While most COPDs, like asthma and chronic bronchitis, involve irritation and inflammation of bronchial tubes, emphysema damages the alveoli and capillary beds where gas exchange occurs. Alveoli are miniscule air sacs connected to blood vessels (capillaries) so tiny that blood cells can only pass through in single file. Here, oxygen enters the bloodstream and carbon dioxide is removed.
Emphysema damages the walls of the alveoli, causing large, irregular pockets where gas cannot be exchanged efficiently. Eventually, the alveoli sacs become stuck open or collapse and the capillary beds die.
In addition, elastic fibers that control the opening to the alveoli are destroyed, collapsing the duct, and preventing air from the leaving the alveoli. Eventually the lung tissue stiffens from loss of this elasticity, which allows for inhaling, but makes exhaling difficult. Extra air is retained in the lungs, causing more damage.
People with emphysema are often oxygen hungry, hypoxic (low on oxygen), and cyanotic (bluish skin), especially in the lips and fingertips. Normal breathing does not supply enough air for oxygen exchange and victims utilize ‘accessory muscles,’ muscles in the neck, shoulders, and abdomen to assist with breathing.
A progressive disease, emphysema begins with mild symptoms which increase overtime. Tragically, usually a third or more of lung volume has been destroyed before the disease can be diagnosed and properly treated. Common symptoms include shortness of breath, wheezing, chest tightness, reduced capacity for physical activity, chronic coughing, loss of appetite and weight, and fatigue.
As the disease progresses, excessive amounts of energy are required for breathing, leading to malnutrition and excessive weight loss. In addition, the extra air in the lungs pushes on front and back of the chest wall outward into an identifiable ‘barrel shape.’
The accessory muscles become enlarged from constant use and the ends of fingers become ‘clubbed,’ meaning bulbous or rounded. Diminished breath sounds and clubbed fingers are also signs of advanced emphysema. In addition, victims tend to exhale through pursed lips in an involuntary effort to maintain air pressure in the lungs, which causes a noticeable puffing sound.
Constant hypoxia causes polycythemia, a major increase in red blood cells, causing the blood to thicken and the skin to retain a pink color, rather than a pale or bluish color. These malnourished, barrel-chested, pink-skinned, respiratory patients, who exhale through pursed lips, have been labeled ‘pink puffers.’
Emphysema is incurable. Patient’s gradually, or rapidly, depending upon circumstances worsen until they die. Complications are many, especially as emphysema is usually accompanied by other serious health problems, including chronic respiratory infections, high blood pressure, pneumonia, and congestive heart failure.
Medical treatment of emphysema includes supplemental oxygen, bronchodilators, corticosteroids, antihistamines, and decongestants. Exacerbations or flare-ups often require hospitalization. Preventive treatment involves limiting stress, irritants, and excessive exercise. Strict adherence to prescribed medications, eating healthy, and utilizing support groups are also important in keeping exacerbations to a minimum.
However, the most important step to managing emphysema or any respiratory disease is to quit smoking cigarettes. Sadly, many COPD sufferers continue to smoke after being diagnosed; a habit that worsens their condition, and drastically shortens their lives.