What is Emphysema?
Emphysema is a respiratory disease characterized by expansion and destruction of lung tissue known as alveoli or air sacs.
What are the causes of Emphysema?
Emphysema results from the breakdown of the walls of the alveoli. In a normal lung, there are many enzymes (proteins that facilitate chemical reactions to take place readily) with opposing functions that are present in a harmonious balance.When this balance is disrupted, the enzymes with detrimental properties predominate and lead to the destruction of the walls of the air sacs/alveoli, thus resulting into emphysema.
The enzymatic imbalance may result from a number of causes. These include
- Cigarette smoking, which is probably the most predominant factor that leads to emphysema. The cigarette smoke causes inactivation of the protective enzymes, thus creating an imbalance, with consequent destruction of the lung tissue by the destructive enzymes and thereby producing emphysema.
- Cigarette smoke also damages the surfactant (the surface active agent responsible for elastic recoil of the lung tissue) thus resulting into over-distention of the alveoli.
- Climate and air pollution may also contribute to the development of emphysema.
- Congenital deficiency of the protective enzyme named alpha 1-antitrypsin leads to the development of inherited form of the disease called congenital/infantile emphysema.
- Lung infections may also contribute, though not in the development, but to the exacerbation of an episode of emphysema by producing enzymatic imbalance.
Emphysema occurs more commonly in men and is more prevalent among 40-65 years of age group.
What are the symptoms of emphysema?
In emphysema, symptoms result from the loss of air sacs and the reduced lung elastic recoil. Alveolar destruction leads to decreased gas transfer. In a normal lung, take up of the oxygen by the blood in exchange of carbon dioxide takes place in the alveoli. When an increasing number of air sacs are destroyed in emphysema, the surface through which the gas exchange can take place reduces markedly and thus results in progressively decreasing amounts of oxygen transferring into your blood.
Impaired gas exchange and reduced lung elasticity results in breathlessness and difficulty in breathing out.
Symptoms of emphysema develop gradually over a period of many years and include
- Cough with production of sputum.
- Progressively increasing breathlessness.
- Wheeze.
You may be one of the two types of patients with emphysema. One is the pink and puffing type, in which you may be very breathless but you may not have any heart disease secondary to the lung disease. The other is the blue and the bloated, in which you may not be very breathless but you have bluish skin discoloration and oedema (swelling). You may also develop heart disease and have had chronic bronchitis. However here is usually a considerable overlap between the two clinical patterns of the emphysema and you may have mixed type of symptoms.
Cold, pollution and foggy weather usually exacerbate your symptoms. In advanced stages, you may become breathless even after mild exercise like dressing.
How is it diagnosed?
Your doctor usually diagnoses the condition on the basis of your history and physical examination. The lifetime history of cigarette smoking and coughing particularly helps your doctor in reaching a diagnosis. Various tests that your doctor may do:
- Chest x-ray.
- Lung function tests.
- Measurement of alpha 1- antitrypsin levels, particularly in familial cases.
- ECG (electrocardiography)
What is the treatment?
The single most important aspect in the management of emphysema is that you must quit smoking. This will greatly slow the rate of further deterioration in your condition and prolong the time before disability occurs.
Your doctor will give you treatment both for an acute exacerbation and also for long-term relief of your symptoms. The choice of drugs depends upon your symptoms and includes bronchodilators (drugs that open up air passages in case of airways constriction), steroids to improve airflow limitation, antibiotics to treat acute infective exacerbations, diuretics (water pills) to relive swelling and alpha 1-antitrypsin replacement therapy if your emphysema is due to enzyme deficiency.
Your doctor may also advise you to take steam inhalation. This helps to liquefy your sputum so that it can be more easily coughed up. You may also be given physiotherapy (exercises). This would help you both in clearing up your secretions as well as strengthening up of your breathing muscles.
What are the complications of emphysema?
In advanced stages of emphysema you may develop
- Respiratory failure.
- Cor Pulmonale (Development of heart disease secondary to lung disease).
How is emphysema prevented?
You may prevent the development of emphysema by quitting cigarette smoking. Even if you have alpha 1-antitrypsin deficiency, abstinence from smoking would help you a lot. Try to avoid atmospheric pollution as much as you can and keep yourself healthy and fit with proper diet and exercise.
Written by Medpages Editorial Team
Last Editorial Review: 15/1/2010
