchitis.
  
• Inhaled steroids. Corticosteroid drugs inhaled as aerosol sprays may help relieve shortness of breath. But prolonged use can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes.
  
• Antibiotics. If you develop a bacterial infection, like acute bronchitis or pneumonia, antibiotics are appropriate.

Therapy

• Pulmonary rehabilitation. A pulmonary rehabilitation program can teach you breathing exercises and techniques that may help reduce your breathlessness and improve your ability to exercise. You'll also receive advice about proper nutrition. In the early stages of emphysema, many people need to lose weight, while people with late-stage emphysema often need to gain weight.
  
• Supplemental oxygen. If you have severe emphysema with low blood oxygen levels, using oxygen regularly at home and when you exercise may provide some relief. Many people use oxygen 24 hours a day. It's usually administered via narrow tubing that fits into your nostrils.

Surgery
Depending on the severity of your emphysema, your doctor may suggest one or more different types of surgery, including:

• Lung volume reduction. In this procedure, surgeons remove small wedges of damaged lung tissue. Removing the diseased tissue helps the remaining lung tissue work more efficiently and helps improve breathing.
  
• Lung transplant. Lung transplantation is an option if you have severe emphysema and other options have failed.