January 29, 2015

Kathy Kurth, APRN, CNP
Internal Medicine
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It’s a fact of life. Everyone breathes a little harder and heavier as they age, but in people with emphysema, the progression occurs much faster. In the United States, nearly four million people have emphysema and more than 100,000 people die from the disease each year. And, many more people die from a secondary disease caused by emphysema. Lung disease, including emphysema, is the fourth most common cause of death in the United States.

What is emphysema?
Emphysema is a serious disease that affects the lungs. It is one of three major diseases included under the category of COPD, or chronic obstructive pulmonary disease, along with chronic bronchitis and asthmatic bronchitis. Because severe bronchitis and emphysema are so closely interrelated, physicians often refer to a combined disorder known as COPD. The two diseases often develop simultaneously and require similar treatments. When the two occur together, it is sometimes difficult to distinguish between the two. When a person suffers from emphysema, the alveoli, or tiny air sacs in the lungs, lose elasticity, making it difficult to breathe.

Smoking, the most common cause of emphysema, often causes chronic bronchitis, which tends to narrow and obstruct the bronchial airways with mucus, scarring, and muscle spasms in the walls of the bronchial tubes. As a result, air becomes trapped in the lungs, making it difficult to exchange with new air; therefore, hard to breathe. There are four stages of emphysema: mild, moderate, severe and very severe. As the disease advances, an individual will see more symptoms and quality of life changes. Although symptoms of emphysema may appear suddenly and rapidly, the disease itself takes a long time to develop.

What causes emphysema?
Smoking is the biggest contributing factor to emphysema. It accounts for 80 percent of all cases. Not surprisingly, cigarette smokers are 10 to 15 times more likely to develop emphysema than non-smokers. Emphysema may also be caused by exposure to other pollutants including occupational hazards and exposures such as chemicals and dust, secondhand smoke, poor indoor ventilation and outdoor air pollution. Some individuals may have a rare genetic deficiency of alpha-1 antitrypsin which is a natural chemical in the body that controls elasticity in the lungs and may protect against damage to the lungs. This deficiency may cause emphysema to develop in non-smokers at a young age, typically under age 40.

What are symptoms of emphysema?
Emphysema is a serious disease that may be fatal. Detecting emphysema in its early stages may make treating and living with emphysema more manageable. The symptoms sometimes do not appear right away but rather when the disease is in its later stages typically in smokers after age 50.

 – Shortness of breath (even with light activity)

 – Rapid, labored breathing and persistent craving for air Enlarged chest

 – Constant tiredness (even after waking up)

 – Cough-with or without mucus Inability to exercise

Rare symptoms may include:
 – Unintentional weight loss

 – Excessive sweating

 – Fever and chills

If any of the symptoms listed above develop, contact a health care provider immediately. The earlier the diagnosis can be made, the easier it will be to manage the disease and benefit from more treatment options.

How is emphysema diagnosed?
A health care provider may diagnose emphysema by physical exam, history and symptoms. Upon physical exam, a physician may hear wheezing, decreased breath sounds or prolonged exhalation. But, the gold-standard for diagnosing emphysema is via spirometry which is a lung function test that measures volume and force of air as it is exhaled from the lungs. It measures how much air and how fast the air is exhaled. A chest x-ray or CT scan may show inflated lungs but at the point an x-ray reveals the disease, symptoms are apparent to the patient. X-ray or CT may be helpful in ruling out lung cancer.

What kinds of treatment are available for emphysema?
There is not any treatment currently available to reverse emphysema but there are measures to control it and its symptoms. Emphysema is typically considered a progressive, non-reversible disease. The goal is to identify the disease soon enough to administer general maintenance treatments.

Because smoking is the main cause of emphysema, permanent smoking cessation is necessary. Smoking cessation is the only way to stop the progression of emphysema. Continuing to smoke may increase the severity of the disease. In many who do quit smoking early, lung function may stabilize but the lost lung function is never fully recovered.

There are many medical treatments available to slow the progression of the disease. A health care provider may prescribe some medications to relax the bronchial muscles, open the airways and reduce inflammation including short-acting and long-acting bronchodilators. An inhaled steroid, in addition to a long-acting bronchodilator, often heeds the best results. Although bronchodilators do not improve or cure the disease, they do help improve day-to-day quality of life by improving breathlessness and the ability to exercise.

Receiving annual influenza vaccines and the pneumococcal vaccine when recommended can help prevent infections and associated complications in those with emphysema.

Patients may also participate in pulmonary rehabilitation which focuses on exercise training, breathing classes and nutritional education which help ease the symptoms of emphysema. These treatments usually work best for those in the early stages of the disease.

For those with very severe emphysema, some surgeries may be an option including bullectomy (removal of a consolidated area of emphysema) and lung transplant, although these are rare occurrences.

Keeping infection under control is important for maintenance of the disease because any infection can worsen symptoms and speed deterioration of the lungs. A physician may treat an individual with emphysema for respiratory infections such as bronchitis with antibiotics early to prevent this from happening and in severe cases, may add breathing equipment that helps administer oxygen.

Who develops emphysema?
Not surprisingly, smokers have the highest risk of developing emphysema. The typical patient with emphysema is a current or former smoker, over the age 50. Studies show that 15 to 20 percent of all smokers will develop emphysema in their lifetime. Emphysema is very rare in young people under 40 but the incidence of emphysema steadily increases with age. Women are just as likely to develop the disease as men but more women tend to die from emphysema. Women also report more severe symptoms, greater depression and tend to have poorer quality of life. They seem to be more susceptible to the effects of smoking and pollutants possibly because of hormones.

There are a fair number of occupations that put workers at a higher risk of exposure to potentially harmful irritants. Workers exposed to toxic chemicals, dust and air pollutants are at a greater risk to develop emphysema than workers who choose other occupations. Some potential occupations may include: grain farmers, miners, furnace workers, welders and cooks.

What can be done to reduce the risk of emphysema?
Once an individual develops emphysema, the damage cannot be reversed so it is best to reduce the risk of emphysema from happening in the first place. The simplest way to reduce the risk of emphysema is to refrain from smoking altogether. If it is too late to refrain, quit smoking immediately. It is also important to avoid second-hand smoke. Try and avoid occupational risk factors. Additional healthy life-style choices are also helpful. Exercising and eating healthy meals and snacks has been shown to reduce the risk of emphysema.