EMPHYSEMA

DEFINITION

Emphysema is a respiratory disorder characterized by problems in breathing. The disorder is caused by the enlargement of air sacs in the lungs.

DESCRIPTION

Emphysema is the most common cause of death from respiratory disease in the United States. It is generally caused by heavy cigarette smoking. In a small number of cases, it is caused by an inherited defect.

Emphysema is most common among people over the age of fifty. In the late 1990s, males are considered more likely to develop the disorder than females. However, that pattern is changing. The number of women who smoke is increasing rapidly. As this number continues to increase, the number of women who die of emphysema will also increase. In 1999, there were around two million people in the United States with emphysema.

CAUSES

When a person inhales, air travels into the nose and mouth. The air then moves downward into the windpipe (trachea, pronounced TRAY-kee-uh). The windpipe branches off into two large tubes called the bronchi (pronounced BRON-ki). Each bronchus, in turn, divides into many smaller tubes called bronchioles (pronounced BRON-kee-olz). Finally, the bronchioles end in many small air sacs called alveoli (pronounced al-VEE-o-lie). It is in the alveoli that oxygen from the air passes into the blood. The blood then carries the oxygen to cells.

A healthy person's lungs contain many tiny alveoli. The total surface area of these alveoli is very large. Oxygen can get through the alveoli into the blood very easily.

In people who smoke, the lungs undergo a change. The walls that separate the alveoli from each other break down. Air spaces combine with each other to make larger and larger air sacs. Although the air sacs get bigger, there are far fewer of them. Overall, the total surface area of these air sacs is much smaller than the surface area of the original alveoli. Less and less oxygen can pass through the air sacs into the blood. When this happens, the symptoms of emphysema begin to appear.

SYMPTOMS

A person with emphysema has to breathe harder to take in more oxygen. He or she is often short of breath and may have to gasp for air. Patients often develop a chronic (long-lasting) mild cough and may begin to lose weight.

These conditions gradually become worse over time. At first, a person may notice shortness of breath only when exercising. Later, even a mild exertion may cause breathing problems. Eventually, the person has trouble breathing even when sitting quietly.

Emphysema often leads to other problems of the pulmonary (lung) system. These problems include pneumonia (see pneumonia entry), pulmonary

Emphysema in lung tissue. The walls between the alveoli have broken down, creating fewer alveoli. (© 1992

J.L. Carson

. Reproduced by permission of

Custom Medical Stock Photo

.

hypertension (high blood pressure in the lungs), and chronic respiratory failure.

DIAGNOSIS

The symptoms of emphysema are obvious. However, they are similar to the symptoms of other respiratory disorders. A major goal of diagnosis is to eliminate other possible causes of the patient's symptoms.

A first step in diagnosis is a medical history. A doctor will determine if there are factors in the patient's background that might suggest emphysema. Smoking is the most obvious of these factors.

A physical examination can provide further information. A doctor may listen through a stethoscope as he or she taps on the patient's chest. A clue to the presence of emphysema is a hollow sound produced by the tapping.

A cross section of a smoker's lung with emphysema. (Photograph by

Dr. E. Walker

. Reproduced by permission of

the Science Photo Library/Photo Researchers, Inc.

)

The hollow sound is caused by the large air sacs that develop as a result of emphysema.

A pulmonary function test may also be conducted. A pulmonary function test involves measuring the amount of air a patient can breathe in and out. That amount is measured against the amount that a healthy person can breathe. The test tells whether the person has emphysema and, if so, to what extent it has developed.

As the disease develops, an X ray can be helpful in making a diagnosis. The X ray may show expansion or stretching of the lungs. The position of the heart may change, or blisters may show up on the lungs. Muscles around the lungs may also appear larger.

Late in the disease, an electrocardiogram (pronounced ih-LEK-tro-KAR-dee-uh-gram) may show progress of the condition. An electrocardiogram measures electrical activity of the heart. As the heart is stressed by the patient's efforts to breathe, changes in electrical activity may begin to show up.

TREATMENT

Once emphysema has developed, there is no way to cure the disease or reverse the damage it has done. However, there are many steps that can be taken to slow the progress of the disease, make the patient more comfortable, and prevent the worst complications of the condition.

The first step is for the patient to stop smoking. Unless the patient makes this decision, his or her condition will only continue to get worse. Further treatment can do relatively little to relieve the symptoms of the disorder.

Special exercises may be prescribed for the patient. One objective of these exercises is to keep the lungs healthy and free of infection. Another goal is to develop the muscles used in breathing.

Bronchodilators (pronounced brong-ko-die-LATE-urs) are sometimes used to help relieve the symptoms of emphysema. Bronchodilators are substances that help tissue relax. They assist airways in opening up to allow air to travel more easily through the lungs. Antibiotics may also be used to reduce the risk of lung infections.

In later stages of the disease, oxygen therapy may be necessary. Oxygen therapy consists of providing patients with an extra supply of oxygen, usually through a nose or face mask. The additional oxygen helps the heart to work more easily and reduces the stress that can lead to heart disorders.

Volume reduction surgery is increasingly used to treat emphysema. In volume reduction surgery, damaged portions of the patient's lung are removed. The procedure makes it easier for the patient to use healthy parts of the lung to get the oxygen needed for ordinary functioning.

A man with emphysema is wheeled from a courtroom by his wife. He is part of a class-action lawsuit against cigarette companies. (Reproduced by permission of

AP/Wide World Photos

)

A treatment of last resort is a lung transplant. In a lung transplant, a healthy lung is removed from a donor and used to replace the damaged lung of an emphysema patient. The procedure is very risky. In addition, there are seldom enough lungs available for transplant to meet the needs of all patients who want them.

Alternative Treatment

Alternative treatments are most valuable when they are used in conjunction with traditional medical care. Aromatherapists may use a variety of oils to make breathing easier. These oils include eucalyptus (pronounced YOOK-ahlip-tus), hyssop (pronounced HEYE-sop), aniseed, lavender, pine, and rosemary. The Chinese herb ephedra (pronounced EF-ed-ra; called ma huang in Chinese) is regarded as a bronchodilator, but it should not be used by patients with heart disorders or high blood pressure. Several herbs, such as elecampane (pronounced EL-i-cam-pane), may help patient's clear mucus from the lungs. Mullein (pronounced MULL-en) tea is recommended to soothe the linings of the lungs. Yoga may be helpful in improving a patient's breathing techniques.

PROGNOSIS

Emphysema is a serious and chronic disease. It cannot be cured or reversed. However, early treatment can slow the progress of the disease. It can also help to prevent its most serious complications. Overall, the survival rate of patients diagnosed with emphysema is about four years. However, that prognosis is dependent on a variety of factors. The ability of a patient to give up smoking is one of the most important factors. The availability and use of oxygen therapy is another factor.

PREVENTION

Emphysema is a condition that is relatively easy to prevent. The best way to prevent the disease is not to smoke cigarettes or, if a person already smokes, to quit. A relatively small number of cases are caused by genetic factors, over which a person has no control. But the vast majority of emphysema cases result from cigarette smoking.

Patients who have already developed emphysema can take a number of steps to slow its progress. For example, they should avoid breathing polluted air as much as possible. The pollutants in air have much the same effect on lungs as does cigarette smoke. Patients should also consider being vaccinated against diseases that affect the respiratory system, such as influenza (the flu; see influenza entry).

FOR MORE INFORMATION

Books

Adams, Francis V. The Breathing Disorders Sourcebook. Los Angeles: Lowell House, 1998.

Haas, Francois, and Sheila Sperber Haas. The Chronic Bronchitis and Emphysema Handbook. New York: John Wiley & Sons, 1990.

Ries, Andrew L., ed. Shortness of Breath: A Guide to Better Living and Breathing, 5th edition. St. Louis, MO: Mosby-Year Book, 1995.

Organizations

American Lung Association. (800) LUNG–USA (800–586–4872). http://www.lungusa.org.

National Heart, Lung, and Blood Institute. Building 31, Room 4A21, Bethesda, MD 20892. (301) 496–4326. http://www.nhlbi.nih.gov.

The National Lung Health Education Program and the National Emphysema Foundation. http://www.emphysemafoundation.org.

Web sites

IVI Publishing Healthnet. "Emphysema." [Online] http://www.healthnet.ivi.com/bh/cond/ailments/htm/emphysema.htm (accessed on October 25, 1999).