Introduction

Emphysema is a lung disease.  The condition of emphysema makes it difficult to exhale air and empty the lungs when breathing.  In turn, the lungs are unable to completely fill up with fresh air when inhaling.  This leads to a decreased level of oxygen in the blood over time.  Your body cells need oxygen to function. 

Cigarette smoking is the major cause of emphysema.  It is a long-term progressive disease.  Patients with emphysema have shortness of breath and limited activity levels.  Symptoms can reduce with treatments including oxygen.  In severe cases, lung surgery or lung transplants may be treatment options.

Anatomy

Your lungs are located inside the ribcage in your chest.  Your diaphragm is beneath your lungs.  The diaphragm is a dome-shaped muscle that works to open your lungs when you breathe. 

From your nose and mouth, air travels towards your lungs through a series of tubes.  The trachea or windpipe is located in your throat.  The bottom of the trachea separates into two large tubes called the main stem bronchi.  The left main stem bronchus goes into the left lung, and the right main stem bronchus goes into the right lung. 

Inside the lung, the bronchi branch off and become smaller.  These smaller air tubes are called bronchioles.  There are approximately 30,000 bronchioles in each lung.  The end of each bronchiole has tiny air sacs called alveoli.  There are about 600 million alveoli in your lungs.  Each alveolus is covered in small blood vessels called capillaries.  The capillaries move oxygen and carbon dioxide in and out of your blood.

When you breathe air in or inhale, your diaphragm flattens and your ribs move outward to allow your lungs to expand.  The air that you inhale through your nose or mouth travels down the trachea.  Tiny hair-like structures in the trachea, called cilia, filter the air to help keep mucus and dirt out of your lungs.  The air travels through the bronchi and the bronchioles and into the alveoli.  Oxygen in the air passes through the alveoli into the capillaries.  The oxygen attaches to red blood cells and travels to the heart.  The heart then sends the oxygenated blood to the cells in your body. 

When you breathe air out or exhale, the process is the opposite of when you inhale.  Once your body has used the oxygen in the blood, the deoxygenated blood returns to the capillaries.  The blood now contains carbon dioxide and waste products that must be removed from your body.  The capillaries transfer the carbon dioxide and wastes from the blood and into the alveoli.  The air travels through the bronchioles, the bronchi, and the trachea.  As you exhale, your diaphragm rises and your ribs move inward.  As your lungs compress, the carbon dioxide is released out of your mouth or nose. 

Causes

Emphysema is categorized as a chronic obstructive pulmonary disease (COPD), meaning that it is a lifelong condition that impairs the lungs.  Emphysema is caused by damage to the alveoli.  Long-term cigarette smoking is the most common cause of damage.  Air pollutants contribute to the condition as well.  Researchers believe that these irritants cause chemicals to be released in the lungs that damage the alveoli.  As the condition progresses, the alveoli do not exchange oxygen and carbon dioxide efficiently.

Cigarette smoking also damages the cilia in the airways, eventually eliminating them.  Mucous builds up in the respiratory tract without the sweeping motion of the cilia.  Mucus buildup can lead to infection.

Symptoms

 Shortness of breath is the most common symptom of emphysema.  You may also cough or wheeze.  Over time, you may experience a decrease in your physical activity level.  Anxiety, being tired, unintentional weight loss, and ankle, foot, or leg swelling are also symptoms associated with emphysema.

Diagnosis

Your doctor can start to diagnose emphysema by reviewing your medical history and conducting a physical examination.  You should tell your doctor about your symptoms and risk factors.  Your doctor will listen to your heart and the lung sounds in your chest while you breathe.  Your doctor may order tests to detect infection, determine the extent of your condition, and rule out other conditions that have similar symptoms.

Your doctor may ask you to undergo some tests called pulmonary function testing (PFTs).  For example, your doctor will have you breathe into a hand-held device called a spirometer.  A spirometer measures how much air you breathe out and how forcefully you breathe the air out.  Your doctor will also have you breathe into a peak flow meter.  A peak flow meter is a hand-held device that monitors the airflow through your bronchi.  The peak flow meter measures your ability to expel air from your lungs under the best or peak conditions.  Other more complex PFTs may be performed to further define your breathing condition.  By monitoring the changes in your breathing patterns your doctor can identify how well your lungs are functioning, the severity of your symptoms, and appropriate treatment.

Your doctor may use a pulse oximeter to determine the amount of oxygen in your blood.  For this test, a probe will simply be placed on your fingertip.  A medical device attached to the probe displays the percentage of oxygen in your blood. 

Your doctor may take a sample of your blood to determine the amount of carbon dioxide and oxygen in your blood.  If you have a family history of alpha-1 antitrypsin deficiency, your doctor can test your blood for this as well.  Additionally, your doctor may order a chest X-ray to look for signs of infection or structural changes in your lungs.

Treatment

The most important thing you can do if you have emphysema is to quit smoking.  Quitting smoking can stop the progression of the disease and improve the functioning of your lungs.  Your doctor can help you to quit smoking thru counseling and/or medication.  Your doctor can prescribe medications to help you breathe, including oxygen.  Rehabilitation can improve your activity level and quality of life.  If you develop a lung infection, your doctor can prescribe antibiotic medications or you may need hospitalization. 

Some people with advanced emphysema may be candidates for surgery.  Lung reduction surgery is used to remove the damaged portion of the lung.  This allows the healthy portion of the lung to perform better.  People with very advanced emphysema may be candidates for lung transplants.  One or both lungs maybe remove and replaced with donated lungs.  Lung transplant surgery can improve activity levels and quality of life.

The experience of emphysema can be an emotional process for people with the condition and their loved ones.  It is important that you receive support from a positive source.  Some people find comfort in their family, friends, co-workers, and faith.  Lung disease support groups are another good option.  They can be a good source of information and support from people who understand what you are experiencing.  Ask your doctor for a lung disease support group located in your area.

Prevention

Avoiding and quitting smoking can greatly decrease your risk of developing emphysema.  Talk to your doctor about methods to help you quit smoking if you are unable to do so by yourself.  There are many smoking cessation products on the market that your doctor will be happy to recommend.

Am I at Risk

Certain risk factors may increase your likelihood of developing emphysema, although some people that develop the condition do not have any risk factors.  People with all of the risk factors may never develop the disease; however, the chance of developing emphysema increases with the more risk factors you have.  You should tell your doctor about your risk factors and discuss your concerns. 

Risk factors for emphysema:

_____ Smoking is a major cause and significantly increases the risk of emphysema.
_____ Men are more likely to develop emphysema than women.
_____ Older age is associated with emphysema because lung function normally declines with age.
_____ Bronchiole asthma is a risk factor for emphysema.
_____ Air pollution contributes to emphysema.
_____ People with alpha-1 antitrypsin deficiency are at an increased risk for the disease.
Alpha-1 antitrypsin is a substance in the lungs that may protect against lung destruction leading to emphysema.
_____ Researchers suspect that emphysema may be inherited.  If your close relatives have the condition, you may have an increased risk.

Complications

Emphysema is associated with recurrent respiratory system infections.  It can also affect your heart.  Emphysema can cause changes in the blood pressure of your lungs leading to the right side of your heart enlarging.  It can lead to an increase in red blood cells. 

Emphysema is a chronic condition that gets worse over time.  It can result in a decreased quality of life as it reduces your energy and activity level.  Complications from emphysema can result in death.

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