| Signs and symptoms |
Emphysema may produce the following signs and symptoms:
- Shortness of breath (dyspnea). As emphysema progresses, you're likely to become
increasingly short of breath. In time, you may have trouble breathing even when you're lying down.
Breathing may be especially difficult during and after respiratory infections, such as colds or the
flu.
- Chronic, mild cough. You may produce sputum or phlegm when you cough.
- Loss of appetite and weight loss. It's a vicious cycle. Emphysema can make eating more
difficult, and the act of eating can rob you of your breath. The result is that you simply may not
feel like eating much of the time.
- Fatigue. Because it's more difficult to breathe and your body's getting less oxygen, you feel tired.
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| Causes |
When you inhale, air travels to your lungs through two major airways called bronchi. Inside your lungs, the bronchi subdivide nearly 20 times into a million smaller airways (bronchioles), which finally end in clusters of tiny air sacs. You have about 300 million air sacs in each lung. Within the walls of the air sacs are small blood vessels (capillaries) where oxygen is added to your blood and carbon dioxide — a waste product of metabolism — is removed.
The air sac walls also contain elastic fibers that help them expand and contract like small balloons when you breathe. But in emphysema, inflammation destroys these fragile walls, causing them to lose their elasticity. As a result, the bronchioles collapse when you exhale, and air becomes trapped in the air sacs, which overstretches them.
In time, this overstretching (hyperinflation)may cause several air sacs to rupture, forming one larger air space instead of many small ones. Because the larger air sacs aren't able to force air completely out of your lungs when you exhale, you have to breathe harder just to get enough oxygen and eliminate carbon dioxide.
What causes emphysema?
Most damage to the elastic fibers and other supporting structures in your air sacs and small airways results from inflammation caused by tobacco smoke and other air-borne irritants. The process begins when tobacco smoke temporarily paralyzes the microscopic hairs (cilia) that line your bronchial tubes. Normally, these hairs sweep irritants and germs out of your airways. But when smoke interferes with this sweeping movement, irritants remain in your bronchial tubes, inflaming the tissues and eventually breaking down the elastic fibers.
A small number of people are born with a deficiency of a protein called alpha-1-antitrypsin (AAT), which normally protects the elastic fibers in the walls of your air sacs. People who have too little AAT are likely to develop severe emphysema in their 30s or 40s — a condition called AAT deficiency-related emphysema.
| Risk factors |
The single greatest risk factor for emphysema is smoking, which accounts for at least 80 percent of all cases of the disease. Emphysema is most likely to develop in cigarette smokers, but cigar and pipe smokers also are at risk. Men are affected more often than women, but this statistic is changing as more women begin to smoke.
Other risk factors include:
- Exposure to secondhand smoke. Secondhand (passive) smoke is smoke you inadvertently inhale
from someone else's cigarette, pipe or cigar. Breathing this smoke increases your risk of emphysema
and other respiratory diseases.
- Occupational exposure to chemical fumes. If you breathe fumes from certain chemicals at
work or dust from grain, cotton, wood or mining products, you're more likely to develop emphysema. The
risk is even greater if you smoke.
- Exposure to indoor and outdoor pollution. If you smoke, breathing certain indoor pollutants
— such as fumes from home heating fuels — as well as outdoor pollutants, increases your risk of
emphysema.
- Heredity. A rare inherited deficiency of the protein alpha-1-antitrypsin (AAT), which protects your lungs from a destructive enzyme, also can cause emphysema, especially before age 50, and even earlier if you smoke. A blood test can detect the deficiency.
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| When to seek medical advice |
See your doctor if you experience any of the following:
- You feel short of breath most of the time.
- You can't breathe well enough to tolerate even moderate exercise.
- You frequently cough up sputum that's colored and possibly infected.
| Screening and diagnosis |
To determine if you have emphysema, your doctor will discuss your medical history and perform a physical examination. You also may have certain tests including:
- Pulmonary function tests (PFTs). These noninvasive tests can detect emphysema before you
have symptoms. They measure how much air your lungs can hold and the flow of air in and out of your
lungs. They can also measure the amount of gases exchanged across the membrane between your lung wall
and capillary membrane. During the tests, you're usually asked to blow into a simple instrument called
a spirometer. PFTs may be done before and after the use of inhaled medications to test your response
to them. If you're a smoker or a former smoker but don't have symptoms of COPD, ask your doctor about
taking this test.
- Chest X-ray. Looking at an X-ray image of your lungs may help your doctor detect lung
conditions other than emphysema that may be causing your symptoms. Chest X-rays are often normal even
in advanced stages of emphysema.
- Arterial blood gases (ABG) analysis. These are blood tests that measure how well your lungs
bring oxygen into your blood and remove carbon dioxide from it.
- Pulse oximetry. This test involves use of a small device that attaches to your fingertip.
The oximeter measures the amount of oxygen in your blood. To help determine when you need supplemental
oxygen, tests may be performed at rest, during exercise and overnight.
- Sputum examination. Analysis of cells in sputum can help determine the cause of some lung
problems.
- Computerized tomography (CT) scan. A CT scan allows your doctor to see your organs in two-dimensional "slices." Split-second computer processing creates these images as a series of very thin X-ray beams are passed through your body. A CT scan can detect emphysema sooner than an X-ray can, but it can't assess the severity of emphysema as accurately as pulmonary function tests.
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| Treatment |
Emphysema can't be cured, but prompt treatment may prevent further damage to your respiratory system and lead to an improvement in your lung function. Besides steps you can take on your own, your doctor may recommend these treatments for emphysema and its complications:
- Antibiotics. A course of broad-spectrum antibiotics, such as ampicillin, tetracycline,
erythromycin and cephalosporin, may help combat the periodic respiratory infections that can accompany
emphysema. This must be done carefully so as not to overuse these drugs and cause excessive resistance
to bacteria.
- Inoculations against influenza and pneumonia. If you have emphysema or other forms of COPD,
you'll need an influenza (flu) shot annually and a pneumonia shot every 5 to 7 years.
- Bronchodilators. These are medications that help open up constricted airways. Taking
bronchodilators may provide relief if you have emphysema accompanied by symptoms of asthma.
- Supplemental oxygen. If you have severe emphysema, using oxygen at home may provide some
relief. Various forms of oxygen are available as well as different devices to deliver oxygen to your
lungs. Talk with your doctor about which is best for you. Ask your doctor for oxygen distributors in
your area. Your dealer can set up your equipment, instruct you on care and maintenance and provide
follow-up visits.
- Inhaled steroids. Corticosteroid drugs inhaled as aerosol sprays may relieve symptoms of
emphysema associated with asthma and bronchitis. Although inhaled steroids have fewer side effects
than oral steroids, prolonged use may increase the risk of conditions such as high blood pressure,
cataracts and diabetes.
- Protein therapy. If you have emphysema because you inherited a deficiency of
alpha-1-antitrypsin — a protein that protects your lungs from destructive enzymes — weekly infusions
of the protein may slow damage to your lung tissue.
- Surgery. In a procedure called lung volume reduction surgery, or "lung shaving," your
surgeon removes small wedges of damaged tissue from both of your lungs — usually 20 percent to 30
percent of each lung. A CT scan before the operation helps your doctor assess the location and extent
of the damage. Removing some damaged air sacs reduces the size of your lungs. Your diaphragm then
returns to a more normal position and contracts and relaxes more effectively, and air exchange
improves. Another procedure uses lasers to remove damaged lung tissue, but this technique hasn't been
as effective as volume reduction surgery. Both surgeries still are considered experimental. A large
clinical trial, called the National Emphysema Treatment Trial, is under way at a number of medical
centers across the United States to evaluate the potential of lung volume reduction surgery, but it
will be a number of years before doctors know how beneficial the procedure may be.
- Transplant. Lung transplantation is an option if you have severe emphysema and other options have failed. Usually just one lung is transplanted because the survival rate has proved to be higher for people with single-lung transplants.
Part of treatment involves a pulmonary rehabilitation program, which combines education, exercise training and behavioral intervention to help restore you to the highest possible level of independent living.
You'll receive help with smoking cessation and your nutritional needs, and you may learn special breathing techniques and ways to conserve energy.
You'll also be given an exercise program that's appropriate for you. This may include aerobic exercises such as walking and riding an exercise bike as well as special exercises for your arms and legs.
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| Prevention |
Most cases of emphysema are due to smoking. If you smoke — cigarettes, cigars or a pipe — your chance of developing emphysema is 10 times greater than it is for nonsmokers. The best way to prevent emphysema is to not smoke or to stop smoking. In addition, try to limit your exposure to secondhand smoke.
Although smoking is the most common cause of emphysema, occupational exposure to chemical fumes and dust also is a risk factor. Try wearing a dust mask for protection if you work in such an environment.
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| Self-care |
If you have emphysema, you can take a number of steps to halt its progression and to protect yourself from complications:
- Stop smoking. This is the best step you can take to halt the progression of emphysema. Join
a smoking cessation program if you need help giving up smoking. As much as possible, avoid secondhand
smoke. Sit in nonsmoking areas when you're out and ask family and friends not to smoke in your home.
- Exercise regularly. Less strenuous exercise, such as walking or cycling, can increase your
exercise tolerance. So can simple breathing techniques prescribed by your doctor. Some people are able
to improve the efficiency of their lungs using these techniques.
- Avoid other respiratory irritants. These include fumes from paint and automobile exhaust,
some cooking odors, certain perfumes, dust, cold air and extremely humid air. Keep the humidity level
in your home at 40 percent to 50 percent. Change furnace and air conditioner filters regularly to
limit pollutants in your home. If you enjoy hobbies such as woodworking or ceramics, use a dust mask
for protection.
- Clear your airways. With emphysema, mucus tends to collect in your air passages and can be
difficult to clear. To keep secretions thin and easy to bring up, drink at least eight 8-ounce glasses
of nonalcoholic fluids every day.
- Protect yourself from cold air. During cold weather wear a soft scarf or a cold air mask —
available from a pharmacy — over your mouth and nose to warm the air that is entering your lungs. For
the same reason, breathe through your nose because cold air can cause spasms of the bronchial
passages.
- Avoid respiratory infections. Get a pneumonia vaccination as advised by your doctor and an
annual influenza immunization. Avoid direct contact with people who have a cold or the flu.
- Maintain good nutrition. A well-balanced diet gives your body the nutrients it needs for
energy, building and maintaining body cells, and regulating body processes. Work toward and maintain a
desirable body weight. Being overweight requires more oxygen and can interfere with breathing. If
you're underweight, achieving a healthy weight may increase your strength. When the effort to eat is
taxing, you may need to eat smaller meals more frequently. Some people are helped by eating their
larger meal earlier in the day and avoiding lying down after meals. Choosing soft, easy-to-digest
foods such as yogurt, rice, baked potatoes, and poached chicken or fish may also help.
- Express your feelings. Having COPD may cause a gradual change in your lifestyle and that of
your family. Share your feelings and concerns about your disease with your family, friends and doctor.
Be alert to changes in your mood and your relations with others. Living with emphysema can be
difficult. Don't be afraid to seek counseling if you feel depressed or overwhelmed.
- Consider a support group. You may also want to consider joining a support group for people with emphysema. Although support groups aren't for everyone, they can be a good source of information about new treatments and coping strategies. And it can be encouraging to be around other people who are meeting the same challenges you are. If you're interested in a support group, talk to your doctor. Or, contact your local chapter of the American Lung Association.
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| Coping skills |
Some simple exercises can improve your breathing if you have emphysema or another chronic lung disorder. They help you control the emptying of your lungs by using your abdominal muscles. You can also increase the efficiency of your lungs. Ask your doctor about them. Do them two to four times daily.
Diaphragmatic breathing
Lie on your back with your head and knees supported by pillows. Begin by breathing in and out slowly and smoothly in a rhythmic pattern. Relax.
Place your fingertips on your abdomen, just below the base of your rib cage. As you inhale slowly, you should feel your diaphragm lifting your hand.
Practice pushing your abdomen against your hand as your chest becomes filled with air. Make sure your chest remains motionless. Try this while inhaling through your mouth and counting slowly to three. Then purse your lips and exhale through your mouth while counting slowly to six.
Practice diaphragmatic breathing on your back until you can take 10 to 15 consecutive breaths in one session without tiring. Then practice it on one side and then on the other. Progress to doing the exercise while sitting erect in a chair, standing up, walking and, finally, climbing stairs.
Pursed-lip breathing
Try the diaphragmatic breathing exercises with your lips pursed as you exhale, that is, with your lips puckered — the flow of air should make a soft "sssss" sound. Inhale deeply through your mouth and exhale. Repeat 10 times at each session.
Deep-breathing exercise
While sitting or standing, pull your elbows firmly backward as you inhale deeply. Hold the breath in, with your chest arched, for a count to five, and then force the air out by contracting your abdominal muscles. Repeat the exercise 10 times.
— September 12, 2002 —