Emphysema is a type of Chronic Obstructive Pulmonary Disease (COPD). Also in the category of COPD is chronic bronchitis, but this article will focus on the causes and manifestations of emphysema, as well as a few points on how to manage and treat this debilitating disease.
Emphysema is caused by long term damage to the air sacs in your lungs, known as alveoli. In a healthy person these air sacs expand and contract as you breathe, allowing air to enter the lungs and get blown back out again once the oxygen is taken up by the blood. In a person with emphysema, these alveoli are damaged and loose the ability to contract back when you exhale. Doctors call this a loss of elasticity. The end result is a permanent expansion (dilation) of the air sacs and trapping of the air within the lungs. It becomes very hard for a person to exhale even simple breathing at rest becomes difficult.
There are two major types of emphysema, with the most common type, centriacinar emphysema, causing over 90% of cases. Smoking is by far the overwhelming cause of centriacinar emphysema. The less common type is known as panacinar emphysema and is caused by a defect in an enzyme known as alpha-1 antitrypsin. People with this defect are born with it. The clinical manifestations of both types are very similar and for the rest of this article, I’ll make no further distinction between the two.
Smokers are at greatest risk for developing emphysema. People with emphysema will typically have a chronic cough, which may produce a nasty, phlegm-like sputum. There is often a wheeze on breathing and being short of breath is not uncommon, especially in the later stages of the disease. Emphysema makes a person more susceptible to colds and other infections, due to the damage the lining of the lungs.
Weight loss is common with emphysema. A chest x-ray will show hyperinflation of the lungs. The air trapped in the lungs small air sacs causes the lungs to expand and remain inflated, making the lungs look large on an x-ray. When the disease progresses, the person may even develop what is known as a “barrel chest”, where the chest wall itself expands out due to the large amount of air trapped in the lungs.
The best tests to determine if a person is suffering from emphysema are called lung function tests, or spirometry. A person suffering from emphysema will not be able to blow air out as rapidly as a healthy person. This factor is known as FEV1, which is the amount of air you are able to blow out in one second. It is lowered in emphysema. In later stages of the disease, the total amount of air able to be expelled in a single breath is also reduced. This is known as Forced Vital Capacity (FCV).
Treating emphysema involves several methods. The first and foremost step in treatment is to STOP SMOKING! It is never too late to quit. Although much of the damage done by smoking is not reversible, you can slow the rate of new damage by eliminating the toxins you inhale with cigarette smoke.
Medications used to treat emphysema include beta agonists and corticosteroids. Beta agonists are known also as bronchodilators and serve to open up the airways and allow the trapped air to flow properly. Albuterol is an example of a bronchodilator. These medications are inhaled directly in to the lungs with an inhaler.
Corticosteroids are also used to treat emphysema. Prednisolone is often tried, although there is not much evidence that it is effective over the long term.
Also used commonly is home oxygen therapy. Tanks of oxygen are supplied to the patient, who should use the high concentration of oxygen at least 15 hours per day. Significant improvement in survival and quality of life are seen in people who use oxygen regularly, making it one of the best treatments for emphysema.
Emphysema is a horrible disease that is easily preventable in most cases. The best way to reduce your risk of getting this is simply to not smoke. If you do smoke, it’s one more reason to try and quit. Talk to your doctor if you have questions about emphysema or smoking cessation.