Facts about Emphysema

What is Emphysema?

Emphysema is a condition in which there is overinflation of structures in the lungs known as alveoli or air sacs. This overinflation results from a breakdown of the walls of the alveoli. The overinflation causes a decrease in respiratory function (the way the lungs work) and often, breathlessness. Early symptoms of emphysema include shortness of breath and cough.

How serious is emphysema?

* Emphysema is a widespread disease of the lungs. In 1994, 2.0 million people in the US had emphysema.

* In the Philippines, the extrapolative prevalence of emphysema is 634,130 based on an estimated population of 8,624,697.

* Emphysema ranks 14th among chronic conditions that cause 30% or more limitations in major or outside activity. Over 44% of individuals with emphysema report that their daily activities have been limited by the disease.

* Many of the people with emphysema are older men, but the condition is noted increasingly among women. Males with emphysema outnumber females by 24%.

What are the Causes of Emphysema?

It is known from scientific research that the normal lung has a remarkable balance between two classes of chemicals with opposing action. The lung also has a system of elastic fibers. The fibers allow the lungs to expand and contract. When the chemical balance is altered, the lungs lose the ability to protect themselves against the destruction of these elastic fibers. This is what happens in emphysema. 

There are a number of reasons this chemical imbalance occurs. Smoking is responsible for 82% of chronic lung disease, including emphysema. Exposure to air pollution is one suspected cause. Some irritating fumes and dust on the job are also thought to be factor.

A small number of people with emphysema have a rare inherited form of disease called alpha1-antitrysin (AAT) deficiency-related emphysema, or early onset emphysema. This form of the disease is caused by an inherited lack of protective protein called alpha 1-antitrypsin (AAT).

How does Emphysema develop?

* Emphysema begins with the destruction of air sacs (alveoli) in the lungs where oxygen from the air is exchanged for carbon dioxide in the blood.

* The walls of air sacs are thin and fragile.

* If the air sacs are damaged, it becomes irreversible and results in permanent "holes" in the tissues of the lower lungs.

* The air sacs are destroyed, the lungs are able to transfer less and less oxygen to the bloodstream, causing shortness of breath.

* If the air sacs are destroyed, the lungs also lose their elasticity. The patient will experience great difficulty exhaling.

Emphysema doesn't develop suddenly - it comes on very gradually. Years of exposure to irritation or cigarette smoke usually precede the development of emphysema.

A person may initially visit the doctor because he has begun to feel short of breath during activity or exercise. As the disease progresses, a brief walk can be enough to bring on difficulty in breathing. Some people may have had chronic bronchitis before developing emphysema.

What is the treatment for Emphysema?

Doctors can help people with emphysema live more comfortably with their disease. The goal of treatment is to provide relief of the symptoms and prevent progression of the disease with minimum side effects. The doctor's advice and treatment may include:

* Quitting smoking - the single most important factor for maintaining healthy lungs.

* Bronchodilator drugs (prescription drugs that relax and open up air passages in the lungs) - may be prescribed to treat emphysema if there is a tendency toward air constriction or tightening. These drugs may be inhaled as aerosol  sprays or taken orally.

* Antibiotics - if the patient has a bacterial infection such as pneumococcal pneumonia.

* Exercise - include exercises to strengthen the muscles used in breathing. This is part of a pulmonary rehabilitation program to condition the rest of the body.

* Treatment - with Alpha 1 - Proteinase Inhibitor (A1P1) only if a person has AAT deficiency related emphysema. A1P1 is not recommended for those who develop emphysema as a result of cigarette smoking or other environmental factors.

* Lung transplantation - Some recent reports have been encouraging. Experience at this point in time is limited.   

* Lung volume reduction surgery is a new modification of a surgical procedure in which the most severely diseased portions of the lungs are removed to allow the remaining lung and breathing muscles to work better. Early studies are promising, but more information is needed to fully understand the usefulness of this procedure.

How is Emphysema prevented?

Continuing research is being carried out to find answers to many questions about emphysema, especially about the best ways to prevent the disease.

Researchers show that quitting smoking can prevent the occurrence and decrease the progression of emphysema. Other environmental controls can also help prevent the disease.

if an individual has emphysema, the doctor will advise the patient to prevent the disease from getting worse. This would include maintaining resistance against infections.

General Health Guidelines:

1. QUIT SMOKING. A majority of those who get emphysema are smokers. Continued smoking makes emphysema worse.

2. Maintain overall good health habits, which include proper nutrition, adequate sleep, and regular exercise to build up your stamina and resistance to infections.

3. Reduce the exposure to air pollution, which may aggravate symptoms of emphysema. On days when the ozone (smog) level is unhealthy, restrict the activity to early morning or evening. When pollution levels are dangerous, remain indoors and stay as comfortable as possible.

4. Consult the doctor at the start of any cold or respiratory infection because infection can make the emphysema symptoms worse. Ask about getting vaccinated against influenza and pneumonococcal pneumonia.

To receive more information about emphysema, please contact:

PULMONARY DIAGNOSTIC & THERAPEUTICS CENTER
Tel. No. (632) 988-1000 / (632) 988-7000 Ext. 6238

CENTER FOR PATIENT PARTNERSHIP
Tel. No. (632) 988-1000 / (632) 988-7000 Ext. 6444

References:

- American Lung Association

- WHO, 1994

- The Medical City, Department of Medicine, Section of Pulmonary Medicine

Note:   This information is not intended to be used as a substitute for professional medical advice, diagnosis or treatment.   If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.