Pulmonary Emphysema

Pulmonary emphysema, known as emphysema, is a chronic lung condition in which the air sacs (alveoli) may be collapsed, destroyed, narrowed, overinflated or stretched.

Overinflation of the air sacs is a result of breakdown of the alveoli walls. It causes breathlessness and a decrease in respiratory function. Damage to the air sacs is irreversible, resulting in permanent holes in the lower lung tissues.

Emphysema is part of a group of lung diseases called chronic obstructive pulmonary disease (COPD). COPD causes airflow blockage and breathing problems. The two most common COPD conditions are chronic bronchitis and emphysema.

Causes

  • Smoking (the leading cause)
  • Air pollution, such as chemical fumes, dust and other substances
  • Industrial work environments with irritating fumes and dusts
  • A rare inherited deficiency of protein that protects the elastic structures in lungs called alpha 1-antitrypsin (AAT) deficiency emphysema 

Emphysema does not develop suddenly, but very slowly over time.

Symptoms

  • Coughing with or without sputum (mixture of saliva and mucus)
  • Rapid breathing
  • Shortness of breath, which worsens with activity
  • Wheezing
  • Anxiety
  • Depression
  • Fatigue or sleep problems
  • Chest tightness (often related to heart disease)
  • Loss of appetite or weight loss 
  • Lips or fingernails that turn blue or gray with exertion
  • Not being mentally alert

Symptoms vary from person to person and may closely resemble symptoms of other lung conditions or health problems. 

Diagnosing Emphysema

  • Physical exam
  • Pulmonary function testing: evaluates lung function and determines severity of lung disease
  • Peak flow monitoring: uses a non-invasive device (peak flow meter) that measures the speed of air flow from the lungs and evaluates how well the disease is being controlled
  • Blood tests: checks the amount of carbon dioxide and oxygen in the blood
  • Chest X-ray: takes pictures of internal tissues, bones and organs
  • CT scan: produces horizontal, or axial, images (often called slices) of the body and can show details such as the width of airways and thickness of airway walls
  • Sputum culture: performed on the material that is coughed up from the lungs into the mouth and checks for infection

Treatments

It is not possible to repair or regrow damaged lung tissue. The goal in treating emphysema is to help people live more comfortably, control symptoms, and prevent the disease from getting worse. A critical part of treatment is to stop smoking.

  • Quitting smoking
  • Pulmonary rehab program that may include breathing exercises, cardiovascular and musculoskeletal training
  • Antibiotics for bacterial infections
  • Avoiding the secondhand smoke and removing other air pollutants from the home or workplace
  • Bronchodilators, which can be oral or inhaled
  • Getting the flu and pneumococcal vaccines
  • Nutritional support in the event of malnutrition and weight loss
  • Other types of oral and inhaled medications to treat symptoms like coughing and wheezing
  • Oxygen therapy from portable containers
  • Surgery to remove the excessively damaged, overinflated areas of the lungs, restoring ability of the diaphragm and ribs to participate in breathing. This is known as lung volume reduction surgery (LVRS).
  • Lung transplant