Pulmonary Emphysema

Healthy Bronchiole and Alveoli - Click to Enlarge

What is pulmonary emphysema?

Emphysema is a chronic lung condition in which the alveoli, or air sacs, may be:

• Destroyed

• Narrowed

• Collapsed

• Stretched

• Over-inflated

Over-inflation of the air sacs is a result of a breakdown of the walls of the alveoli. It causes a decrease in respiratory function and breathlessness.

Damage due to Emphysema - Click to Enlarge

Damage to the air sacs is irreversible and results in permanent "holes" in the tissues of the lower lungs.

What are the symptoms of pulmonary emphysema?

The following are the most common symptoms for pulmonary emphysema. However, each individual may experience symptoms differently.

Early symptoms of pulmonary emphysema may include:

• Shortness of breath

• Cough

Other symptoms may include:

• Fatigue

• Anxiety

• Sleep problems

• Heart problems

• Weight loss

• Depression

The symptoms of pulmonary emphysema may resemble other lung conditions or medical problems. Consult your physician for a diagnosis.

What are the causes of pulmonary emphysema?

Emphysema does not develop suddenly, but occurs very gradually. Pulmonary emphysema occurs when there is an obstruction of air flow generally caused by the following:

• Smoking

• Exposure to air pollution (chemical fumes, dust, and other substances)

• Irritating fumes and dusts on the job

• A rare, inherited form of the disease called alpha 1-antitrypsin (AAT) deficiency-related pulmonary emphysema, or early onset pulmonary emphysema

How is pulmonary emphysema diagnosed?

In addition to a complete medical history and physical examination, the physician may request the following:

• Pulmonary function tests. These are diagnostic tests that help to measure the lungs' ability to exchange oxygen and carbon dioxide appropriately. The tests are usually performed with special machines into which the person must breathe, and may include the following:

  • Spirometry. A spirometer is a device used by your physician to assess lung function. Spirometry, the evaluation of lung function with a spirometer, is one of the simplest, most common pulmonary function tests and may be necessary for any/all of the following reasons:

    • To determine how well the lungs receive, hold, and utilize air

    • To monitor a lung disease

    • To monitor the effectiveness of treatment

    • To determine the severity of a lung disease

    • To determine whether the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow)

  • Peak flow monitoring (PFM). A device is used to measure the fastest speed at which a person can blow air out of the lungs. During an asthma or other respiratory flare-up, the large airways in the lungs slowly begin to narrow. This will slow the speed of air leaving the lungs and can be measured by a PFM. This measurement is very important in evaluating how well or how poorly the disease is being controlled.

• Blood tests. To analyze the amount of carbon dioxide and oxygen in the blood.

• Chest x-ray. A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

• Sputum culture. A diagnostic test performed on the material that is coughed up from the lungs and into the mouth. A sputum culture is often performed to determine if an infection is present.

• Electrocardiogram (ECG or EKG). This is a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.

What is the treatment for pulmonary emphysema?

Specific treatment for pulmonary emphysema will be determined by your physician based on:

• Your age, overall health, and medical history

• Extent of the disease

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

The goal of treatment for people with pulmonary emphysema is to live more comfortably with the disease by providing relief of symptoms and preventing progression of the disease with minimal side effects. Treatment may include:

• Quitting smoking, which is the single most important factor for maintaining healthy lungs.

• Antibiotics for bacterial infections.

• Bronchodilators -- either oral or inhaled -- which are the mainstay of treatment.

• Other classes of oral and inhaled medications.

• Vaccinations. Infection can worsen emphysema symptoms, so both the pneumococcal and influenza vaccinations are recommended to prevent infection.

• Exercise, including breathing exercises to strengthen the muscles used in breathing as part of a pulmonary rehabilitation program to condition the rest of the body.

• Oxygen supplementation from portable containers.

• Nutritional support, since patients may experience malnutrition and weight loss.

• Lung reduction surgery to remove the damaged area of the lung.

• Lung transplantation.

What is Chronic Obstructive Pulmonary Disease (COPD)?

COPD is a term that refers to a large group of lung diseases which can interfere with normal breathing. More than 12 million Americans have COPD, and an additional 12 million may have impaired lung function, suggesting it may be significantly under-reported. As many as 24 million people may be affected. The two most common conditions of COPD are chronic bronchitis and emphysema.

The causes of COPD are not fully understood. It is generally agreed that the most important cause of chronic bronchitis and emphysema is cigarette smoking. Causes such as air pollution and occupational exposures may play a role, especially when combined with cigarette smoking. Heredity also plays a contributing role in some patients' emphysema, and is especially important in a rare form due to alpha 1 anti-trypsin deficiency.

Patients with chronic bronchitis usually have a cough and sputum production for many years before they develop shortness of breath.

Patients with emphysema usually have shortness of breath and develop a cough and sputum during a respiratory infection, or in the later stages of the illness.