Emphysema

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Definition

Emphysema is a long-term disease of the lungs. It is a problem with the tiny air sacs that make up the lungs. These tiny elastic sacs should stretch to fill with air and then get smaller as air moves out of the lungs. Emphysema is caused by the destruction of these air sacs. This makes it difficult to move air in and out of the lungs.
Emphysema is a type of chronic obstructive pulmonary disease (COPD).
Normal Lung vs Emphysemic Lung
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Causes

Emphysema is caused by damage to the air sacs of the lung. This damage may be caused by:
  • Smoking
  • Inhaling toxins or other irritants
  • Alpha1-antitrypsin deficiency (A1AD)—a genetic defect which can cause emphysema at an early age

Risk Factors

Emphysema is more common in people over 40 years old. Other factors that may increase your risk of emphysema include:
  • Smoking
  • Long-term secondhand or passive smoke exposure
  • Family members with emphysema
  • Exposure to pollutants at work
  • History of frequent childhood lung infections

Symptoms

Early symptoms include:
  • Coughing
  • Increased sputum production (mucus from deep in the lungs)
  • Wheezing
  • Shortness of breath with activity
As the disease progresses, you may have:
  • Increased shortness of breath.
  • Rapid breathing.
  • Choking sensation when lying flat. You may need to prop up with pillows or sleep in a chair.
  • Fatigue.
  • Trouble concentrating.
  • Barrel chest, which is an increase in chest size.
  • Increased risk of serious lung infections.
  • Heart problems.
  • Coughing up thick and/or bloody mucus.
  • Weight loss.
  • Breathing through pursed lips.
  • Desire to lean forward to improve breathing.
  • More frequent flare-ups, which are periods of more severe symptoms.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.
Your doctor will need to test how impaired your lungs may be. This may be done with:
  • Lung function tests, called spirometry—to test the force of your breath
  • Arterial blood gas test—to test oxygen and carbon dioxide levels in the blood
Your doctor may also need detailed pictures of your lungs. This may be done with:

Treatment

There is no cure for emphysema. Treatment is focused on managing symptoms and improving your quality of life. .
Treatment options may include one or more of the following:

Smoking Cessation

Quitting smoking slows the disease. It the most important part of treatment. There are many programs to help you quit including:
  • Behavior change program
  • Medication
  • Combination of behavior program and medication

Environmental Management

Limit the number of irritants in the air you breathe. It may help make breathing easier. Avoid smoke, dust, smog, extreme heat or cold, and high altitudes.

Medication

Medication for emphysema may help by:
  • Opening the airways
  • Relaxing the breathing passages
  • Decreasing swelling
  • Treating lung infections with antibiotics
Some medication may be taken as pills or liquids. Others are inhaled medication that is delivered directly to the lungs.

Vaccines

The flu and pneumonia can make your symptoms worse. Get vaccinated against pneumonia and the flu. The flu vaccine may also reduce flare-ups.

Oxygen

Oxygen therapy may be helpful if the oxygen levels in your blood are too low. It can relieve trouble breathing and improve energy. You may only need it for specific activities or it may be given throughout the day.

Exercise

Special exercises can strengthen chest muscles. This can make it easier to breathe.
Regular physical activity can reduce the workload on your lungs by building you endurance. Physical activity is also associated with improved quality of life. Follow your doctor's recommendations for activity levels and restrictions.

Breathing and Coughing Techniques

Special methods of breathing can help bring more air into the lungs. They can also help force trapped air out of the lungs. Effective coughing techniques can also help clear mucus from your lungs. Ask your doctor if these techniques can help you. Some examples include:
  • Pursed lip breathing
  • Controlled coughing technique

Nutrition

Eating habits to consider with emphysema:
  • Eat a healthy diet. It should be low in saturated fat. It should also be rich in fruits, vegetables, and whole grain foods.
  • Maintain a normal weight. Excess weight causes the lungs and heart to work harder.
  • It may be hard to eat because you feel full. Try eating several smaller meals during the day instead of a few large meals.
  • Slow down your eating pace. This will make it easier to breathe.
  • If you need to gain weight, add food or drinks throughout the day. Talk to a dietitian about how many calories you need each day.

Lifestyle Changes

The following may help you manage emphysema symptoms:
  • Pace your activities.
  • Learn relaxation techniques and other methods to manage stress.
  • Seek emotional support from professionals, family, and friends. Anxiety can increase your breathing rate.

Surgery

A small number of people may benefit from surgery. Surgery options include removing a part of the lung or a lung transplant.

Prevention

To reduce your chance of getting emphysema, take these steps:
  • If you smoke, quit
  • Avoid exposure to secondhand smoke
  • Avoid exposure to air pollution or irritants
  • Wear protective gear if exposed to irritants or toxins at work

RESOURCES

American College of Chest Physicians http://www.chestnet.org

American Lung Association http://www.lung.org

CANADIAN RESOURCES

The Canadian Lung Association http://www.lung.ca

Health Canada http://www.hc-sc.gc.ca

References

Chhabra SK, Gupta RK, Singh T. Cutis laxa and pulmonary emphysema. Indian J Chest Dis Allied Sci. 2001;43(4):235-237.

COPD. American Lung Association website. Available at: http://www.lung.org/lung-disease/copd/. Accessed March 29, 2013.

COPD. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated March 5 ,2013. Accessed March 29 ,2013.

COPD and asthma. National Lung Health Education Program website. Available at: http://www.nlhep.org/Pages/COPD-and-Asthma.aspx. Accessed March 29, 2013.

Emphysema. American Lung Association website. Available at: http://www.lung.org/lung-disease/emphysema/. Accessed March 29, 2013.

Explore COPD. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd%5FWhatIs.html. Updated June 8, 2012. Accessed March 29, 2013.

Petrache I, Diab K, Knox KS, et al. HIV associated pulmonary emphysema: a review of the literature and inquiry into its mechanism. Thorax. 2008;63(5):463-469. Review.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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