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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
Incidence and Cause; Population Affected; Indications
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
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,
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
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
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
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.