Emphysema: How You Get It, and How to Fight It
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Emphysema: How You Get It, and How to Fight It

The Surgeon General is right. Cigarette smoking is hazardous—even lethal—to your health.

Affecting an estimated two million Americans, emphysema is a chronic respiratory condition, nearly always caused by the destruction of lung tissue by toxins contained in cigarette smoke. This in turn leads to chronic overinflation of the lungs, greatly decreasing their ability to function.

Like chronic bronchitis, emphysema is a chronic obstructive pulmonary disease (COPD) that evolves over a period of time. Specifically, emphysema destroys the structural architecture of the lungs and results in destruction of the alveoli, the approximately three million tiny air sacs in the lungs. Oxygen is delivered to the lungs and carbon dioxide is carried from the lungs across the walls of the alveoli. As more and more alveoli are damaged, it becomes harder and harder for the lungs to function, causing one or more of the following symptoms:

  • Shortness of breath
  • Increasing difficulty exercising
  • Great difficulty exhaling
  • Chronic coughing
  • Tiredness and fatigue
  • Chest pain
  • Persistent swelling of feet and ankles (this is a sign that your lungs aren't functioning properly)
  • Weight loss
  • The need to sleep on more pillows than usual to breathe at night

As the disease progresses, breathing becomes increasingly difficult. In its most severe stage, virtually any physical activity becomes extremely difficult, if not impossible. (To feel what it's like to have emphysema, try the following: take a very deep breath then, without exhaling, try to continue breathing in and out.)

What Causes Emphysema?

According to Dr. Joseph Zibrack, associate director of pulmonary and critical care medicine at Boston's Beth Israel Deaconess Medical Center, "Like chronic bronchitis, over 90% of all cases of emphysema are caused by long-term smoking of cigarettes or other tobacco products. [In rare cases], emphysema is inherited and results from a deficiency of a protein known as alpha-1 proteinase inhibitor (alpha-1)."

Diagnosis and Treatment

When a patient complains of the chronic presence of the symptoms of emphysema, a physical exam and various lung capacity tests are done to confirm the diagnosis. Chest x-rays may also be performed, but are only informative for moderate to later stages of emphysema.

Since, at present, emphysema cannot be cured, the goals of treatment are to:

  • Relieve the symptoms of the disease
  • Prevent further loss of lung function

Relieving Symptoms

To relieve symptoms, one or more of the following treatments may be used:

  • Bronchodilator medications, which can be inhaled or taken orally to help relax the lungs' airways. In addition to improving quality of life through relief of symptoms, anticholinergic medications (tiotropium) may possibly reduce the rate of decline in lung function if started fairly early in the course of emphysema. New treatments that can similarly slow the progression of this disease are likely to emerge within the next few years.
  • Antibiotics, to help fight infections that may become more prevalent in a patient with emphysema.
  • Breathing exercises and a physical conditioning program, to help improve lung capacity and general overall physical condition.
  • Anti-inflammatory medications (corticosteroids) may be prescribed in efforts to heal the linings of air passageways.
  • Oxygen therapy, in the form of supplemental oxygen, may be used for patients with severely impaired lung function.
  • Administration of alpha 1-proteinase inhibitor (also called alpha 1 antitrypsin (AAT)), in those extremely rare cases where emphysema is caused by an inherited deficiency.

In recent years, three types of surgery have been performed to treat patients with severe COPD, emphysema, and chronic bronchitis. These include:

  • Bullectomy: removal of blebs on the lungs, sometimes performed via laser
  • Lung transplant
  • Lung volume reduction surgery, where seriously damaged portions of the lungs are removed, allowing the less diseased and healthy portions to expand and work more efficiently

Surgical treatment of emphysema can be of value in highly selected persons with severe disease but may not be available except in large centers or those participating in research concerning these surgical procedures. Lung transplantation is often used when all other treatments fail. Lung reduction surgery may delay the need for lung transplantation and can significantly improve quality of life in some individuals.

Stop Smoking

The treatments noted above can only help limit and relieve the symptoms of emphysema. To slow its progression, the agent causing emphysema must be removed. And since long-term smoking of cigarettes or other tobacco products causes the overwhelming number of cases of emphysema, the only effective way to slow the progression of emphysema is to quit smoking.

Prevention

To prevent the onset (or worsening) of emphysema, you should take the following steps:

  • If you smoke, quit. Or seek assistance to help you quit. Insurance plans will pay for most smoking cessation programs.
  • Avoid workplace and environmental pollutants.
  • Take measures to avoid colds and the flu (including a yearly flu vaccination).
  • Seek treatment at the earliest sign of any pulmonary (lung) infection or if you have trouble breathing.
  • Drink plenty of liquids.
  • Exercise regularly and eat a healthful diet to help strengthen your immune system.
  • Avoid extremes of temperature and altitude.

As noted, emphysema does not suddenly occur. It develops over a long period of time. Unfortunately, many sufferers ignore their condition until it becomes serious, at which point treatment options are less effective. Therefore, at the first sign of any of the symptoms listed above, it is imperative that you consult your doctor.

RESOURCES:

American Lung Association
1-800-LUNG-USA
http://www.lungusa.org

Inherited Emphysema
National Jewish Medical and Research Center
http://www.nationaljewish.org

UCLA ATRA Emphysema Trial
http://www.med.ucla.edu/EduMatrls/atra.htm

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/

Lung Association
http://www.lung.ca/

References:

Tutic M, Lardinois D, Imfeld S, Korom S, Boehler A, Speich R, et al. Lung-volume reduction surgery as an alternative or bridging procedure to lung transplantation. Ann Thorac Surg. 2006 Jul;82(1):208-13.



Last reviewed July 2008 by Jill Landis, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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