Emphysema

What is emphysema?

Emphysema is a chronic (long-lasting) disease that gradually destroys the lungs. The damage makes it hard to breathe. You have trouble breathing out carbon dioxide, and eventually you become unable to breathe in enough oxygen.

How does it occur?

Cigarette smoking is the main cause of emphysema. The smoke damages the cells in your lungs. As the air sacs (alveoli) in your lungs become damaged, it gets harder for you to breathe out carbon dioxide after you breathe in. This means more carbon dioxide stays in your lungs and you have less room for oxygen when you breathe in. The damage to the lungs does not go away. Eventually you cannot breathe in enough oxygen to meet the needs of your body. About 15 to 20% (1 in 5 or 6) of smokers develop emphysema.

An inherited disorder (passed down from parents) called alpha-1 antitrypsin deficiency, or AATD, can also cause emphysema. Alpha-1 antitrypsin (AAT), also called alpha-1 proteinase inhibitor, is a substance that is made in the liver. The liver releases AAT into the bloodstream. AAT helps protect the lungs against damage from other chemicals in the blood. If you have AATD, you have too little of this substance and your lungs can be damaged more easily. If you are a smoker AND have this genetic disorder, the lungs become damaged more quickly.

What are the symptoms?

The most common symptom of emphysema is a feeling of shortness of breath. At first this occurs with mild exercise or normal daily activities. After a while, you have trouble breathing all the time, even when you are resting. Another symptom is coughing.

Sometimes the first obvious symptom of emphysema is wheezing, which can also be a symptom of asthma. These two medical problems can be confused with each other.

How is it diagnosed?

Your healthcare provider will ask about your medical history, including your smoking history and family medical history. Your provider will examine your heart and lungs. Then he or she will examine your hands and feet to look for signs that your body is not getting enough oxygen.

Your provider will check for other problems that could cause your symptoms, such as asthma.

Spirometry, a breathing test also called a pulmonary function test, is the most helpful test for emphysema. It checks your ability to breathe out forcefully and quickly.

You may have blood tests and chest X-rays. Early in the disease, you may not have any physical symptoms and lab tests of your blood and X-rays of your chest may be normal. However, once you begin to have symptoms, blood tests may show that you have more red blood cells than normal. (Red blood cells are the cells that carry oxygen in your blood.) Other blood tests may show that too much carbon dioxide is staying in your body. As damage to your lungs gets worse, chest X-rays will usually show changes that suggest emphysema. (In the early stages of emphysema, chest X-rays are normal.)

If you are young or a nonsmoker and have symptoms of emphysema, your healthcare provider will do a blood test to check the level of alpha-1 antitrypsin.

How is it treated?

There is no cure for emphysema, but treatment can help control the disease. The treatment goals for emphysema are to:

• Relieve symptoms and keep you as active as possible, based on your ability and lifestyle.
• Avoid things that make emphysema or its symptoms worse, such as smoking and lung infections.

The most important part of treatment is to stop smoking. Talk to your healthcare provider about ways to stop smoking. You might find it helpful to join a quit-smoking program or to use nicotine patches or gum.

Asthma medicines can make it easier for you to breathe. Ipratropium (Atrovent) is a commonly prescribed asthma inhaler. Other inhaled or oral asthma medicines may also be prescribed.

For times when you are feeling especially bad, other medicines such as antibiotics or steroids may be given for a short time. Steroids are available in forms that may be inhaled or taken by mouth.

At some point it is likely that you will need oxygen therapy. At first you may need oxygen only in some situations, but later you may need continuous oxygen.

Emphysema caused or worsened by AAT deficiency may be treated with medicine that gives you more AAT (AAT replacement therapy). The medicine will not cure the emphysema, but it will help you have more AAT in your body. It may slow down damage to your lungs caused by the lack of AAT.

How long will the effects last?

There is no cure for emphysema. It gradually worsens over many years until the lungs can no longer function.

How can I take care of myself?

• Do not smoke. If you stop smoking before much of your lungs have been damaged, the disease may progress more slowly. Also, if you stop smoking you are less likely to have problems with frequent bronchial infections.
• Follow your healthcare provider's recommended treatment.
• Ask your provider how often you need follow-up appointments.
• If you are able to exercise, get regular exercise according to your healthcare provider's recommendations. Exercise will help keep your heart and other muscles healthy. Do not start an exercise program without your provider's approval.
• Eat healthy foods.
• Eat high-calorie snacks between meals if you are underweight.
• Take vitamin and mineral supplements if recommended by your healthcare provider.
• Do the breathing exercises recommended by your provider. They can help strengthen the muscles used for breathing. You may need a physical therapist to help you learn to do them properly.
• Get plenty of rest and sleep.
• If you think you are getting a cold or the flu, contact your healthcare provider right away. You need prompt treatment for any possible lung infections. Symptoms of emphysema often worsen during an infection.
• To help avoid lung infections, you should have a Pneumovax shot. This is a shot that protects against a common type of pneumonia. You should have no more than 2 shots of the pneumonia vaccine in your lifetime. The shots should be given at least 5 years apart.
• Get a flu shot every October.
• If you live in an area where smog or air pollution is a problem, be sure to ask your provider how you should take care of yourself when the air is bad.
• If you plan to travel, discuss your plans with your healthcare provider. It's good to make sure there will be no problems with high altitude, humidity, temperature, pressurized airplane cabins, or smoggy cities, especially if you are using oxygen.
• Call your healthcare provider if you have:
  • chest pain
  • fever
  • phlegm that thickens or changes in color
  • blood in the phlegm
  • worsening shortness of breath
  • shortness of breath even when you are resting.

How can I prevent emphysema?

The best way to prevent emphysema is never to smoke. If you are a smoker, quit now. The fewer years you smoke, the less likely it is that you will develop emphysema.