Emphysema
Definition:
A lung disease which involves damage to the air sacs (alveoli) in the lungs. The air sacs are unable to completely (hyperinflation) and are therefore unable to fill with fresh air to ensure adequate oxygen to the body.Causes, incidences, and risk factors:
Cigarette smoking is the most common cause of emphysema. Tobacco smoke and other pollutants are thought to release chemicals into the lungs that damage the walls of the air sacs. This damage becomes worse over time affecting the exchange of oxygen and carbon dioxide in the lungs.
A naturally occurring substance in the lungs called alpha 1 antitrypsin may protect against this damage. People with antitrypsin deficiency are at an increased risk for the disease.
Prevention:
Avoiding smoking - or quitting if you do smoke - can greatly decrease your risk for this disease.
Symptoms:
- shortness of breath
- chronic cough with or without sputum production
- wheezing
Additional symptoms that may be associated with this disease:
- anxiety
- unintentional weight loss
- ankle, feet, and leg swelling
- fatigue
Signs and Tests:
A physical examination may show decreased breath sounds, wheezing, and/ or prolonged exhalation (exhalation that's more than twice as long as inspiration). There may be an increased front-to-back diameter of the chest (barrel shaped chest) may be signs of chronically insufficient oxygen levels in the blood.
These tests help confirm the diagnosis:
- pulmonary function tests
- chest x-ray
This disease may also alter the results of the following tests:
- arterial blood gases showing reduced oxygen
- pulmonary ventilation/perfusion scan
- chest CT scan
Treatment:
Smoking cessation is the most important and effective treatment. Only quitting smoking can stop the progression of lung damage once it has started. Medications used to improve breathing include bronchodilators (hand-held inhaler or nebulizer), diuretics, and corticosteroids. Antibiotics may be prescribed when respiratory infections occur. Influenza vaccines and Pneumovax are recommended for people with emphysema.
Low-flow oxygen can be used during exertion, continuously, or at night. Pulmonary rehabilitation can improve exertion tolerance and quality of life in the short term. Lung transplantation is an option for patients with severe disease
EXPERIMENTAL THERAPY:
An experimental surgery, called lung reduction, is currently being studied in patients with severe emphysema. Lung surgery removes the damaged portions of the lung, allows the normal portions of the lung to expand more fully to take advantage of increased aeration. It is not yet known whether this surgery is effective.
Prognosis:
The outcome is better for patients with less damage to the lung. However, patients with extensive lung damage may live for many years so predicting prognosis is difficult. Death may occur from respiratory failure, pneumonia, or other common diseases.
Complications:
- recurrent respiratory infections
- pulmonary hypertension
- cor pulmonale (enlargement and strain on the right side of the heart)
- erythrocytosis (increased blood count)
- death
Calling your health care provider:
Call your health care provider if symptoms of emphysema develop.
If you know you have emphysema, call your health care provider if breathing difficulty, cough, sputum production develops or changes.