References

1. Mayo Clinic Online (http://www.mayoclinic.com/health/emphysema/DS00296)

2. National Emphysema Foundation (http://www.emphysemafoundation.org/)

TREATMENT

Once emphysema is diagnosed, the most important next step is getting the smoker to stop. Enrollment in a comprehensive smoking cessation plan is vital, and includes a target quit date, relapse prevention, assessment of social support systems and advice on how to change ones lifestyle. In addition, prescriptions might include nicotine patches or gum, along with drugs like Zyban or Chantix, which may aid in cessation and curb withdrawal symptoms like depression, irritability or difficulty sleeping.

Beyond the smoking cessation, other emphysema treatments that focus on relieving symptoms and complications include:

- Enrollment in a pulmonary rehab program to provide general and nutritional education, breathing and exercise training
- Bronchodilators, which relieve coughing and shortness of breath by opening constricted airways.
- Corticosteroid drugs inhaled via aerosol sprays to relieve symptoms
- Supplemental oxygen to help increase low blood oxygen levels.
- Antibiotics to help relieve complications brought on by respiratory infections
- Inoculations against influenza and pneumonia

A more invasive intervention might be surgery, specifically lung volume reduction surgery. Here, a small wedge of damaged lung tissue is removed, creating extra space in the chest to help the remaining tissue and diaphragm work more effectively.

Severe sufferers may even require a lung transplant.

Diagnosis

Tests performed to determine if someone is suffering from emphysema include

Pulmonary function tests (PFTs) to measure how much air your lungs can hold. These tests also measure the extent of gas exchanged between your alveolar wall and capillary membrane.

Chest X-ray to rule out other possible lung problems.

Arterial blood gas analysis, to measure how well your lungs transfer oxygen and remove CO2 in the bloodstream.

Computerized tomography (CT) scan, which can detect emphysema more reliably and sooner than a chest X-ray.

SIGNS and SYMPTOMS

Symptoms include shortness of breath, fatigue and a reduced capacity for physical activity, which get worse as the disease progresses. Eventually, sufferers have trouble breathing when relaxing, and especially during colds, flu or other respiratory infections.

Oddly, coughing is not common with the disease, but when it does arise, the cough is unproductive. A chronic productive cough may be a sign of bronchitis.

Sufferers of emphysema also experience a loss of appetite and marked weight loss. Because of labored breathing, eating becomes more difficult and can make breathing even more laborious. The expansion of the stomach caused by eating can push on the diaphragm, compressing the lungs even further.

The most common cause is...

The most common cause of emphysema is smoking, whether it be cigarettes, pipe smoke or even drugs like marijuana or crack. Smoke temporarily paralyzes the cilia that line your bronchial tubes, which normally clean germs and irritants out of your airways. With smoking, those irritants remain in your bronchial tubes, inflaming the alveoli and breaking down the elastic fibers.


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Other causes:

A small percentage of sufferers get emphysema due to a protein deficiency, specifically a protein called alpha-1-antitrypsin (AAt), which protects the lung structures from the destructive effects of certain enzymes. If you’re a smoker with an AAt deficiency, onset of emphysema can begin in your 30s.

Other risk factors include age, exposure to secondhand smoke, exposure to chemical fumes, pollution, dust and other lung irritants. HIV infection can also put one at greater risk, especially if the infected is also a smoker.

Pathophysiology

Emphysema causes inflammation in the walls of your alveoli – where CO2 and oxygen in the blood are exchanged – making them lose elasticity.

Eventually, the bronchioles of the lungs collapse, trapping air in the alveoli. They overstretch and interfere with the body’s ability to exhale, eventually rupturing and forming larger pockets of air. This forces the afflicted to breathe even harder in attempt to metabolize CO2.

There are two kinds of breathing: ACTIVE and PASSIVE. Passive breathing is done at rest. Your diaphragm contracts and your chest muscles expand to take air in, and then the elastic tissue around your air sacs contracts and your lungs passively shrink.

With active breathing during physical exertion, you need more oxygen, so your chest muscles contract and force air out rapidly. Emphysema destroys these elastic fibers and you must force air out of your lungs, compressing many of your small airways, making expelling air even more difficult.

EMPHYSEMA is...

a progressive lung disease, caused by damage to the small air sacs (alveoli) and airways in your lungs. This damage reduces and obstructs your airflow during exhalation.

This damage is progressive and irreversible, and may take years or even decades manifest. In its advanced stages, the simple act of breathing can take almost all the energy a person has, thus limiting or preventing further physical activity.

Emphysema is the fourth largest cause of death in the United States, killing approximately 100,000 sufferers per year.