Chronic pulmonary disease that develops due to gradual destruction of alveoli (air sacs) of lungs resulting in shortness of breath is termed as emphysema. Among chronic obstructive pulmonary diseases (COPD) emphysema is considered highly dangerous. As the disease progresses structural changes occur in lungs. Air sacs get clustered resulting in large pockets. As a result, surface area of the lungs decreases reducing the amount of oxygen supplied to the body via bloodstream. In few cases thin elastic fibers that
Increased exposure to toxic irritants such as tobacco and marijuana smoke, fumes from factories, coal and silica dust and air pollutants often cause for emphysema. People who smoke more and those in the age group of 40-60 years are highly susceptible to this disease. Rarely, deficiency of protein Alpha-1-antitrypsin that plays role in maintaining the elastic nature of lungs also results in this pulmonary disease.
Stages of Emphysema
Emphysema is staged in to four stages. This staging termed as GOLD emphysema staging is done considering FEV1- forced expiratory volume (amount of air that a patient can forcefully exhale in one second).
- Stage 1: FEV1 is more than or equal to 80% of normal value.
- Stage 2: FEV1 between 80% and 50%.
- Stage 3: FEV1 between 30% and 50%.
- Stage 4: FEV1 less than 30%. In some cases, it may be between 50% and 30% but the blood oxygen levels will be low. This is considered as severe stage.
Patients suffering with emphysema do not show any signs or symptoms for a long time. Emphysema symptoms develop gradually as the lung damage increases. Symptoms also vary between patients at same stage of emphysema.
- Shortness of breath: This is the major sign of emphysema. In the initial days patients avoid activities that make them feel breathless as a result everything goes fine. It becomes problematic only when the daily activities get interrupted.
- Pursed lip breathing: due to trouble exhaling air out of lungs patients often purse their lips. As a result pressure on the airways increases causing them to open and empty the trapped air.
- Barrel shaped chest: Due to blocking of air inside the lungs chest gets deformed in to a barrel shape. Distance from side to side that is normally greater than chest to back will become less.
- Tightness and pain in the chest region especially if there are any associated heart problems.
Often wheezing and cough are mistaken as signs of asthma and pain the chest region as heart disease.
Emphysema symptoms in advanced cases
- Loss of weight and muscle wasting.img alt="emphysema" src="/sites/default/files/symptoms/emphysema%20symptoms.jpg" style="width: 330px; height: 310px; margin-left: 4px; margin-right: 4px; float: right;" />
- Poor appetite.
- Lowered sexual activity.
Emphysema symptoms often get worse with respiratory illnesses such as cold and bronchitis. It is very important to seek immediate medical advice if symptoms such as shortness of breath while talking or performing daily activities, blue or gray colored nails and rapid heartbeat are observed.
Severe emphysema often results in life threatening complications:
- Collapsed lung (pneumothorax) : Failure of a lung to function makes the condition even worse in people with emphysema.
- Cardiac problems: Increased pressure on the arteries connecting heart and lungs causes a portion of heart to expand. This in turn weakens that specific portion of heart.
- Large holes in lungs (Giant bullae): rarely large holes form in the lungs reducing the lung space to expand and hold the air. The holes may also get infected increasing the risk for pneumothorax.
There is no treatment to reverse the damage caused due to emphysema. However, treatment relieves emphysema symptoms and prevents further damage. Patients can continue to survive for about four years. However, those with severe emphysema may be alive for only a year.
To start an appropriate therapy physician first confirms the disease by conduction different tests. Imaging tests such as CT scan and X-ray of the chest region are done to know the extent of damage and to rule out other diseases with similar symptoms. Blood test named arterial blood gas is performed to know the extent of oxygen and carbon dioxide present in the blood. Lung function tests are done to know the efficiency of lungs in holding the air and the amount of air entering the lungs.
Medications: Bronchodilators, corticosteroids, antibiotics and drugs to quit habits such as smoking are prescribed for emphysema patients depending on requirement.
- Bronchodilators dilate the narrowed airways and relieve emphysema symptoms shortness of breath and cough. However, they do not work as effective as they work for bronchitis and asthma. Short acting bronchodilators such as albuterol are used to relieve symptoms when there is a flare up. Long acting bronchodilators are used to keep the symptoms under control.
- Corticosteroids: Inhalation of corticosteroids also helps to relieve shortness of breath. But, long term usage weakens bones and increases the risk for diseases such as diabetes, high blood pressure and development of cataract. Inhaled steroids like Advair and oral corticosteroids like prednisone are prescribed for emphysema patients. Corticosteroids may also be given intravenously in case of complications.
- Antibiotics are used if emphysema is associated with bacterial infections such as pneumonia or bronchitis.
- People who cannot resist themselves from smoking are prescribed drugs such as varenicline and bupropion hydrochloride to help them stay away from smoking.
- Pulmonary rehabilitation: To alleviate emphysema symptoms breathing exercises and comfortable breathing techniques are taught to help the patient cope up with the problem and continue regular activities normally. Nutritious diet is also suggested depending on the severity of the disease. In the initial days of disease, patient should lose weight while they should gain weight at later stages.
- Oxygen therapy: If the blood oxygen levels are very low oxygen is used to obtain relief. Oxygen is passed through a narrow tube that fits easily into the nostrils.
Surgery: If the disease is worse and medications or therapies fail to offer relief the surgery is performed to increase the lung efficiency. Two types of surgery are performed depending on the damage.
- Lung transplantation: If the damage is worse, then lung is transplanted.
- Reduction of lung volume: In this type of surgery abscessed portion of lung is removed to allow healthy portion of lung to function efficiently and relieve trouble breathing. However, this will be useful only if upper lobes of the lungs are affected.
Simple lifestyle changes to arrest further lung damage
- Avoiding contact with substances or fumes that can irritate respiratory system.
- Practice of regular exercises to improve lung capacity.
- Staying warm. Though cold air causes temporary trouble breathing, it can also result in spasms of muscles of bronchial passages.
- Staying protected from respiratory infections by taking required vaccines. Pneumococcal vaccine should be taken once in five years and flu vaccine should be taken every year.
- Taking diet rich in antioxidants and amino acid cysteine. Antioxidants and cysteine help to remove free radicals and prevent toxic effects of pollutants and irritants.
- Avoiding mucous forming foods such as dairy products, processed foods, eggs and red meat.
- Stay away from gas forming foods as bloating makes breathing even more difficult.
- Quit smoking.
Measures to prevent emphysema
As respiratory irritants are the major culprits for development of emphysema staying away from them prevents you from contracting the disease:
- Avoid smoking.
- Stay away from second hand smoke and industrial smoke.
- Covering nose and mouth to prevent entry of air pollutants.