Emphysema is a disease that will typically develop after a long period of attack on the lungs and airways (usually from smoke or fumes). Cigarette smoking is the primary cause of this condition. Possible symptoms include coughing, wheezing, and chronic mucus production. There are many ways to treat this condition; treatment options include medications, oxygen therapy, and surgery. However, the most important part of treatment is to stop smoking.
Emphysema is a degenerative disease that usually develops after many years of assault on lung tissues from cigarette smoke or other toxins that pollute the air. These toxins destroy the small air sacs in the lungs, called alveoli, that stretch as they transport oxygen from the air to the blood and then shrink as they force out carbon dioxide. As a result, the lungs lose their elasticity, and exhaling becomes difficult as the damaged lungs trap air and cannot effectively exchange it with fresh air. As the damage progresses, the effort needed to breathe increases and, ultimately, each breath becomes labored.
Emphysema is a form of COPD (chronic obstructive pulmonary disease). Other diseases that fall under COPD include asthma and chronic bronchitis. Nearly 16 million Americans are estimated to suffer from some form of COPD, and COPD is the fourth-ranking cause of death, just behind heart ailments, cancers, and stroke.
The predominant symptom of emphysema is shortness of breath or the feeling of not being able to get enough air. A person may initially visit the doctor because he or she has begun to feel short of breath during activity, but as the disease progresses, this symptom may be present all the time. A cough that doesn't go away and coughing up lots of mucus are also common; these often occur years before the flow of air in and out of the lungs is reduced. The severity of a person's symptoms depends on how much of the lung has been destroyed.
Most people with emphysema are at least 40 years old or around middle age when symptoms start. It is unusual, but possible, for people less than 40 years old to have emphysema symptoms.
Common Emphysema Symptoms
Common symptoms of emphysema include:
Cough
Sputum (mucus) production
Shortness of breath, especially with exercise
Wheezing (a whistling or squeaky sound when you breathe)
Chest tightness.
A cough that doesn't go away and coughing up lots of mucus are common in people with emphysema. These often occur years before the flow of air in and out of the lungs is reduced. However, not everyone with a cough and sputum production goes on to develop COPD (chronic obstructive pulmonary disease), and not everyone with emphysema has a cough.
The severity of the emphysema symptoms depends on how much of the lung has been destroyed. If you continue to smoke, the lung destruction is faster than if you stop smoking.
Worsening Symptoms
People with symptoms of emphysema often have symptoms that suddenly get worse. When this happens, you have a much harder time catching your breath. You may also have chest tightness, more coughing, change in your sputum, and a fever.
It is important to call your doctor if you have any of these worsening emphysema symptoms.
Your doctor will look at things that might be causing these emphysema symptoms to suddenly worsen. Sometimes the symptoms are caused by a lung infection. Your doctor may want you to take an antibiotic medication that helps fight off the infection.
Your doctor may also recommend additional medications to help with your breathing. These medications include bronchodilators and glucocorticosteroids.
Your doctor may recommend that you spend time in the hospital if:
You have a lot of difficulty catching your breath
You have a hard time talking
Your lips or fingernails turn blue or gray
You are not mentally alert
Your heartbeat is very fast.
Home treatment of worsening symptoms doesn't help.
Emphysema Symptoms and Prognosis
Emphysema is a disease that slowly worsens over time, especially if you continue to smoke. If you have emphysema, you are more likely to have lung infections, which can be fatal. If the lungs are severely damaged, the heart may be affected. A person with emphysema dies when the lungs and heart are unable to function and get oxygen to the body's organs and tissues or when a complication, such as a severe infection, occurs. Treatment for emphysema may help prevent complications, prolong life, and improve a person's quality of life.
People who have emphysema are also more likely to develop:
Collapsed lung (pneumothorax). A collapsed lung can be life-threatening in people who have severe emphysema, because the function of their lungs is already so compromised.
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 (giant bullae). Some people with emphysema develop empty spaces in the lungs called bullae. Giant bullae 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 become infected and are more prone to causing a collapsed lung (pneumothorax).
The most common emphysema causes are from breathing in fumes and other irritants that damage the lungs and airways. Cigarette smoking is the most common irritant that causes the disease, but other factors (including dust and genetics) can cause it as well. People with a family history of emphysema are more likely to get the disease if they smoke. The chance of developing emphysema is also greater in people who have spent many years in contact with lung irritants such as air pollution and chemical fumes.
Most emphysema causes involve repeated breathing in of fumes and other things that irritate and damage the lungs and airways.
Specific causes of emphysema can include:
Cigarette smoking
Pipe, cigar, and other types of tobacco
Certain fumes or dust
Genetic factors.
Smoking
Cigarette smoking is the most common irritant that causes emphysema. Pipe, cigar, and other types of tobacco smoking can also cause emphysema, especially if the smoke is inhaled.
Fumes and Dust
Breathing in other fumes and dusts over a long period of time may also cause the disease. The lungs and airways are highly sensitive to these irritants. They cause the airways to become inflamed, narrowed, and destroy the elastic fibers that allow the lung to stretch, then come back to its resting shape. This makes breathing air in and out of the lungs more difficult.
Other things that may irritate the lungs and contribute to emphysema include:
Working around certain kinds of chemicals and breathing in the fumes for many years
Working in a dusty area over many years
Heavy exposure to air pollution
Being around secondhand smoke (smoke in the air from other people smoking cigarettes).
Genetic Factors
Genes (tiny bits of information in your body's cells passed on by your parents) may play a role in developing emphysema.
In rare cases, emphysema is caused by a gene-related disorder called alpha-1 antitrypsin deficiency. Alpha-1 antitrypsin is a protein in your blood that inactivates destructive proteins in the blood. People with antitrypsin deficiency have low levels of alpha-1 antitrypsin; the imbalance of proteins leads to the destruction of the lungs. If people with this condition smoke, the disease progresses more rapidly.
Factors that increase your risk of developing emphysema include:
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.
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 your risk of 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.
Exposure to indoor and outdoor pollution. Breathing indoor pollutants, such as fumes from heating fuel, as well as outdoor pollutants — car exhaust, for instance — increases your risk of emphysema.
Emphysema can't be cured, but treatments can help relieve symptoms and slow the progression of the disease.
Medications
Smoking cessation drugs. Prescription medications, such as bupropion hydrochloride (Zyban) and varenicline (Chantix), can help you quit smoking.
Bronchodilators. These drugs can help relieve coughing, shortness of breath and trouble breathing by relaxing constricted airways, but they're not as effective in treating emphysema as they are in treating asthma or chronic bronchitis.
Inhaled steroids. Corticosteroid drugs inhaled as aerosol sprays may help relieve shortness of breath. But prolonged use can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes.
Antibiotics. If you develop a bacterial infection, like acute bronchitis or pneumonia, antibiotics are appropriate.
Therapy
Pulmonary rehabilitation. A pulmonary rehabilitation program can teach you breathing exercises and techniques that may help reduce your breathlessness and improve your ability to exercise. You'll also receive advice about proper nutrition. In the early stages of emphysema, many people need to lose weight, while people with late-stage emphysema often need to gain weight.
Supplemental oxygen. If you have severe emphysema with low blood oxygen levels, using oxygen regularly at home and when you exercise may provide some relief. Many people use oxygen 24 hours a day. It's usually administered via narrow tubing that fits into your nostrils.
Surgery
Depending on the severity of your emphysema, your doctor may suggest one or more different types of surgery, including:
Lung volume reduction. In this procedure, surgeons remove small wedges of damaged lung tissue. Removing the diseased tissue helps the remaining lung tissue work more efficiently and helps improve breathing.
Lung transplant. Lung transplantation is an option if you have severe emphysema and other options have failed.
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 most important measure you can take for your overall health and the only one that might halt the progression of emphysema. Join a smoking cessation program if you need help giving up smoking. As much as possible, avoid secondhand smoke.
Avoid other respiratory irritants. These include fumes from paint and automobile exhaust, some cooking odors, certain perfumes, even burning candles and incense. Change furnace and air conditioner filters regularly to limit pollutants.
Exercise regularly. Try not to let your breathing problems keep you from getting regular exercise, which can significantly increase your lung capacity.
Protect yourself from cold air. Cold air can cause spasms of the bronchial passages, making it even more difficult to breathe. During cold weather, wear a soft scarf or a cold-air mask — available from a pharmacy — over your mouth and nose before going outside, to warm the air entering your lungs.
Avoid respiratory infections. Get pneumonia vaccinations as advised by your doctor. Also get an annual influenza immunization. Do your best to avoid direct contact with people who have a cold or the flu. If you have to mingle with large groups of people during cold and flu season, wear a face mask, wash your hands frequently and carry a small bottle of hand sanitizer to use when needed.
To prevent emphysema, don't smoke and avoid breathing secondhand smoke. Wear a mask to protect your lungs if you work with chemical fumes or dust.