Emphysema, a type of chronic obstructive pulmonary disease (COPD), is a progressive chronic lung disease caused by damage to the alveoli . These are small air sacs in the lungs where oxygen and carbon dioxide are exchanged. As a result, air is trapped, the level of oxygen in the blood decreases ( hypoxemia ), and the level of carbon dioxide in the blood increases ( hypercapnia ). Emphysema is associated with severe disability and loss of up to six years of life.
About three million Americans live with emphysema . COPD is the third leading cause of death in the United States today .
Symptoms of emphysema
Emphysema primarily affects the lungs, but as the disease progresses, it can affect other organs and systems as well, including the heart, muscles, and circulatory system .
Depending on the stage of the disease and other factors, symptoms of emphysema can include:
In addition to respiratory symptoms, emphysema can also lead to exercise intolerance and muscle atrophy . The combination of reduced physical activity and chronic respiratory stress can contribute to the loss of muscle mass, especially the core muscles, a situation that only increases the severity of respiratory symptoms.
Finally, emphysema is characterized by so-called exacerbations of COPD . These are periods when symptoms get worse and require hospitalization. Exacerbations can be triggered by infections or exposure to polluted air, wood smoke, or even perfumes.
People with emphysema are also at increased risk of developing lung cancer . According to a study from Northwestern University Feinberg School of Medicine, COPD increases the risk of lung cancer by approximately 200-500% compared to non-smokers of COPD.
If your COPD symptoms get worse, talk to your doctor about the possibility of lung cancer. Lung cancer is much more curable if it is diagnosed early in the disease.
Smoking is the most common cause of emphysema, accounting for 85-90% of cases. But there are many other causes that can act alone or in combination with smoking to cause emphysema.
While researchers can't be completely sure why some people get COPD and others don't, several risk factors have been identified, including :
Up to 5% of people with COPD have a genetic condition known as alpha-1 antitrypsin deficiency . The condition should be suspected if multiple family members develop emphysema, especially if no one has ever smoked .
A diagnosis of emphysema or another type of COPD is often suspected with a complete history and physical exam, and then confirmed by pulmonary function tests (PFTs).
History of the disease
Several factors can alert the doctor to a possible diagnosis of COPD. These factors include the sensation of shortness of breath in the patient at rest or while exercising and / or in a patient who has a chronic cough with or without sputum production.
A history of severe smoking, especially between 30 and 40 packs of years , or a history of significant exposure to various air pollutants or industrial dust are additional factors that can lead to suspect a COPD diagnosis.
The results of the physical exam for emphysema depend on the severity of the disease. Although the physical examination in the early stages of the disease is usually normal, the following results may appear over time:
- Reduced breath sounds
- Wheezing and crackles at the base of the lungs.
- Distant heart sounds
- Using accessory muscles to breathe in and out through pursed lips (with advanced emphysema)
Pulmonary function tests.
Pulmonary function tests, particularly spirometry , are necessary to confirm the diagnosis of COPD.
Spirometry involves taking a very deep breath and then exhaling as forcefully as possible into a tube connected to the machine. A machine (called a spirometer) measures the amount and speed of air in and out of the lungs.
The two key spirometry measures are FVC (forced vital capacity) and FEV 1 (forced expiratory volume).
- FVC is the amount of air exhaled with effort after taking a deep breath and inhaling as much air as possible.
- FEV 1 is the amount of air exhaled during the first second of the FVC test.
Traditionally, for the diagnosis of COPD, the FEV 1 / FVC ratio is less than 70%. However, some health care providers use the American Thoracic Society (ATS) ratio, especially to diagnose non-smoking youth or adults. The SAR criteria define COPD as an FEV 1 / FVC ratio less than the fifth percentile of a healthy, nonsmoking control group.
Currently, emphysema remains an irreversible disease and treatment aims to slow the progression and complications associated with this disease. Research on treating lung regeneration is ongoing and may help develop new therapies for COPD in the future.
Today, treatment involves a combination of approaches and the course of treatment is largely determined by the stage of the disease :
- Mild: short-acting bronchodilator and annual flu shot.
- Moderate: long-acting bronchodilator and pulmonary rehabilitation
- Severe: addition of inhaled corticosteroids to treat exacerbations.
- Very serious: oxygen therapy and lung surgery if necessary.
Changes in lifestyle
Quitting smoking is critical for people living with the condition and can help slow the progression of the condition. Talk to your doctor about ways to support your efforts.
Regular physical activity is also important as this will help prevent muscle atrophy and, as a result, disease progression. But there's no question that emphysema itself can make exercise difficult.
The best exercises for COPD involve a combination of resistance, flexibility, and strength training. Your doctor can help you determine which regimen is best for you.
There are no medications that have been shown to be effective in slowing the decline in lung function in emphysema. Instead, medications are used to help increase exercise tolerance, reduce COPD flare-ups, and improve overall health.
Medications used for stable COPD include :
It can be given continuously, during activity, or to relieve sudden bouts of shortness of breath. Long-term oxygen therapy lasting more than 15 hours a day is prescribed when a patient has low oxygen saturation during progressive COPD (stage IV) .
The benefits of pulmonary rehabilitation are many, an interdisciplinary program that should last at least six weeks. Pulmonary therapy can make a big difference in people living with emphysema by improving exercise tolerance , reducing symptoms, and reducing hospital admissions and length of hospital stay .
Lung volume reduction surgery to remove severely damaged tissue may be beneficial for some people with severe emphysema, especially those with a predominantly upper lobe disorder. Bullectomy can be performed in patients with giant bladders. Another consideration is lung transplantation .
Get the word of drug information
Emphysema can be frustrating in many ways. You not only need to cope with the physical impact of symptoms and treatments, but also the impact they can have on your mental health and daily life. Unfortunately, many people with COPD do not receive adequate support. If this applies to you, trust your healthcare team, consider seeing a therapist, and join support groups ( the American Lung Association is a good place to start). You are not alone.