In the US, over 4 million people have received a diagnosis of emphysema, a number that represents about 1.7% of the population. In 2013, 8,284 people in the country died with emphysema.1
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Fast facts on emphysema
Here are some key points about emphysema. More detail and supporting information is in the body of this article.
- Most cases of COPD, and therefore emphysema, are caused by cigarette smoking.
- Emphysema is rarely caused by a congenital condition known as α1-antitrypsin deficiency, for which there is a lab test.
- Shortness of breath and cough are the main symptoms of emphysema.
- Doctors diagnose COPD and emphysema with lung function tests to measure lung capacity.
- Spirometry is used in diagnosis - to measure the volume of air a patient can blow out in one second after a deep breath.
- Treatment does not halt or reverse lung damage but eases symptoms and prevents exacerbations.
- Drugs and supportive therapies are the mainstay of emphysema treatment.
- Drugs may include inhaled bronchodilators, corticosteroids and, when there is an infection, antibiotics.
- Support therapy includes oxygen supplementation, nutrition, help with smoking cessation, and other educational interventions.
- Surgical intervention, including lung transplantation, is reserved for severe cases of emphysema.
- People with emphysema and COPD should have an annual flu jab and may be recommended for a pneumonia shot once every 5 years.
What is emphysema?
Emphysema is a condition that forms part of chronic obstructive pulmonary disease (COPD) and involves the enlargement of the air sacs in the lung.2-4
The alveoli at the end of the bronchioles of the lung become enlarged because of the breakdown of their walls. The fewer and larger damaged sacs that result mean there is a reduced surface area for the exchange of oxygen into the blood and carbon dioxide out of it.2-4
The damage is permanent - not reversible - and it causes reduced respiratory function and breathlessness. The damage takes a number of forms - the sacs can be destroyed, narrowed, collapsed, stretched or over-inflated.2-5
Causes of emphysema
The biggest known cause or risk factor for emphysema - and for COPD - is smoking.4,6-8 Cigarette smoking is responsible for around 90% of cases of COPD.7 However, COPD will develop only in smokers who are genetically susceptible - smoking does not always lead to the disease.8
Smoking is the leading cause of emphysema.
Other inhaled toxins also lead to emphysema and COPD, including work-related ones. In developing countries, smoke from indoor cooking and heating is also an important cause.7,8
While the following are not as important as primary cigarette smoke exposure, they are minor contributory risk factors:4,7,8
- Low body weight
- Childhood respiratory disorders
- Exposure to passive cigarette smoke
- Air pollution
- Occupational dust (mineral dust, cotton dust, for example)
- Inhaled chemicals (coal, grains, isocyanates, cadmium, for example).
Genetics are responsible for a rare form of COPD - emphysema can be caused by α1-antitrypsin deficiency. The protein is necessary for protecting the lungs against neutrophil elastase destruction of alveolar tissue.8,9 The deficiency is congenital - that is, people are born with it.
The genetic disease affects non-smokers, explaining some of the cases, with onset earlier in life, of COPD that are not caused by smoking. Smoking does, however, accelerate genetically predisposed cases of emphysema.8
Symptoms of emphysema
Two symptoms are the main markers of emphysema and present early on:4,9,10
Cough is one of the main symptoms of emphysema.
- Shortness of breath
Shortness of breath is also known as dyspnea and gives the feeling of being unable to catch a breath. This symptom may be present only during physical exertion but as the disease progresses may be present during rest, too - emphysema and COPD take years to develop and progress.8-10
Other symptoms may be experienced, especially in more advanced lung disease:4,6,8,10
- Frequent lung infections
- Producing a lot of mucus (phlegm or sputum)
- Reduced appetite
- Weight loss
- Blueness of the lips or fingernail beds (from cyanosis caused by poor respiration)
- Anxiety, depression
- Sleep problems
- Morning headache signals nighttime breathing difficulty (nocturnal hypercapnia or hypoxemia)
Many of the symptoms of emphysema and COPD are shared by other medical conditions; it is important to seek a doctor's examination and diagnosis.
On the next page we look at tests and diagnosis of emphysema as well as prevention and treatment.