Emphysema

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What is emphysema?

Emphysema is a condition where the alveoli (air sacks) of the lungs are overinflated as a result of the destruction of the walls of the alveoli. These air sacs are responsible for the oxygen transfer from the inhaled air from the atmosphere to the blood stream of the person, as the alveoli get the carbon dioxide from the blood stream to be exhaled and elimnated. These damages from emphysema reduce the respiratory function of the lungs causing severe (dyspnea) shortness of breath. With this disease, the lungs become very inefficient in oxygen diffusion and renders the blood low in oxygen content. Hence the shortness of breath.

How common is emphysema?

Emphysema is found worldwide, mostly among cigarette smokers, who have "burned" their lungs. In the United States alone, more than 2 million people have emphysema. Medical literature records that 70,000 to 100,000 Americans were born with a deficiency of alpha 1-antitrypsin (AAT), a special and important protective protein, which is responsible for the inherited form of emphysema. Among chronic illnesses, emphysema, which debilitates the person, ranks the 15th. Men with emphysema outnumber the women by 22%, but since women have also started smoking, the gap is becoming narrower.

What causes emphysema?

The deadly poison (smoke and chemical) from cigarettes is responsible for 82% of chronic lung diseases, including emphysema. Air pollution, irritating fumes and dust are factors in the development of emphysema. Majority of lung cancers are from smoking.

What is COPD?

COPD is Chronic Obstructive Lung Disease, a group of respiratory illnesses that are long-standing, obstructive (blocking normal air flow), leading to severe shortness of breath due to poor oxygen exchange and a resultant poor blood oxygenation and poor elimination of carbon dioxide in the body. Chronic Bronchitis, Emphysema, Bronchial Asthma are some examples.

How severe can the shortness of breath be?

Dyspnea (shortness of breath) and orthopnea (shortness of breath when lying down) can be moderate to severe, to the point that the person cannot breather (nor survive) without oxygen. When the lungs are burned and destroyed by smoking, their capacity to absorb oxygen and oxygenate the circulating blood is greatly diminished. This explains why the person with severe emphysema is huffing and puffing, gasping for air, and is having a hard time coughing up collected phlegm in his lungs and throat.

Is emphysema contagious?

No, emphysema is not an infectious disease, so it is not contagious and cannot be transmitted from one person to another. Someone who is a chronic smoker and has emphysema, could adversely affect others through the "passive" smoke that these people inhale for a period of time. As a result, these "passive smokers" could also develop emphysema or even lung cancer.

How does emphysema develop?

The normal lungs function well with a remarkable balance between two chemical systems with opposing action. The lungs have elastic fibers that allow them to expand and contract, as we inhale and exhale. When the chemical balance is affected by, say, cigarette smoking, fumes, etc., the lungs lose their ability to protect themselves against the damages to these elastic fibers. The walls of the air sacs become thin and fragile, get destroyed and then become overinflated, losing their efficiency in oxygen-carbon dioxide diffusion. A small percentage of people have emphysema due to deficiency in AAT, as we have alluded to earlier.

What is chronic bronchitis?

Chronic bronchitis is the frequent, long-standing, inflammation of the air passages or bronchi (breathing pipes), causing frequent coughs. Among smokers, chronic bronchitis (And the so-called smoker's cough) is usually a prelude to the development of emphysema. The combination of bronchitis and emphysema affect more than 15.8 million people in the United States alone. More than 100,000 people die each year from COPD.

What effect do cigarettes have on our bronchi?

The local adverse effects of smoking on our breathing pipes and lungs include, among others, the destruction of the ciliary motion on the mucosa (wall lining) of our bronchi. Normally, this ciliary function acts like strands of brushes (hair like structures that move in a wavy fashion) that moves secretion (phlegm) upwards and outwards, so the person could cough it out. With smoking, this action ceases to function, so that whatever phlegm is in the lungs, remain there (causing more damages as it get infected), the person having great difficulty coughing it out, without the help of the cilia. The constant irritation from the fumes is also carcinogenic (cancer-causing).

Can emphysema affect the heart?

Yes, when the emphysema is severe and the oxygen level in the blood is low as a result, then the heart will also suffer from lack of oxygen, besides being overworked by the lungs that are inefficient. The heart tries to compensate for the low oxygen level in the blood stream by beating harder and faster.

Is emphysema curable?

No, once emphysema has developed and the lungs are "burned," they will not recover and be normal again. The destruction of the lungs and breathing pipes in emphysema is permanent. This is the reason why prevention of emphysema is essential.

How do we prevent emphysema?

Abstinence from cigarette smoking is an effective way to prevent emphysema. A healthy diet, regular exercises, a good sleep, on top of a smoke-free lifestyle, are almost a sure-way to ward off emphysema. Those with AAT deficiency obviously can benefit a lot from avoiding tobacco. Also, stay away from air pollution and fumes whenever possible. When the ozone (smog) level is unhealthy, limit your activities to early morning or evening.

What is the treatment for emphysema?

The main objective of the treatment is to give relief of symptoms and prevent worsening of the disease. To accomplish this major goal, the recommendation include: quitting smoking, brochodilators (to open up airway passages and ease breathing), antibiotics to prevent infection, breathing exercises, use of Alpha 1-Proteinase Inhibitor for those with AAT deficiency, lung volume reduction to remove the damaged lungs and allow the remaining healthier lungs to expand better, and lung transplantation for those who are otherwise beyond help.

©2003Raoul R. Diez, M.A.O.D.