Chronic obstructive pulmonary disease, commonly known as COPD, refers to a group of progressive lung diseases that cause increasing breathlessness.
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, according to the COPD Foundation. Over 50 percent do not realize that they have it.
Early screening can identify COPD or emphysema before major loss of lung function occurs. Quitting smoking or never smoking can reduce the risk.
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.
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
The main problem in emphysema is that the walls of the air sacs are 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, so that less oxygen can get into the bloodstream through the capillaries.
Because of the damage to the air sacs, the old air is unable to escape and stays 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.
Most symptoms of COPD and emphysema take time to appear. Unfortunately, symptoms usually 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
- 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 a person continues to smoke or be exposed to smoke.
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 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, they have a condition called alpha-1 antitrypsin deficiency (AATD), according to the National Human Genome Research Institute (NHGRI).
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 they already have serious damage in their 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.
Tests that can help confirm the diagnosis include:
Spirometry test: This is the most common lung function test. The person blows into a tube connected to a machine called a spirometer. The machine measures how much air the lungs can hold and how fast the person can blow the air 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 that a person inhales and exhales. They also examine the lungs' ability to deliver enough oxygen to the blood.
Blood gas analysis: This blood test measures the amount of oxygen and carbon dioxide in the blood. These measures can show 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.
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 a person is already receiving treatment, they 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 does not improve with medications should see a doctor.
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 include inhaled and oral medicines.
Options often include:
Bronchodilators: A person normally inhales these medications. They relax the muscles around the lungs, relieving cough and shortness of breath.
Steroids: Taking oral or inhaled steroids can stop COPD from getting worse.
Pulmonary therapy and rehabilitation
A doctor may also recommend pulmonary therapy and rehabilitation.
A respiratory therapy program: The individual learns new ways to improve their breathing and their ability to exercise. Therapy aims to improve a person's quality of life and to decrease the frequency and duration of hospital stays.
Supplemental oxygen: A person may need this to take the burden off the damaged lungs.
Some people may need surgery to improve their quality of life and to manage the symptoms of the disease.
Lung transplant: A surgeon replaces the COPD-damaged lungs with healthy lungs from a donor. It is not suitable for everyone, and major risks include organ rejection.
Lung volume reduction: This decreases lung volume by removing damaged lung tissue. This creates more room for the lungs to expand.
Bullectomy: This 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.
Managing COPD can improve a person's quality of life and slow disease progression.
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: A person can use the techniques they learn in pulmonary rehab to manage their shortness of breath.
Eating a healthy diet: This helps to maintain strength and boost the 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.
A person with COPD should follow the physician's instructions, take all prescribed medications, and see their doctor regularly.
COPD refers to a number of lung conditions, and emphysema is one of them.
COPD and emphysema can be life-threatening. It is important for people to recognize the signs and learn how to manage their symptoms.
Stopping smoking and asking others not to smoke around you is one way of reducing the risk of developing COPD and emphysema.