Lung Disease - Emphysema and bronchitis

Emphysema and chronic bronchitis are diseases that involve the whole lung. They can be of varying severity, and both are characterized by the gradual progression of breathlessness.

Because chronic bronchitis is almost invariably associated with pulmonary emphysema, the combined disorder frequently is called obstructive-airway disease . The disease involves damage to the lung tissue, with a loss of normal elasticity of the air sacs ( emphysema ), as well as damage to the bronchi , the main air passages to the lungs. In addition, chronic bronchitis is marked by a thickening of the walls of the bronchi with increased mucus production and difficulty in expelling these secretions. This results in coughing and sputum production.

The condition known as acute bronchitis is an acute process generally caused by a sudden infection, such as a cold, with an exaggeration of bronchitis symptoms. If a spasm of the bronchi occurs, accompanied by wheezing, the ailment is called infectious or nonallergic asthma.

Obstructive-airway disease is very insidious, and characteristically people do not, or will not, notice that they are sick until they suddenly are very sick. This is partly because of chronic denial of the morning cough and breathlessness, but also because we are fashioned in such a way as to have great reserve strength in our organs. As the disease progresses one starts using up his reserve for exertion. Because most people's life styles allow them to avoid exertion easily, the victim of this disease may have only rare chances to notice his breathlessness. Then, suddenly, within a period of a few months he becomes breathless with ordinary activity because he has used up and surpassed all his reserve. He goes to a physician thinking he has just become sick. Usually this event occurs when the patient is in his fifties or sixties and little can be done to correct the damage. The time for prevention was in the previous 30 years when elimination of smoking could have prevented much or all of the illness.

Chronic cough and breathlessness are the two earliest signs of chronic bronchitis and emphysema. A smoker's cough is not an insignificant symptom. It indicates that very definite irritation of the bronchi has developed and it should be respected early. Along with the cough there is often production of phlegm or sputum, especially in the morning, because of less effective emptying of the bronchial tree during the relatively motionless period of sleep. Another early manifestation of disease is the tendency to develop chest infections along with what would otherwise be simple head colds. With these chest infections there is often a tightness or dull pain in the middle chest region, production of sputum and sometimes wheezing.

Treatment

Once emphysema or bronchitis are diagnosed there are many forms of therapy that can help. Stopping smoking is the most important measure, and will in itself often produce dramatic effects. The more bronchitis the patient has, the more noticeable the effect, as the bronchial irritation and mucous production decrease, cough lessens, and a greater sense of well-being ensues. The emphysema component does not change, as the damage to the air sacs is irreversible, but the progression may be greatly slowed. When chest infections develop they can be treated with antibiotics.

For more severe disease a program of breathing exercises and graded exertion may be beneficial. When these people develop heart trouble as a result of the strain on the heart, a treatment to strengthen the heart is rewarding. For those with the most advanced stage of the disease new methods of treatment have been devised in recent years. One of the most encouraging is the use of controlled oxygen administration, treatment that can sometimes allow a patient to return to an active working life from an otherwise helpless bed-and-chair existence. But it must be remembered that all these measures produce little effect if the patient continues to smoke.

Vaporizers, Nebulizers, IPPB

Mechanical methods have been developed to help control emphysema, bronchitis, acute and chronic asthma, and other respiratory disorders. These methods include the use of vaporizers, nebulizers, and intermittent positive pressure breathing (IPPB).

The vaporizer is a device that increases the moisture content of a home or room. In doing so, the vaporizer relieves the chronic condition that makes breathing difficult: the increased humidity loosens mucus and reduces nasal or bronchial congestion. One simple type of vaporizer or humidifier is the “croup kettle” or hot-steam type that releases steam into the air when heated on the stove or electrical unit. A more formal type of vaporizer is the electric humidifier that converts water into a spray. In dispersing the spray into the atmosphere, the vaporizer raises the humidity level without increasing the temperature.

The nebulizer also converts liquid into fine spray. But the nebulizer dispenses medications, such as isoproterenol hydrochloride, directly into the throat through a mouthpiece and pressure-injector apparatus like an atomizer. Used in limited doses according to a physician's instructions, nebulization can relieve the labored or difficult breathing symptoms common to various respiratory diseases, among them asthma and bronchitis. The patient controls the dosage while using the nebulizer simply by employing finger pressure and obeying instructions.

In IPPB, a mask and ventilator are used to force air into the lungs and enable the patient to breathe more deeply. The ventilator supplies intermittent positive air pressure. The IPPB method of treatment has been used to help persons suffering from chronic pulmonary disease that makes breathing difficult. But IPPB may also be used with patients who cannot cough effectively; these patients include those who have recently undergone surgery. Newer IPPB units are highly portable; but they must be cleaned carefully with an antibacterial solution before use, and should always be used carefully to avoid producing breathing difficulties or aggravating heart problems.

Smoking and Obstructive Diseases

The problems encountered by patients with obstructive disease do not encompass merely that disease alone. Because of their smoking history these patients are also prone to develop lung cancer. All too often a person with a potentially curable form of lung cancer is unable to undergo surgery because his lungs will not tolerate the added strain of surgery. Patients with obstructive disease are also more prone to pneumonia and other infectious pulmonary conditions. When these develop in the already compromised lung, it may be impossible for the patient to maintain adequate oxygen supply to his vital tissues. If oxygen insufficiency is severe and prolonged enough, the patient dies from pulmonary failure.

Despite the emphasis placed on smoking as the predominant factor for the development of obstructive disease, there are people with the disease who have never smoked. For many of these individuals there is no known cause for their disease. However, a group of younger people with obstructive disease has been found to be deficient in a particular enzyme. (Enzymes are agents that are necessary for certain chemical reactions.) Individuals with this deficiency develop a particularly severe form of emphysema, become symptomatic in their third or fourth decade, and die at a young age. They may not smoke, but if they do, the disease is much more severe. Just how the enzyme deficiency leads to emphysema is not clear, but a great amount of research is being conducted on this new link to try to learn more about the causes of emphysema.