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Emphysema

 

What is emphysema?

Emphysema is a lung disease that results from damage to the walls of the alveoli in your lungs. Alveoli are small, fragile air sacs at the end of your airways in your lungs. As you inhale, the air travels through the bronchial tubes (airways) until it reaches the alveoli. If a blockage occurs in the walls, air may become trapped inside your lungs, causing your chest to appear fuller and causes less oxygen to move into your bloodstream.

Emphysema is included in chronic obstructive pulmonary disease, also known as COPD. Both Emphysema and chronic bronchitis are types of COPD, and many people have them both at the same time.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) categorizes COPD into four stages to help describe emphysema. These stages are:

  • Stage 1 – Mild emphysema. Your lungs operate at least 80% as well as people with healthy lungs of the same age, height and sex.
  • Stage 2 – Moderate emphysema. Your lungs operate between 50% and 79% as well as people with healthy lungs of the same age, height and sex.
  • Stage 3 – Severe emphysema. You lungs operate between 30% and 49% as well as people with healthy lungs of the same age, height and sex.
  • Stage 4 – Very severe emphysema. Your lungs operate less than 30% as well as people with healthy lungs of the same age, height and sex.

What causes emphysema?

Lung damage caused by long-term smoking is the main cause of emphysema. Tobacco smoke irritates the airways and triggers inflammation that narrows the airways. All of these changes can cause shortness of breath. Though smoking is typically the main cause, there can be other factors at play in the development of emphysema, including:

  • Marijuana
  • Vaping and e-cigarettes
  • Cigar smoke
  • Air pollution
  • Dust
  • Chemical fumes

Life expectancy for people living with emphysema will vary depending on your age, stage of emphysema and whether you have ever smoked. It most commonly affects men between the ages of 50 and 70. However, it can also affect women and may be diagnosed as young as 40. Smoking reduces your life expectancy by 3.5 years.

What are symptoms of emphysema?

In many people, symptoms of emphysema do not become apparent until about 50% or more of their lung tissue has already been damaged. Until then, common symptoms include gradual shortness of breath and fatigue. Once symptoms have begun to appear, you may notice any of the following:

  • Long-term coughing.
  • Wheezing.
  • Shortness of breath, especially with exercise or exertion.
  • Constant feeling of not being ablet to get enough air.
  • Tightness in your chest.
  • Increased mucus production with abnormal color and thick consistency.
  • Increased tiredness (fatigue).
  • Heart problems.
  • Trouble sleeping.
  • Anxiety
  • Depression
  • Weight loss

How is emphysema diagnosed?

Emphysema can have similar symptoms as those of asthma, like shortness of breath and blocked airflow. Since emphysema is a type of COPD, your provider can’t diagnose it solely from your symptoms. To diagnose your condition, your provider will perform a physical examination and review your medical history. They will also ask you about any exposure you have had to lung irritants, especially cigarette smoke. During your examination, they will listen to your lungs with a stethoscope pressed against your chest while tapping on your chest to listen for a hollow sound. If they hear a hollow sound, it means your lungs are trapping air and most likely confirms the diagnosis of emphysema.

Additional tests may be needed to confirm your diagnosis, including:

  • Lung function tests – Most commonly called a spirometry test, this test measures the amount of air you can inhale and exhale and whether your lungs deliver enough oxygen to your blood. Other tests include measuring your lung volume and diffusing capacity and pulse oximetry.
  • Chest X-ray – can show emphysema and rule out other lung conditions.
  • CT scan – can help detect emphysema and determine whether you would benefit from a surgery for COPD. A CT scan can also be used to screen for lung cancer.
  • Arterial blood gas analysis – measures how well your lungs bring in oxygen to your blood and remove carbon dioxide.
  • Lab tests – can help to determine the cause of your symptoms and rule out other conditions, such as Alpha-1.

What are treatment options for emphysema?

Although your lungs can’t heal from emphysema, there are treatments that can help reduce your symptoms and improve your quality of life. It is important to treat emphysema as soon as you start experiencing symptoms to allow for the best chance of slowing emphysema down and maximizing the function of your remaining healthy lung. Common treatments include:

  • Quitting smoking – the best way to slow down emphysema is by quitting smoking. You and your provider can work together to find the best methods to help you quit smoking.
  • Bronchodilators – typically come in an inhaler form that helps to relax the muscles around your airways. This can help to relieve coughing and shortness of breath and make breathing easier. 
  • Inhaled corticosteroids – these medications can help to reduce airway inflammation and help prevent exacerbations.
  • Oral steroids – for patients with more frequent, severe cases, oral steroids may prevent further worsening of emphysema. This medication can have potentially serious long-term side effects, so consult with your provider.
  • Oxygen therapy – for people who do not have enough oxygen in their blood, supplemental oxygen may be needed. There are several devices that can deliver oxygen to your lungs, including lightweight devices to always carry with you. Oxygen therapy can be useful in improving quality of life.
  • Lung volume reduction surgery (LVRS) – during this procedure, your provider removes a portion of your diseased lung tissue and joins the remaining tissue together. This help to relieve pressure on your breathing muscles and improve the healthy lung’s ability to stretch. Not all people with emphysema are eligible for this procedure.
  • Bronchoscopic lung volume reduction – during this procedure, your provider places a one-way value into your airways that allows air to leave sections of your lungs, but not enter. This help to decrease the “trapped” air in your lungs, making it easier to breathe. Not all people with emphysema are eligible for this procedure.
  • Lung transplant – in some severe cases, a total lung transplant may be needed to improve your ability to breathe and to be active. This surgery comes with significant risks and will require lifelong medication.

Even with treatment, you may experience times when your symptoms become worse for days or even weeks. If left untreated, these exacerbations can potentially lead to lung failure. If you notice a sustained increase in coughing, a change in mucus or experience a hard time breathing, contact your healthcare provider right away.

If your symptoms are not improving with treatment or getting worse, or if you notice symptoms of an infection, contact your provider right away. Seek immediate medical attention if you cannot catch your breath, experience severe blueness of your lips or fingernail beds, have a rapid heartbeat or have trouble concentrating.

How can I prevent emphysema?

The best way to prevent and reduce your risk of developing emphysema is to quit or avoid smoking. Quitting smoking can be easier said than done. Your provider can recommend a tobacco cessation program that can help you quit for good. Other methods like chewing nicotine gum, wearing a patch and controlling your cravings with mediations are other good ways to aid in quitting smoking.

If you currently have emphysema, the best way to prevent further complications is to quit smoking and avoid respiratory infections. Washing your hands frequently, staying up to date on vaccinations, avoiding irritants and keeping your environment clean are some of the best ways to prevent respiratory infections.