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Health, Tobacco and emphysema

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  • 1. Emphysema Importance Emphysema is a widespread disease of the lungs. Over 2 million people in the United States have emphysema. Emphysema ranks ninth among chronic conditions that contribute to inactivity. Over forty-three percent of individuals with emphysema have had their daily activities limited by the disease. Emphysema is a serious disease that can damage your lungs and your heart. You should see your doctor at the first sign of symptoms. Symptoms of Emphysema The first symptom of emphysema is usually shortness of breath. Sometimes coughing or wheezing are noticed first, and patients and doctors alike may confuse it with asthma. Weight loss occurs frequently and may be so sever that cancer is suspected. Some patients have chronic bronchitis before developing emphysema. With time, the patient develops an expanded "barrel chest" due to trapped air in the outer parts of the lung. Incidence and Cause; Population Affected; Indications for Treatment: Emphysema is caused by over-inflation of the small air- containing sacs in the lungs known as alveoli. This over- inflation is caused by the breakdown of the walls of the alveoli by various factors. The lungs are normally highly
  • 2. elastic structures which contract by themselves when a person exhales; exhalation normally requires little to no effort by a person. In emphysema, however, the elasticity of the lungs is reduced, and so it requires more time and effort for a person to exhale. Emphysema is a progressive disease and so it becomes worse with time. It may take many years for the disease to develop to the point that a person notices it. Eventually, emphysema will begin to have a negative impact on a person’s daily activities. It is very important that emphysema be diagnosed and treated as early as possible. The longer the disease goes undetected, the more serious a patient’s impairment is likely to be. The are two main forces which cause the lung damage that leads to emphysema. The first, and most important, is tobacco smoke. Tobacco smoke is highly irritating to the airways and it acts in several ways within the lungs to cause the breakdown of alveolar walls. The other main cause of emphysema is a condition known as alpha-1 antitrypsin deficiency. Alpha-1 antitrypsin is a protein which is normally present in the lungs and which protects the lungs from the damage which can lead to emphysema. Some people have a deficiency of this protein and so they are at a greater risk of developing emphysema. Other causes are thought to include air pollution and long- term exposure to toxic chemicals. The incidence of emphysema has been increasing steadily in the last several decades. Current estimates place the number of individuals affected in the United States at around 2-3 million. Emphysema is more common in men,
  • 3. but its incidence in women is increasing. Smoking is the most important cause of emphysema and it is estimated that over 80% of emphysema cases are due to smoking. It is thought that around 100,000 people in the United States have alpha-1 antitrypsin deficiency, a condition which often leads to emphysema. Treatment of Emphysema Through early diagnosis, symptomatic treatment, and patient education, those who suffer from emphysema may lead fuller more active lives. The most important though oftentimes most difficult element in treating emphysema is lifestyle modification. Those patients who smoke should stop smoking immediately; this is the most important step patients can take to stabilize their disease and guard against further lung damage. Also, regular exercise, such as water aerobics, may lead to an improvement in overall strength and endurance. Patients whose emphysema is the result of alpha-one antitrypsin (an enzyme) deficiency may receive a specific treatment with alpha-one antitrypsin to halt their disease. Unfortunately, the effectiveness of this treatment has not been well demonstrated; there are also significant side effects such as liver damage associated with this replacement therapy. Otherwise, emphysema is treated with drugs that combat specific disease complications. Bronchodilators act to enlarge constricted airways and ease the work of breathing. Short acting (3-6 hrs) powerful bronchodilators, such as
  • 4. albuterol or tertbuterol, usually are inhaled for sudden attacks of breathing difficulty and have few side effects. Other bronchodilators taken in pill form have longer lasting effects but are not generally useful in treating emphysema. Corticosteroids, drugs that reduce airway inflammation, are most often inhaled early in an attack to lessen the degree of airway obstruction over the next day. Few side effects are associated with this use of corticosteroids. Additionally, emphysema may require patients to use supplemental oxygen. Some may need oxygen therapy only during activities or sleep while others may need 24-hour oxygen. In either case, patients should be re-evaluated around two months after the start of therapy as up to forty percent may have improvement sufficient to end oxygen therapy. Patients not requiring oxygen therapy may benefit from breathing techniques, such as pursed-lipped breathing, to lessen the shortness of breath. Finally, emphysema patients are generally treated with pneumococcal vaccine (Pneumovax) and a yearly influenza vaccine (flu-shot) to prevented complicating their disease. Surgical treatment for emphysema includes volume reduction surgery and lung transplant. Volume reduction surgery reduces the work of breathing but does not correct the shortness of breath; lung transplant can potentially cure emphysema in some patients.