Emphysema

1 What is Emphysema?

Emphysema is the gradual destruction of the air sacs (called alveoli) in your lungs. Alveoli tiny air-filled sacs with blood vessels, and allows removal of carbon dioxide and oxygenation of the blood. Emphysema gradually destroys alveoli and makes you progressively short of breath.

Emphysema

Smoking is the main cause of emphysema as tobacco contains several substances that destroy alveoli.

The lungs are filled with millions of alveoli where they are clustered like grapes, which enlarge the surface area for the blood vessels to exchange oxygen and carbon dioxide from the air. Destruction of alveoli due to emphysema reduces this surface area, so less oxygen goes into the bloodstream. The damaged alveoli are no longer flexible, which traps stale are and leaves no place for fresh oxygen-rich air.

Emphysema is not reversible, and there is no procedure to replace damaged alveoli in the lungs. Treatment only slows progression of the condition.

2 Symptoms

Emphysema often does not cause any symptoms at all until plenty of alveoli already sustained damage. The emphysema’s main symptom is shortness of breath, and it starts gradually. You may first tend to avoid activities that cause shortness of breath that progress until it affects your daily tasks. Patients with emphysema have severe shortness of breath to the extent that it happens even at rest.

You need to see a doctor if you have unexplained shortness of breath for several months.

You need medical attention if you have the following symptoms:

  • Shortness of breath that is so serious you cannot climb a flight of stairs.
  • Clubbing of the fingernails.
  • Bluish or greyish color of the lips or nail beds.
  • Reduced alertness.

3 Causes

Smoking tobacco is the main cause of emphysema.

However, you can also develop emphysema from exposure to the following:

  • Second hand and third hand smoke
  • Air pollution
  • Fumes from factory or manufacturing
  • Marijuana smoke

Alpha-1-antitrypsin deficiency emphysema is a rare kind of emphysema caused by an inherited deficiency in a protein that keeps the alveoli elastic.

4 Making a Diagnosis

You might get help from a primary physician or be referred to specialist doctor for lung problems called a pulmonologist to receive a diagnosis of emphysema.

You can improve care received by doing the following:

  • Detail your smoking habits honestly, like age when you first started smoking and how many packs were smoked.
  • Exposure to tobacco smoke in the environment, like living with a person who smokes.
  • Exposure to chemical or industrial fumes and dust.
  • Examine if anyone in the family has lung problems.
  • Detail medicines or supplements you take.

During the appointment, your doctor may discuss with you the following:

  • If you have cough, and if you do, when did it start and how severe it is.
  • Your smoking habits and if you have tried to quit.
  • Changes in body weight.
  • Having bluish or greyish lips or nails.
  • If shortness of breath interferes with daily activities.
  • Family history of emphysema, if any.
  • When did you first notice having shortness of breath?

5 Treatment

There is no way to restore alveoli destroyed by emphysema and the treatment is focused on relieving symptoms and slow destruction of remaining alveoli.

Medications

Medications may work to control symptoms.

Here are the most commonly prescribed drugs for emphysema:

  • Bronchodilators help relax constricted airways and relieve coughing, shortness of breath and breathing problems. Note that bronchodilators may not cause good relief as they do for asthma or chronic bronchitis.
  • Antibiotics to address infections that cause acute bronchitis and pneumonia.
  • Inhaled steroids relieve shortness of breath, and it acts quickly. However, steroids have notable side effects like weakened bones and increased risk for hypertension, diabetes, and formation of cataracts.

Surgery

Surgery may be needed for severe emphysema. The doctor may recommend lung volume reduction surgery, wherein small wedges of diseased lung tissue are removed so healthy ones can expand and work more efficiently.

For very severe emphysema that does not respond to treatment, a lung transplant may be necessary.

6 Prevention

Emphysema is preventable by avoiding smoking tobacco and second hand smoke.

You must also reduce your exposure to volatile chemicals, dust, and air pollution.

Wear an air-filtering mask or simply stay inside the house when outside air has high levels of pollution.

7 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with emphysema.

If you have emphysema, you can reduce symptoms or exacerbations by doing the following:

  • Quit smoking, if you still smoke. Tobacco cessation significantly slows down alveoli destruction and can give you some much-needed relief from emphysema symptoms. If you face difficulties, join a smoking cessation program.
  • Identify and avoid substances that irritate your lungs. Some common irritants include car exhaust, household cleaning chemicals, hot stale air, perfumes, incense and scented candles. Make sure to clean furnace and air conditioning filters regularly.
  • Avoid exposure to cold air, which can irritate and constrict the airways. During cold weather, protect yourself by wearing a soft scarf or cold-air facemask when going outside.
  • Make sure to have exercise regularly, which helps expand the lungs and preserve lung capacity.
  • Guard against respiratory infections, which make emphysema worse. You can do this by washing hands regularly, having the annual flu and pneumonia vaccinations, and staying away from large groups of people.

8 Risks and Complications

There are several risks and complications associated with emphysema.

Here are the risk factors for emphysema:

  • Smoking is the most significant risk factor. Emphysema risk is evident in individuals who smoke cigarettes, pipes and cigars. Those who smoke more packs per day and whose smoking habits span several years face increased risk.
  • Exposure to second hand smoke is often overlooked, but it is the cause of the majority of emphysema cases in non-smoking individuals. This means that living with someone who smokes, like spouses or children of smokers, also face risk.
  • Older individuals face more risks than the younger. Though it starts at any age, emphysema symptoms tend to strike at ages 40 to 60.
  • Occupational exposure to fumes and dust, which irritates the lungs, is also a risk factor. Those working in industries involving wood, grain, cotton, and mining are at risk of having emphysema.
  • Living in regions with high levels of indoor and outdoor pollution. Sources of indoor pollution include fumes from heating fuel, mold, household cleaning products and fine dust. Outdoor pollution is caused by smog, car exhaust and particulates suspended in the air.

Emphysema can cause serious complications if not treated. It can increase pressure in the arteries, causing the heart to enlarge and weaken, leading to cor pulmonale.

Untreated emphysema causes the lungs to develop large empty spaces (called bullae) that further reduce lung capacity. Large sections of bullae are not flexible therefore can cause the lung to collapse (pneumothorax), which is a very serious condition that can cause death.

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