Emphysema: Causes, treatment, types, and diagnosis

Emphysema is a form of chronic pulmonary obstructive disease. In the lungs the air sacs get weakened and stretched out. That results in persistent cough and breathing difficulties.

Smoking is the most common cause but it may be hereditary as well as emphysema. There is no cure, but stopping smoking can stop emphysema from worsening.

In the United States ( U.S.) 3.5 million people were diagnosed with emphysema in 2016, or 1.5 per cent of the population. The number of emphysema-related deaths was 7,455, or 2,3 of every 100,000.

Important facts about emphysema

Below are some of the key points about emphysema. The body of this article contains more detail.

  • Most cases of emphysema are due to cigarette smoking.
  • Shortness of breath and cough are the main symptoms of emphysema.
  • Doctors diagnose COPD and emphysema with lung function tests that measure lung capacity.
  • Treatment includes medications, the use of an inhaler, respiratory assistance and possibly surgery.
  • Treatment does not halt or reverse lung damage, but it can ease symptoms and prevent attacks.
  • Vaccinations can help prevent additional diseases that could become dangerous alongside emphysema.

What is emphysema?

A man smoking
Smoking is one of the key triggers of emphysema in those who are genetically predisposed to the condition.

Emphysema is one form of chronic pulmonary obstructive disease ( COPD). This involves the loss of elasticity and the air sacs in the lung being expanded.

If their walls break down or the air sacs are broken, compressed, split, extended, or over-inflated, the alveoli at the end of the lung bronchioles are enlarged.

Having fewer and larger damaged sacs indicates there is a lowered surface area for the exchange of oxygen into the blood and carbon dioxide out of it.

The resulting damage is permanent. Can’t fully regain the ability to breathe properly.

Symptoms

Two of emphysema ‘s main signs are shortness of breath, and chronic cough. These show up in the early stages.

An adult with shortness of breath, or dyspnea, feels unable to catch a breath.

It can only occur during physical exertion, but it can also begin to happen at rest as the disease progresses.

Emphysema and COPD develop over a period of several years.

The person in the later stages may have:

A lady having chronic cough
A chronic cough is one of the early signs of emphysema, alongside shortness of breath.
  • frequent lung infections
  • a lot of mucus
  • wheezing
  • reduced appetite and weight loss
  • fatigue
  • blue-tinged lips or fingernail beds, or cyanosis, due to a lack of oxygen
  • anxiety and depression
  • sleep problems
  • morning headaches due to a lack of oxygen, when breathing at night is difficult

Other conditions share many of the symptoms of emphysema and COPD so finding medical advice is necessary.

Treatment

Treatment of COPD and emphysema helps to control the condition by using medication and supportive therapy and to prevent complications.

Supporting treatment includes oxygen therapy and smoking reduction assistance.

Drug therapies

Bronchodilators are the primary type of medication used by COPD and emphysema to alleviate symptoms.

They aid by calming the air openings in the lungs and opening them.

Bronchodilators supplied with the inhalers include:

  • Beta-agonists, which relax bronchial smooth muscle and increase mucociliary clearance
  • Anticholinergics, or antimuscarinics, which relax bronchial smooth muscle.

These medications are equally successful when used regularly for improving lung function and enhancing exercise ability.

There are, and these can be mixed, short-acting and long-acting medications.

The choice depends on the causes, desires and symptoms of each.

Types include albuterol, indacaterol, formoterol, and salmeterol.

Corticosteroid drugs, including fluticasone, may also be of benefit. The chemicals are inhaled in a mist of aerosols. They can help relieve symptoms of asthma and bronchitis related emphysema.

Corticosteroids may benefit people with poorly managed symptoms who suffer aggravations frequently while using a bronchodilator.

For patients who continue to smoke, corticosteroids do not alter the course of the disease but in some patients they can reduce symptoms and enhance short-term lung function.

These can be used with bronchodilators to reduce attack rates.

There is also a long-term chance of side effects including osteoporosis and cataract formation.

Oxygen therapy

Oxygen therapy can greatly improve the quality of life for those with emphysema.
Oxygen therapy can greatly improve the quality of life for those with emphysema.

When emphysema progresses, and the respiratory function decreases, it becomes more difficult to breathe independently.

Oxygen therapy enhances the absorption of oxygen into the lungs. Oxygen can be supplemented through the use of a range of devices, some for home use.

Options include electrically powered oxygen concentrators, liquid oxygen systems, or compressed gas cylinders, depending on needs and how long the person is spending outside or at home.

Oxygen therapy may be given 24 hours a day, or 12 hours at night.

For people with advanced COPD and emphysema, it prolongs their lives.

To avoid oxygen toxicity, the patients should be checked for oxygen saturation.

Due to the lower air pressure in the cabin flight, air travel can create a need for additional oxygen.

Surgery

People with serious emphysema often undergo surgery to minimize volume of the lung or perform a lung transplant.

Lung volume reduction surgery removes small wedges of lung tissue which is weakened, emphysematous.

It is expected to increase the lung recoil and the diaphragm’s work. It will enhance the lung function, stress tolerance and quality of life in extreme cases.

Lung transplantation increases quality of life for people with serious emphysema but not life-expectancy.

Lifelong drug therapy is necessary to prevent a rejection of the new tissue by the immune system. Can transplant one or both lungs.

Treatment of exacerbations

Drug and oxygen treatment will help treat complications. In cases of bacterial infection antibiotics can help.

Most exacerbations, such as prednisone and oxygen therapy, are treated with corticosteroid drugs.

Opioid medications can alleviate extreme coughing, and opioid drugs can help relieve pain.

In 2014, scientists at Galveston’s University of Texas Medical Branch managed in growing human lungs using stem cells. It could bring hope for humans with emphysema and other lung disorders in the future.

Pulmonary rehabilitation and lifestyle management

Pulmonary rehabilitation is a treatment program for emphysema patients.

It’s aimed at helping people change their lifestyle by avoiding smoking, eating a balanced diet and having some exercise.

Drinking plenty of water will help remove the mucus and keep the airways clear.

Avoiding cold air during winter will avoid muscle spasms. A blanket around the mouth or a face mask with cold air may be of benefit.

Such improvements do not alter the overall course of the disease, but they may benefit people living with the illness, and enhance the opportunity and quality of life to exercise.

Exercises that can help improve breathing include diaphragmatic breathing, breathing with a purse-lip and deep breathing.

Causes

At least 85 percent of cases of emphysema and COPD are responsible for cigarette smoking.

This will not be developed by all smokers, however, only by those who are genetically sensitive.

Other toxins inhaled that can contribute to emphysema and COPD include those related to the work. For certain countries the main cause is smoke from indoor cooking and heating.

Other contributory risk factors are:

  • low body weight
  • air pollution
  • occupational dust, such as mineral dust or cotton dust
  • inhaled chemicals, including coal, grains, isocyanates, cadmium
  • childhood respiratory disorders, either a viral infection, or possibly asthma

Exposed to passive smoke from cigarettes is regarded as a minor contributor.

Several people have a protein deficiency, α1-antitrypsin. This is a genetic factor which may result in a rare type of emphysema.

α1-antitrypsin protects the lungs from neutrophil elastase degradation of alveolar tissue.

This is congenital disorder. People are born with it. Such individuals may develop emphysema at a fairly young age, without ever smoking.

Nevertheless, smoking does accelerate emphysema in genetically prone individuals.

Emphysema is not infectious. One person can’t catch that from another person.

Types

Emphysema is a type of chronic obstructive pulmonary disease ( COPD), and depending on which part of the lungs is affected, it can be classified into different types.

The different types are:

  • paraseptal
  • centrilobular, affecting mainly the upper lobes; this is most common in smokers
  • panlobular, affecting both paraseptal and centrilobular areas

Stages

The Global Initiative for Chronic Obstructive Lung Disease ( GOLD) has identified the stages of emphysema.

The phases are based in 1 second (FEV1) on forced expiratory volume.

  • Very mild or Stage 1: FEV1 is about 80 percent of normal
  • Moderate or Stage 2: FEV1 is between 50 and 80 percent of normal
  • Severe or Stage 3: FEV1 is between 30 and 50 percent of normal
  • Very severe or Stage 4: FEV1 is lower than in Stage 3, or the same as Stage 3 but with low blood oxygen levels

The stages help explain the condition, but they are unable to determine how long a person will actually survive. Doctors may do assessments to learn more about the severity of a person’s condition.

Diagnosis

A physician will conduct a physical exam and will inform the patient about their symptoms and medical history.

Several medical tests can also be used to indicate that instead of asthma and heart failure, the patient has emphysema.

If the patient has never smoked, a test can be performed to see whether the person has a deficiency in α1-antitrypsin.

Lung function tests

Lung function tests are used to confirm emphysema diagnosis, track progression of the disease, and determine treatment response.

They measure the lung’s ability to exchange respiratory gases and include spirometry.

Spirometry assesses resistance to the airflow. After treatment with bronchodilator, it takes measurements according to reduction in forced expiratory volume.

Patients blow into a tube as rapidly and strongly as possible in this test. The tube is mounted on a system that measures the pressure and velocity of the blown out air.

Forced expiratory volume is abbreviated to FEV in one second.

FEV specifies the four stages of COPD, from moderate to extreme.

Other tests

Other tests used by the doctors during the COPD and emphysema treatment process include:

  • imaging, such as a chest X-ray or CT scan of the lungs
  • arterial blood gas analysis to assess oxygen exchange

Prevention

The only way to prevent emphysema or stop it from getting worse is to avoid or quit smoking.

Vaccination

Vaccination can help prevent aggravating COPD and emphysema.

An annual flu vaccination is required, and a 5-year pneumonia vaccination vaccine may be recommended.

Nutrition

Reduced lung capacity puts higher demand for energy on everyday activities, so people with emphysema may be at risk of weight loss and nutritional deficiency.

Many people with emphysema are overweight or obese and are advised to lose weight because these conditions may lead to more ill health.

It is important to have a balanced diet with plenty of fresh fruits , vegetables and wholegrains and a low fat and sugar intake.

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