Emphysema

Emphysema is a chronic respiratory disease in which the air sacs in the lungs are overinflated, causing a loss of lung function and shortness of breath.

Tara's grandfather Barry is a 67-year-old military veteran and retired auto mechanic. Barry started smoking when he was a teenager in high school. He notes, “Back then, it was cool to smoke. All the boys smoked.” He joined the Army after he graduated from high school. Because cigarettes were inexpensive in the military commissary, he continued to smoke until he got to the point at which he was smoking a full pack of cigarettes a day. Barry retired from the Army when he was 38 years old and used the skills he learned there to work as an auto mechanic until he retired at age 62. Over the years, Barry noticed he was becoming less active because any activity caused him to be short of breath. He tried to quit smoking several times, but was never successful because he liked to smoke. He coughed a lot and his wife became concerned about his health because he seemed to be losing weight although he was eating well. At his wife's urging, Barry went to the doctor, who diagnosed emphysema.

Emphysema (EM-fy-SE-ma) is a condition of the lungs in which damage to the air sacs called alveoli * (al-VE-ol-i) makes it difficult to breathe. It is one of a group of diseases categorized as chronic obstructive pulmonary disease (COPD). Chronic means that the disease is of long duration; obstructive means that the disease presents an obstacle; and pulmonary refers to the lungs; thus COPD is a disease of the lungs that develops over a long period of time and blocks or obstructs normal breathing.

Another cause of emphysema and other chronic obstructive pulmonary diseases is secondhand smoke, when someone breathes smoke in the environment that is produced by other people's smoking.

Emphysema is very common in the general population in Canada and the United States. According to the Centers for Disease Control and Prevention, 1.4 percent of American adults, or 2.4 million people, had been diagnosed with emphysema as of 2014. Although men are at greater risk of emphysema than women because more men are smokers, women in the United States have been catching up to men since the 1970s in terms of the number diagnosed with emphysema. About 8,300 Americans die from emphysema each year. Emphysema is not contagious.

Shortness of breath is usually the first sign of emphysema. Early in the disease, shortness of breath occurs only when people are performing some type of vigorous activity, such as sports, physical work, or housework. As the disease progresses, shortness of breath occurs during low-level activity and while resting. People with emphysema often state they are no longer able to perform their normal activities because they get short of breath. Other signs of emphysema include coughing, making a wheezing sound when breathing, and having a feeling of tightness in the chest. As the disease progresses, people may experience severe weight loss and may be unable to lie comfortably in a reclining or flat position. In addition, the act of breathing becomes difficult and requires increasing effort.

To diagnose emphysema, healthcare providers obtain the person's complete health history by asking specific questions about the person's smoking history, such as how long the person has smoked and how many cigarettes per day, as well as the person's occupation and how long they have worked in that job. In addition, doctors need to determine whether there are signs of lung damage. A chest x-ray shows the effect of emphysema on the lungs. Additional studies may be undertaken to determine lung function; these studies are called pulmonary function testing. Because lung disease (emphysema) can affect the amount of oxygen a person is getting to blood and body tissues, laboratory testing of blood samples (called arterial blood gas * testing) is done to determine blood oxygen levels.

Emphysema cannot be cured as of 2016; however, treatment can improve lung function over time and increase the patient's quality of life. The primary treatment for emphysema is for the person to quit smoking. Even when there is significant lung damage, stopping smoking can slow the progression of the disease and make breathing easier.

Avoiding breathing in (inhaling) other substances that irritate the lungs such as chemicals or air pollution can improve breathing. If the person's job appears to be the location of the dust or chemicals that are harming the lungs, the doctor will usually advise the patient to change jobs. A person with emphysema may be referred to a physician specialist called a pulmonologist, who is a doctor with specialized training and experience in the care of people with lung diseases.

In addition, medications to decrease the risk of developing lung infections may be recommended, including vaccination against pneumonia and yearly flu shots. If a bacterial infection of the lung has developed, antibiotics * are prescribed. Other medications that relax the muscles around the airways and improve airflow through the lungs (called bronchodilators * ) may be prescribed. These medications that facilitate breathing may be given by mouth or through respiratory breathing treatments in which a person inhales the medication through a breathing machine.

In addition, breathing exercises may be recommended to improve airflow through the lungs and to make breathing less difficult. Difficult breathing often interferes with eating, personal care, and other normal activities of living. It is important to maintain good nutrition to minimize the risk of lung infections. Resting before meals and eating smaller meals more often throughout the day may help to relieve fatigue. Doctors may recommend vitamins or nutritional supplements. A dietitian * can help a person with emphysema identify foods and their preparation that will improve nutrition and decrease the patient's fatigue.

It is also important to avoid such possible complications of emphysema as lung infections by following the prescribed treatments, maintaining good nutrition, and getting recommended immunizations.

See also Asthma • Bronchiolitis and Infectious Bronchitis • Chronic Obstructive Pulmonary Disease (COPD) • Collapsed Lung (Pneumothorax) • Pleurisy • Pneumonia • Tobacco-Related Diseases: Overview • Toxic Inhalation Injuries • Vaccines and Immunization

* alveoli (al-VE-ol-i) are air sacs in the lungs through which oxygen and carbon dioxide exchange. Oxygen enters the bloodstream; carbon dioxide leaves the bloodstream to be exhaled through the lungs.

* arterial blood gas is a type of blood test that measures the percentage of gases—specifically, oxygen and carbon dioxide—in the blood.

* antibiotic (an-tie-by-AH-tik) is a drug that kills or slows the growth of bacteria.

* bronchodilator (brong-ko-DYElay-tor) is a medication that helps improve air flow through the lungs by widening narrowed airways.

* dietitian is a person who has specialized knowledge and experience in human nutrition and diet therapy. Also called a nutritionist.