Empysema and Chronic Obstructive Pulmonary Disease

What is Emphysema?

Emphysema is a respiratory disease in which millions of tiny air sacs in the lungs (called alveoli) are enlarged more than normal or broken. When these thin and fragile air are injured or destroyed, the lungs lose their natural elasticity and can not be emptied as normal. Emphysema is a progressive disease, meaning that it continues to worsen. As the condition progresses, the lungs also lose their ability to absorb oxygen and release carbon dioxide. Breathing becomes more difficult as the patient lacks air, as if he were not getting enough air.

Emphysema and chronic bronchitis are the two most common forms of chronic obstructive pulmonary disease (COPD) and often manifest themselves together. A person with chronic bronchitis (inflammation of the bronchial walls) typically has a daily cough with phlegm that lasts for months and is continuous for several years. Both emphysema and chronic bronchitis are caused by injuries to the lungs and bronchi, and this injury is often permanent. When damage is caused by smoking, symptoms may improve if the smoker quits, as long as it is caught in the initial stages.

Smoking is responsible for up to 90% of COPD emphysema cases and once you have reached this state, you effectively have succombed to the chronic obstructive pulmonary diseases. Emphysema is a chronic pulmonary disease. Exposure to cigarette smoke and airborne toxins may contribute to the development of emphysema, although these factors are much less important than smoking. Smokers exposed to high levels of environmental pollution, including sulfur dioxide and pollutants, appear to be at greater risk of developing COPD.

About 1% of the population in the United States develop emphysema due to a disease known as hereditary deficiency of alpha-1-anti trypsin. This genetic disease does not allow the body to produce enough protein called alpha-1-anti trypsin (AAT), which protects the lungs from damage caused by enzymes.

In its most severe form, emphysema can develop in people between 30 and 40. Since the habit of smoking interferes with the function of the AAT, the AAT-deficient individuals who smoke develop more severe emphysema at an earlier age than those who do not smoke. Most people with AAT deficiency are Caucasians of northern European descent.

COPD disease is the most common cause of death from respiratory disease in the United States. Most people with emphysema are male smokers over 40 who live in areas where contamination is a constant problem. However, given the dramatic increase of women smoking over the past decades, the rate of emphysema in women continues to grow.

People with COPD disease will many times have to receive long term oxygen therapy.

Bronchitis Symptoms, Emphysema Symptoms : COPD Symptoms

During the early stages of emphysema, there are few symptoms. The disease usually progresses slowly and the changes in breathing are hardly observed. A person does not generally show have symptoms until they have smoked a pack of cigarettes per day for over 20 years.

However, over time, most people with emphysema suffer from shortness of breath. At first it occurs only during strenuous activities such as climbing several flights of stairs or playing sports. Over time, there may be shortness of breath with daily activities such as housework or walking short distances. Eventually, the person may have shortness of breath most of the day, even when resting or sleeping. In the worst cases, emphysema can cause "Kussmaul dyspnea", the constant feeling of not being able to breathe.

These respiratory symptoms are the same regardless of the cause of emphysema. However, two people with the same degree of lung damage may have different symptoms. A person with mild emphysema may feel short of breath, while another person in a more advanced stage of emphysema may have less discomfort. These differences could be caused by other medical conditions and how their lungs are adapted.

Other symptoms caused by emphysema include:

• Wheezing, coughing and expectoration of phlegm (if chronic bronchitis also) 
• Sensation of chest tightness 
• Strained chest barrel chest type 
• Constant fatigue 
• Difficulty sleeping 
• Morning headaches 
• Weight loss 
• Swollen ankles 
• Lethargy or difficulty concentrating 

Diagnosis

Many poeple are at risk from pulmonary diseases and in fact it is thought that a large percentage of people world wide with COPD have not been diagnosed - and therefore treatment is not being administered.

A diagnosis is essential.

Your doctor will ask about your smoking (how long ago it was and how many cigarettes smoked per day). Other questions may be:

• Do you breathe the smoke of other smokers at work or at home? 
• Do you live or work in an area exposed to irritants in the environment or that are hazardous? 
• Do you live in an area with significant environmental contamination? 
• Is there a family history of AAT deficiency, early onset of emphysema or non-smokers who have had emphysema? 

Your doctor will also ask about your respiratory symptoms, particularly if you developed shortness of breath and when? You may also ask about your respiratory allergies, recurrent colds or severe and persistent cough.

Then your doctor will check to see if there are characteristic signs of emphysema. This examination may include:

• Detecting shortness of breath when doing simple activities like walking into the office 
• Examine the size and shape of your chest as well as the movement of this when you breathe 
• Listen to your lungs to detect wheezing or absence of the normal sounds of breathing 
• Examine your ears, nose and throat to find out who you are coughing 
• Listen to your heart 
• Examine your skin, lips and nails of the toes to detect a bluish tint that indicates low levels of oxygen in the blood (your doctor may measure your blood oxygen levels by oximetry 
• Examine your nails of his fingers in search of a curvature ("clubbing fingers") that sometimes occurs with chronic lung disease. 
• Examine you ankles in search of swelling that indicates fluid accumulation. 

It is important to remember that in many people's test results can be quite normal during the early stages of emphysema.

In many people, emphysema will be diagnosed by x-rays or pulmonary function tests. An X-ray may show typical changes of emphysema including pulmonary dilation, scarring or formation of bullae. However, these changes may not become apparent until a significant injury occurs. Computed tomography (CT) is very good at detecting early changes of emphysema and can help diagnose the disease in younger people or those who have never smoked.

Pulmonary function tests (also known as spirometry) is useful both to diagnose emphysema and to determine the stages of the disease. In this test, you blow hard through a tube connected to a machine designed to measure lung capacity. Your doctor also may order special tests in the lungs where you may be required to sit inside a glass box or blow slowly into a mixture of different gases.

Your doctor may request further tests including:

• Arterial blood gas measures, levels of oxygen and blood carbon dioxide, which is extracted with a needle in a small artery in the wrist. 
• Electrocardiogram (ECG): look for evidence of heart problems that can cause breathing problems or pressure on the heart caused by emphysema. If your doctor suspects emphysema, he may order a specific blood test to confirm the diagnosis of deficiency of alpha-1-antitrypsin. If this test is positive, your doctor may recommend that the whole family undergo the test. 

Duration

Whatever the cause, lung damage in emphysema is permanent. If not treated, the injury and symptoms of emphysema will continue to worsen. If treated the symptoms can improve.

Prevention

If you smoke, quit. If you do not smoke, do not start. Studies have shown that smoking cessation helps to both prevent emphysema or stop its progress. You can also limit your exposure to air pollution if you restrict your outdoor activities when there are reports of high levels of contamination. People exposed to harmful chemicals in the workplace should talk to their bosses, about respirators and should consult with a specialist in occupational medicine.

People diagnosed with emphysema should talk to their doctor about flu shots and pneumococcal pneumonia. These vaccines may help prevent respiratory infections that threaten the lives of people with lung disease.

Treatment

No treatment can slow or stop emphysema, but treatment can help relieve symptoms, treat complications and minimize disability. Medical advice places at the top of the list smoking cessation as the single most important factor for maintaining healthy lungs. Quitting smoking is most effective in the early stages of emphysema, but may also halt the loss of lung function in the final stages of the disease.

People with Alpha-1-antitrypsin may be candidates for replacement therapy with infusions of AAT obtained from donors. Although this form of treatment is effective, it takes time to do it and is very expensive. Are being developed genetically engineered forms and an inhaler.

Your doctor may prescribe different medications to relieve symptoms of chronic bronchitis often accompanies emphysema. These include:

• Bronchodilators, including tiotropium (Spiriva), ipratropium (Atrovent), albuterol (Proventil, Ventolin and other brand names) and salmeterol (Serevent). These drugs are used by electric hand-held inhalers or nebulizers that produce a fine mist that can be inhaled. These medicines are called bronchodilators and help open the bronchial tubes in the lungs and reduce shortness of breath, the wheezing and coughing. Theophylline (sold by various brand names) is a bronchodilator in pill form. Because you can interact with some medications and can cause side effects, it is used less often than inhalers. 
• Corticosteroids: These drugs help reduce inflammation in the lungs. During an acute outbreak, these medications are often prescribed as tablets or injections. Corticosteroids that are inhaled or tablets are prescribed to be taken to help control inflammation and chronic bronchitis. 
• Antibiotics: These are generally used for acute flares of COPD triggered by respiratory infections. 

Test have shown oxygen therapy, and specifically long term oxygen treatment, providing an increase of life expectancy in people with emphysema who have blood oxygen levels lower than normal. Oxygen is usually delivered through a plastic tube (nasal cannula) placed under the nostrils. The oxygen is stored in metal cylinders or air is purified with an electric machine (concentrator). Several devices are available that are portable for those who need oxygen as they leave their homes for several hours. Other people with emphysema need oxygen only at night. As the supply of oxygen at home is very expensive, most insurance companies have strict requirements for oxygen at home.

People with emphysema also are at risk of malnutrition and risk of developing psychological problems such as anxiety or depression. Therefore it is important to see your doctor regularly, to follow a proper diet as well as counseling or medications to help with psychological problems.

Several treatments are available for people in advanced stages of emphysema.

• Pulmonary Rehabilitation: This is a form of physical therapy that teaches patients with emphysema to conserve and improve energy and reduce shortness of breath. 
• Volume Reduction Surgery Pulmonary this technique is used to eliminating the parts of the diseased lung to improve function of the healthy part of the lung. 
• Lung Transplants: a lung transplant can be considered for a person whose emphysema is so severe that his life expectancy is projected to two to three years. 

When to call a professional

Call your doctor if you have:

• New episodes of breathlessness 
• Persistent cough with or without phlegm 
• A decreased ability to perform regular physical exercises 
• Frequent respiratory infections 

If you smoke, see your doctor to talk about how to stop. There are several types of treatments (including medication and counseling) that may increase the likelihood of success compared to "quitting cold turkey."

You should see a doctor if a relative was diagnosed with a deficiency of alpha-1-antitrypsin.

Forecast

Emphysema is not curable, but the disease can be controlled. People with mild emphysema who quit smoking have a normal life expectancy. Those who adopt a healthy lifestyle can enjoy a fairly normal life for a long time. Even those with severe emphysema have a good chance of surviving five years or more.

Research has shown that people with emphysema who continue to smoke increase the severity of the disease and may reduce their lifespan by 10 years or more.

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