Emphysema is one of these diseases. It damages the air sacs in the lungs, making it progressively harder for the body to get the oxygen it needs.
Chronic obstructive pulmonary disease (COPD), including emphysema, affects nearly 30 million people in the United States, with over 50 percent not realizing that they have it.
Early screening can identify COPD or emphysema before major loss of lung function occurs.
What is COPD?
When a person breathes, the air travels into tubes in the lungs called bronchial tubes or airways. These tubes split into thousands of smaller pathways called bronchioles. The bronchioles end in alveoli or groups of tiny air sacs. Blood capillaries run through the walls of these air sacs.
Air pollution may be a cause of COPD and emphysema.
Oxygen passes through the walls of the air sacs into the blood-carrying capillaries. While this is happening, the capillaries transfer the waste gas carbon dioxide back into the air sacs so it can be exhaled.
In a healthy individual, the bronchioles and alveoli are elastic. With every breath, each air sac inflates like a small balloon as the person breathes in, and it deflates as they breathe out.
In COPD, this process does not happen as easily, and less air flows through the airways.
This is because:
- The airways and air sacs are no longer elastic, and they cannot fill with as much oxygen
- The walls of the airways thicken and swell
- The airways clog up with extra mucus
- The walls of air sacs are destroyed
What is emphysema?
The main problem in emphysema is that the walls of the air sacs get destroyed. The inner walls of the sacs weaken and burst, creating one large space to hold air instead of many small ones.
This reduces the surface area of the lungs, which means that less oxygen can get into the bloodstream through the capillaries.
Because the air sacs are so damaged, the old air is unable to escape and gets trapped in the lungs. This leaves less room in the air sacs for fresh air to enter, compounding the problem of getting new oxygen to the body.
Symptoms of COPD and emphysema
Most symptoms of COPD and emphysema take time to appear. Unfortunately, symptoms only occur after significant lung damage has occurred.
Symptoms are most noticeable at first during physical activities.
The person may experience:
- Shortness of breath
- Tightness in the chest
- Wheezing or whistling sound in the chest
- A chronic cough that may produce clear, white, yellow, or green mucus
- Feeling of excess mucus in the throat first thing in the morning
- Blue lips or nail beds
- Frequent colds or respiratory infections
- Lack of energy
- Unexplained weight loss
- Swelling in lower extremities
Symptoms tend to worsen over time, especially if exposure to smoke is not eliminated.
Causes of COPD and emphysema
The main causes of all forms of COPD, including emphysema, are environmental.
In developed countries, the main cause of COPD and emphysema is tobacco exposure through smoking. In developing nations, the conditions are more likely to result from exposure to burning fuel in poorly ventilated areas. Other causes include long-term exposure to other irritants such as air pollution, chemicals, or dust.
Some people may develop some forms of COPD and emphysema despite never smoking or being exposed to environmental irritants.
There is a genetic type of emphysema in which a person does not have enough of a protein called Alpha-1 antitrypsin. This protein helps to protect the lungs. When a person does not have enough of the protein, the condition is called alpha-1 antitrypsin deficiency (AATD).
The spirometry test is the most common lung function test.
Diagnosing all forms of COPD, including emphysema, can be difficult. Early diagnosis can help slow the progression of the disease, but many people do not receive a diagnosis until serious damage has already occurred in the lungs.
For diagnosis, a doctor will review the person's symptoms, family, and medical history and will ask about exposure to lung irritants, especially cigarette smoke.
The doctor will probably order tests to conclusively diagnose the condition.
These tests may include:
- Spirometry test: The most common lung function test involves blowing into a tube connected to a machine called a spirometer. The machine measures how much air the lungs can hold and how fast the air can be blown from the lungs. This test can detect lung disease before symptoms start, and it may track progression of the disease. It can also monitor how well treatment is working.
- Other lung function tests: These can measure the amount of air inhaled and exhaled. They also examine the lungs' ability to deliver enough oxygen to the blood.
- Chest X-ray or CT scans: Both of these imaging tests can show emphysema. They can also identify other issues such as cancer and heart failure.
- Blood gas analysis: This blood test measures the amount of oxygen and carbon dioxide in the blood, which indicates how well the lungs are performing.
- Other blood tests: Blood tests do not diagnose COPD or emphysema, but they can rule out other conditions or determine the cause of the disease. Lab tests can identify the genetic disorder alpha-1-antitrypsin deficiency (AATD), which may cause emphysema in up to 12 percent of all cases.
When to see a doctor
Knowing when to seek medical treatment for COPD and emphysema can be tricky since the symptoms may be subtle. Anyone who experiences the symptoms listed above should speak to a doctor promptly.
If the condition is already being treated, a patient will need to seek medical care if any of the following occur:
- Shortness in breath that is worse or more frequent than usual
- Changes to color, amount, or thickness of mucus or sputum
- Mucus or sputum becomes bloody
- Increase in coughing or wheezing
- Weight gain of more than 2 pounds a day or 5 pounds in a week
- New swelling of the feet or ankles that does not go away after sleeping with the feet up
- Headaches or dizziness, most frequently in the morning
- Fever, especially when combined with flu-like symptoms
- Unexplained severe weakness
- Confusion or disorientation
A person who experiences any new shortness of breath or breathing difficulty that is not relieved by medications should see a doctor immediately.
Treating COPD and emphysema
Quitting smoking is crucial after a COPD or emphysema diagnosis.
There is no cure for any form of COPD, including emphysema, but treatment can help to slow the progression of the disease and manage symptoms.
Treatments include medical, surgical, and therapeutic interventions.
Medical treatments for COPD and emphysema may be a mixture of inhaled and oral medicines.
Options often include:
- Bronchodilators: These medications are normally inhaled and they relax the muscles around the lungs, relieving cough and shortness of breath
- Steroids: Taken orally or inhaled, steroids prevent further worsening of COPD
- Antibiotics: Because people with COPD and emphysema are very susceptible to lung infections, antibiotics may be needed to treat bacterial cases of bronchitis or pneumonia
In addition to medication, pulmonary therapy and rehabilitation may be prescribed.
A respiratory therapy program teaches people ways to improve their breathing and ability to exercise. The goal of pulmonary therapy is to improve a person's quality of life and to decrease the frequency and duration of hospital stays. Other therapy may include the use of supplemental oxygen to take the burden off damaged lungs.
Some people may have such severe COPD or emphysema that surgery may be necessary to improve quality of life and to manage the symptoms of the disease.
Surgical treatment options include:
- Lung transplant, a major surgery that involves replacing the damaged COPD lungs with healthy lungs from a donor. It is not suitable for everyone, and major risks include organ rejection.
- Lung volume reduction decreases lung volume through the removal of damaged lung tissue. This creates more room for the lungs to expand.
- Bullectomy involves removing large air spaces called bullae that form in the lungs when the air sacs become damaged. Removing the bullae helps to improve the air flow.
Tips to manage COPD and emphysema at home
For patients with COPD and emphysema, managing the disease is crucial to slowing its progress and for maximizing quality of life.
Some things that people with COPD and emphysema can do to improve their health include:
- Quitting smoking: Smoking causes and worsens COPD and emphysema, so it is crucial to stop smoking as soon as possible after a diagnosis.
- Controlling breathing: Techniques learned in pulmonary rehab can help manage shortness of breath.
- Eating a healthy diet: This helps to maintain strength and a strong immune system.
- Getting plenty of exercise: Activity improves endurance and increases lung function, which can lessen symptoms. Regular physical activity can also improve mood, strength, and balance.
- Managing mucus: Clearing mucus from the airways through controlled coughing and hydration can help.
- Avoiding pollutants: Keeping away from secondhand smoke and staying indoors on days with poor air quality can slow the progression of the disease.
Patients should adhere to the physician's instructions, take all prescribed medications, and see their doctor regularly.