Emphysema, Causes, Diagnosis & Treatment

Emphysema Overview

Emphysema is a form of chronic (long-term) lung disease in which the air sacs (alveoli) may be get damaged. The air sacs weaken and eventually break, which reduces the surface area of the lungs and the amount of oxygen that can reach the bloodstream.

This makes it harder to breathe, especially when exercising. Emphysema also causes the lungs to lose their elasticity.

Emphysema is one of the two most common conditions that falls under the umbrella term chronic obstructive pulmonary disease (COPD). The other major COPD condition is chronic bronchitis. Emphysema is an irreversible condition, so treatment aims to slow its progression and minimize symptoms.

Smoking is the most common cause of emphysema, but other factors can also cause it. There is currently no cure, but quitting smoking can help improve the outlook.

Emphysema is a condition that involves damage to the walls of the air sacs (alveoli) of the lung. Alveoli are small, thin-walled, very fragile air sacs located in clusters at the end of the bronchial tubes deep inside the lungs.

There are about 300 million alveoli in normal lungs. As you breathe in air, the alveoli stretch, drawing oxygen in and transporting it to the blood. When you exhale, the alveoli shrink, forcing carbon dioxide out of the body.

When emphysema  develops, the alveoli and lung tissue are destroyed. With this damage, the alveoli cannot support the bronchial tubes. The tubes collapse and cause an “obstruction” (a blockage), which traps air inside the lungs.

Too much air trapped in the lungs can give some patients a barrel-chested appearance. Also, because there are fewer alveoli, less oxygen will be able to move into the bloodstream.

This damage is permanent and irreversible, but there are ways of managing the condition.

In the later stages, an emphysema patient may have the following symptoms:

• Anxiety
• Blue-tinged lips or fingernail beds, or cyanosis, due to a lack of oxygen
• Depression
• Fatigue
• Frequent lung infections and flare-ups
• Headaches in the morning
• Loss of energy
• Problems having sex
• Reduced appetite  
• Sleep problems
• Weight Loss
• Weakness
• Worsening symptoms, including shortness of breath, mucus production, and wheezing

 

Causes of Emphysema

In most cases, emphysema and COPD result from cigarette smoking. In the United States, the most common irritant that causes COPD is cigarette smoke. Pipe, cigar, and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled.

However, 25 percent of patients with COPD never smoked. Long-term exposure to other lung irritants, such as air pollution, chemical fumes, workplace pollutants, biomass fuels or dust may also contribute to COPD.

The main cause of emphysema is long-term exposure to airborne irritants, including:

• Tobacco smoke
• Marijuana smoke
• Air pollution
• Chemical fumes and dust

Other causes appear to be genetic factors, such as an alpha-1 antitrypsin (AAT) deficiency which is a rare genetic condition called  can also cause COPD.

Alpha-1 antitrypsin (AAT) is a natural protein that circulates in human blood. Its main function is to keep white blood cells from damaging normal tissues. The body needs these cells to fight infections.

An estimated 100,000 people in the United States were born with a condition that keeps their bodies from making enough AAT. If you have AAT deficiency, your normal white blood cells will damage the lungs. The harm is even worse if you smoke.

Over time, most people with severe AAT deficiency develop emphysema. Patients who have this disease, may also develop liver problems.

According to a study published in JAMA, patients with airways in proportion to their lung size may be more at risk than those with wider airways,

 

Diagnosis of Emphysema

To diagnose emphysema your doctor will conduct the following tests:

Medical History

Your doctor will talk to you about your health and any recent changes you might have noticed. such as persistent cough that won’t go away. If you have emphysema, you’ll probably have had shortness of breath, often over a period of months or years. You may also experience wheezing.

Physical Exam

During the physical examination your doctor will check your blood pressure and your weight. They’ll listen to your heartbeat and will lookout for that seems unusual and not normal.

If you have advanced emphysema, your doctor may notice that you have any of the following:

• A “barrel chest” caused by larger-than-normal lungs 
• Blue tinged lips (cyanosis), which is a sign of low oxygen in the blood
• Having a hard time getting air out of the lungs 
• High levels of carbon dioxide in the blood (hypercarbia), because emphysema makes it hard to exhale properly.
• Low levels of oxygen in the blood (hypoxemia) 
• Malnutrition causes muscles to slowly waste away in advanced emphysema.
• Pursing your lips when you breathe, like you’re blowing a kiss.
• Rounded fingertips (clubbing)
• Wheezing

Complete Blood Count

This simple blood test usually shows normal amounts of white and red blood cells. In advanced emphysema, your body produces more red blood cells to make up for decreased oxygen. These cells carry oxygen.

If your white blood cell count is higher than normal, that’s a possible sign of infection.

Chest X-ray and CT Scan

If you have advanced emphysema, your lungs will appear to be much larger than they should be. In early stages of the disease, your chest X-ray may look normal. Your doctor can’t diagnose emphysema with an X-ray alone.

A CT scan of your chest will show if the air sacs (alveoli) in your lungs have been destroyed. These make it hard for you to breathe out like normal.

 

Pulmonary Function Tests (PFTs)

PFT is usually performed at the doctors office or a hospital. For this exam, you may sit inside an enclosed booth and breathe into a tube. This will allow your doctor to measure the following:

• How much air your lungs can hold
• Check for how much air stays trapped in the lungs after you exhale
• How fast you can blow air out of your lungs
• If you’re able to breathe better after using medicines you inhale, such as albuterol.

If a person have normal lungs, you’ll likely be able to empty most of the air from them in 1 second. If you have emphysema, it’ll probably take longer.

Treatment of Emphysema

Although emphysema can’t be cured, but there are a number of treatments that relieve symptoms of emphysema by making it easier for a patient to breathe. Treatment can also prevent other problems and keep the disease from getting worse.

Treatment of emphysema can help with the following:

• It slows the progress of the condition
• manage the symptoms
• prevent complications
• boost a person’s overall health and well-being

Supportive therapy includes oxygen therapy and help with quitting smoking.

Drug Therapies

The main medications for emphysema are inhaled bronchodilators, these drugs relieve symptoms by relaxing the muscles in the lungs and making the air passages wider. Bronchodilators often use an inhaler (“puffer”). They also come in pill or liquid form, but these don’t work as well as an inhaler, and they can have more side effects.

There are short-acting and long-acting bronchodilators. The short-acting drugs work faster but don’t last as long. The long-acting ones don’t work as fast, but they last longer.

If your emphysema symptoms are mild, your doctor may recommend you take short-acting bronchodilators during flare ups. As your symptoms get worse, you may have to take daily doses of long-acting bronchodilators.

The inhaler delivers the following bronchodilators:

• Anticholinergics stop the muscles around your airways from tightening. They also make it easier to clear mucus from the lungs. Anticholinergics, or antimuscarinics, such as albuterol (Ventolin), which relax bronchial smooth muscle.
• Beta-agonists, which relax bronchial muscle around the airways and help clear mucus.
• Inhaled steroids, such as fluticasone, which help reduce inflammation.

If a person uses these drugs regularly, these options can improve lung function and increase exercise capacity.

There are short-acting and long-acting drugs, and patients can combine them. Treatment may also change over time and as the condition progresses.

PDE-4 Inhibitors 

Newer oral drugs called phosphodiesterase-4 (PDE-4) inhibitors have also proved to work in treating chronic obstructive pulmonary disease (COPD).

A number of clinical trials showed the PDE-4 drug Roflumilast improved lung function when used with bronchodilator therapy. Some studies found it also led to fewer flare-ups.

The FDA approved Roflumilast for bronchitis, not emphysema, but the two conditions often have similar symptoms.

Steroids

Steroids reduce swelling and mucus in your airways so you can breathe easier. Usually, you breathe them in with an inhaler.

Over time, steroids can have serious side effects, including weight gain, diabetes, cataracts, high blood pressure (hypertension), weakened bones, and increased risk of infection.

Your doctor may recommend you use steroids in combination with beta-agonist or anticholinergic bronchodilators. This provides more benefits than using either drug alone. It’s also easier because you have one inhaler instead of two.

 

Mucolytics

These drugs help thin the mucus in your lungs so you can cough it up easier. Studies show using them can reduce flare-ups, especially if your emphysema is more severe.

 

Protein Therapy

Some patients have an inherited form of emphysema that’s caused by a lack of the protein alpha-1 antitrypsin (AAT). Getting infusions of AAT can help slow down lung damage.

 

Oxygen Therapy

As the emphysema disease progresses, you may need extra oxygen to help you breathe on your own. Your doctor will prescribe how much oxygen you need and when you should be taking it. You can take supplemental oxygen in one of the following three ways:

• Oxygen concentrator. This device removes other gases from the air and gives you near-pure oxygen. (Air normally contains 21% oxygen.)
• Liquid system. This is supercooled, pure oxygen stored in a canister that looks like a thermos.
• Oxygen cylinders. These contain 100% oxygen, stored under high pressure in large or small tank-like containers.

 

Vaccines

The flu vaccine doesn’t treat emphysema directly, but doctors recommend you get one every year. They also suggest you get a pneumonia shot every 5 to 7 years to prevent infection. If you have emphysema, you have higher odds of serious problems from flu and pneumonia.

Surgery

There are a number of different types of surgical procedure for more serious cases of emphysema.

They include the following:

• Lung volume reduction surgery (LVRS): In this surgical procedure, a surgeon removes part of one or both of your lungs. The goal is to take out your nonworking air sacs so it’s easier to breathe. This is major surgery, so your heart has to be strong and the rest of the lungs need to be heathy before you can have it. It is also necessary to quit smoking and complete a pulmonary rehabilitation program before the surgical procedure. 

 

• Bullectomy: In certain rare cases, air sacs in the lungs caused by emphysema grow larger and can press against healthy parts of the lung. These oversized sacs are called bullae. A bullectomy is surgery to remove them.

 

• Lung transplant: Lung transplants are possible for the most severe cases. This is a 6- to 10-hour surgical procedure, after which the patient needs to be in the hospital for 8 to 21 days, if there are no complications. The two biggest risks of this operation are infection and rejection of the transplanted organ.

 

Risk Factors of Emphysema

Factors that increase a persons risk of developing emphysema include the following:

• Age: Although the lung damage that occurs in emphysema develops gradually, most people with tobacco-related emphysema begin to experience symptoms of the disease between the ages of 40 and 60.

 

• Exposure to secondhand smoke: Secondhand smoke, also known as passive or environmental tobacco smoke, is smoke that you inadvertently inhale from someone else’s cigarette, pipe or cigar. Being around secondhand smoke increases the risk of developing emphysema.

 

• Occupational exposure to fumes or dust: If you breathe fumes from certain chemicals or dust from grain, cotton, wood or mining products, you’re more likely to develop emphysema. This risk is even greater if you smoke.

 

• Smoking: Emphysema is most likely to develop in cigarette smokers, but cigar and pipe smokers also are susceptible. The risk for all types of smokers increases with the number of years and amount of tobacco smoked.

 

• Exposure to indoor and outdoor pollution: Breathing indoor pollutants, such as fumes from heating fuel, as well as outdoor pollutants such as car exhaust, increases the risk of emphysema.

 

Complications of Emphysema

Emphysema patients are also more likely to develop the following conditions:

• Collapsed lung (pneumothorax): A collapsed lung can be life-threatening in patients who have severe emphysema, because the function of their lungs is already so compromised. This is uncommon but serious when it occurs.

 

• Heart problems: Emphysema can increase the pressure in the arteries that connect the heart and lungs. This can cause a condition called cor pulmonale, in which a section of the heart expands and weakens.

 

• Large holes in the lungs (bullae): Some emphysema patients develop empty spaces in the lungs called bullae. They can be as large as half the lung. In addition to reducing the amount of space available for the lung to expand, giant bullae can increase your risk of pneumothorax.

 

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