Emphysema is a form of chronic lung disease and one of the main types of chronic obstructive pulmonary disease (COPD). This disease is regarded as "obstructive" because people who are suffering from emphysema exhale air as if there is an obstruction. There are various factors that can cause emphysema, but one of the main factors is smoking. Even though there is no cure for emphysema, quitting smoking can reduce the progress of the disease.
Emphysema slowly affects the air sacs in the lungs, known as alveoli, making it difficult to breathe. When a person suffering from emphysema exhales, the damaged air sacs do not properly function because old air gets trapped inside, making it difficult for fresh air to enter. The treatment for emphysema can reduce the progression of the disease, but it cannot repair the damage already done to the lungs.
Emphysema may remain undetected for many years because it does not initially show any symptoms. The main symptom of emphysema is difficulty breathing, a symptom which slowly progresses. Initially, a person suffering from emphysema may avoid activities that cause difficulty breathing, so this symptom is not treated as a problem unless it starts affecting the daily activities of the patient. As the disease progresses, patients will find it difficult to breathe even while resting.
The main cause is exposure to airborne irritants, which include tobacco smoke, marijuana smoke, air pollutants, and manufacturing smoke. Very rarely, emphysema is caused by heredity, wherein a person has a shortage of a protein that guards the elastic structure in the lungs, known as alpha-1 antitrypsin deficiency emphysema.
The risk factors associated with emphysema are:
- Smoking – The risk of developing emphysema is greater in people who smoke cigarettes, including those who smoke cigars and pipes. The risk can be greater, depending on the number of years a person is smoking, and the amount of tobacco smoked through the years.
- Age – Even though the symptoms of emphysema are gradually visible, people with tobacco-related emphysema mostly start to experience the symptoms between the ages 40-60 years old.
- Passive Smoking – The secondhand smoke inhaled from someone else’s cigarette, cigar, or pipe can cause emphysema.
- Occupational Exposure to Fumes – This is a common emphysema risk factor if a person is working in an environment where he or she is daily exposed to certain chemicals or dust from grains, cottonwood, or mining products.
- Exposure to Air Pollution – Breathing indoor or outdoor pollutants increases the risk of developing emphysema.
When to See a Doctor
Individuals should consult a healthcare provider if they are experiencing unexplained difficulty breathing for a few months, particularly if it is getting worse with time, and has significantly affected their daily activities. Seek immediate medical assistance in the following cases:
- Finding it difficult to breathe and not able to climb stairs
- When lips or fingernails turn blue or gray with any physical exertion
- Not mentally alert
Some of the complications associated with emphysema are:
- Collapsed Lung - A person can develop a collapsed lung, which can be a life-threatening situation for a person who has severe emphysema. This condition occurs in very rare situations, but if it does, it can lead to serious complications.
- Heart Problems - A person may experience heart problems since emphysema increases the pressure in the arteries that are connected to the heart and lungs. It can lead to a problem called cor pulmonale, in which a part of the heart expands and weakens.
- Pulmonary Bullae - In some people, emphysema can cause large holes or bullae in the lungs. Giant bullae at times are as large as half the lung. These holes reduce the space for the lungs to properly function.
To know if a person is suffering from emphysema, the doctor will suggest the following tests:
- Imaging tests
- Laboratory tests
- Lung function tests
Emphysema cannot be cured, but treatment will help the patient get some relief from the symptoms as well as slow down the progress of the disease. Treatment for emphysema usually depends on the patient's condition and intensity of the disease. In most cases, a step-by-step approach is followed for the treatment of emphysema.
1) Quit Smoking
More of a lifestyle change, quitting smoking is one of the first things to be done by any patient suffering from a lung condition like emphysema. Smoking aggravates any lung disorder and causes irreparable damage, which can quickly worsen a person's condition.
Quitting the bud may greatly help when it comes to slowing down the progression of the disease and helps the lungs to function better. Naturally, the lungs tend to slow down in their function as a person ages. When lung function reduces, the risks associated with the development of chronic lung disorders like COPD become higher.
Smoking only contributes to the deterioration of lung functioning. Quitting unhealthy habits like smoking helps increase the life of the lungs and brings its functioning to normal levels. If you are addicted to smoking and wishes to get rid of this bad habit, your doctor may be able to prescribe you certain medications to help stop your urge to smoke. People could also seek the help of certain support groups that work towards helping people get rid of their addiction.
In some mild cases, the doctor may recommend certain lung exercises to patients to improve their lung function. Such exercises include a spirometer exercise, in which patients use their flow and blow into the spirometer device. These exercises should be done under strict medical supervision and are known to have a great impact on improving lung performance.
3) Bronchodilating Medications
These are medicines that help in opening up the airways for a better and smoother exchange of air to occur in the lungs. Bronchodilators are usually the initial medications prescribed for emphysema. In the first stage of less intensive cases of emphysema, bronchodilators may be recommended for use only as and when required for breathlessness. The most commonly recommended bronchodilator for mild cases of emphysema is albuterol (Proventil or Ventolin). This medication is known to show prompt action with a lasting effect up to 4-6 hours. Albuterol is available in the form of an inhaler and provides immediate relief.
For patients who suffer from shortness of breath even during resting, the treating doctor may prescribe albuterol to be administered at regular intervals either through a direct inhaler or through nebulization. In nebulization, the medication goes into the lungs in a slow vaporized manner and is known to provide relief to the patient by opening up the airways and facilitating smooth flow of air to and from the lungs.
- Ipratropium bromide (Atrovent): This is another bronchodilator used for the treatment of mild cases of emphysema. This medicine similarly functions like albuterol. It is available as a solution for nebulization as well as in the inhaler form. This medicine should be taken at frequent intervals and is not a medicine for immediate relief. Although it is a long-acting medication, it takes time to start showing its effect. This medicine may not be helpful in the case of chronic emphysema patients.
- Other Bronchodilators: Other bronchodilators such as theophylline and methylxanthines are available in various forms including tablets, inhalers, and syrups. These oral medications are known to have a longer impact that helps in keeping the airways open for a longer duration of time. These drugs have a short-term effect, so they are not often recommended these days. The levels of theophylline could suddenly increase in the blood causing an overdose effect. Thus, its levels need to be constantly monitored. Too little of this drug may show no effect at all in improving the condition of the patient. For these reasons, doctors only recommend this drug after careful consideration and upon checking its interaction with other drugs that the patient may be taking. Before taking theophylline, it is important to discuss the patient’s medications and medical history.
- Steroids: Steroids are often used to treat various lung-related issues due to their anti-inflammatory properties and effects in the body. Steroids can help reduce airway inflammation and immediately causes the lungs to come back into normal functioning. However, the use of steroids for the treatment of any medical condition can only be done after careful consideration to avoid having certain side effects. However, there are also patients who may not respond well to steroid treatment, which is why patients who receive steroid treatments need constant monitoring. Steroids can be given in the form of IV injections, inhalers, or as oral medications.
- Antibiotics: Antibiotics are normally given to treat various forms of bacterial infections. Antibiotics may also be given to patients who experience breathlessness, especially individuals with COPD to help prevent a sudden worsening of their condition. An immediate administration of steroids and antibiotics could even reduce the risk of hospitalization.
- Oxygen: If a patient with emphysema is suffering from breathlessness, then an immediate hospital admission may be required to provide oxygen support. An oxygen tube may be inserted into the windpipe and the external machine helps in assisted breathing. This method of treatment is also known as tracheal intubation. In certain cases, patients may be recommended to get oxygen even at home. Home-based oxygen cylinders are made available, which allow patients to be comfortable at home, as far as breathing is concerned. These units are portable and allow the patient to perform their day-to-day activities with ease.
Other Treatment Options
- Pulmonary Rehabilitation - In this therapy, the patient will be taught breathing exercises and methods that will help reduce breathlessness.
- Nutrition Therapy - The patient will be advised about proper nutrition. In the initial stages of emphysema, most patients have to lose weight, while people in the later stage need to gain weight.
- Supplemental Oxygen - For patients suffering from severe emphysema and very low blood oxygen levels, they will have to make use of supplemental oxygen at home and during exercise to get some relief. Some patients are provided with oxygen throughout the day. This supplemental oxygen is administered through narrow tubes that fit into the nostrils of the patient.
Some people suffering from an advanced form of emphysema may require surgery to decrease lung pressure and to better manage the symptoms. Surgery is not usually recommended for older adults with severe emphysema as it only increases other health risks. People who have lung damage around the upper lobes of the lungs are more likely to sustain and experience the positive effects of surgery.
If a patient has severe emphysema, the doctor may suggest the following surgery options:
- Lung Volume Reduction Surgery - In this option, the surgeon will remove small portions of the damaged lung tissue to allow the remaining lung tissues to properly expand and function. This procedure also improves the breathing of the patient.
- Lung Transplant - This is an option for patients in the later stage of emphysema and when no other option has been effective in improving the condition of the patient.
3. Lifestyle Changes and Home Remedies
For patients suffering from emphysema, certain lifestyle changes and home remedies will help reduce the progression of the disease and from any complications.
- Quit Smoking – Quitting smoking is one of the most important steps that one will have to take for the overall improvement of health and to reduce the progression of emphysema. One can join a smoke cessation program to get help to quit smoking. Secondhand smoke must also be avoided as much as possible.
- Avoid Respiratory Irritants – Avoid fumes from paint and automobile exhaust, certain cooking odors, perfumes, and burning candles or incense. Change furnace and air conditioner filters regularly to reduce the pollutants in the air.
- Exercise Regularly – Regular physical exercises will help increase lung capacity.
- Protection from Cold Air – Cold air will increase breathing problems, so during the cold weather, wear a scarf and mask that can cover the nose and mouth to warm the air entering the lungs.
- Avoid Respiratory Infections – Take vaccinations for pneumonia and yearly flu shots. Moreover, avoid people who have a cold or flu. During social gatherings, especially during cold and flu season, wear a mask, wash hands regularly, or use a hand sanitizer.
There is no definite cure for emphysema. However, the symptoms can be managed to slow down the progression of the disease. Certain lifestyle changes may also go a long way in treating the condition.