Emphysema – Better Health Channel

Summary

Read the full fact sheet

• Emphysema is a type of lung disease that causes breathlessness.
• Emphysema is usually caused by cigarette smoking.
• There is no cure, but the condition can be managed using medications and adjustments to lifestyle.
• If you have shortness of breath or a long-term productive cough (a cough that produces mucus or phlegm), see your doctor for a lung function test.

Emphysema and another lung condition known as chronic bronchitis (persistent cough with phlegm) are both features of a common lung disease called chronic obstructive pulmonary disease (COPD).

Emphysema is generally caused by cigarette smoking or long-term exposure to certain industrial pollutants or dusts. A small percentage of cases are caused by a familial or genetic disorder, alpha-1-antitrypsin deficiency. While damaged airways don’t regenerate and there is no cure, emphysema is preventable and treatable.

Symptoms of emphysema

The symptoms of emphysema include:

• breathlessness with exertion, and eventually breathlessness most of the time in advanced disease
• susceptibility to chest infections
• cough with phlegm production
• fatigue
• barrel-shaped chest (from expansion of the ribcage in order to accommodate enlarged lungs)
• cyanosis (a blue tinge to the skin) due to lack of oxygen.

Structure of the lungs

The lungs are sponge-like structures that lie within the chest, protected by the ribcage. They are made up of progressively branching air passages. The largest of these is the windpipe (trachea), which divides into the two bronchi, which divide into the smaller bronchioles.

Bronchioles end in minute air sacs (alveoli), where inhaled oxygen is transferred to the blood stream and carbon dioxide is transferred from the blood into the exhaled breath. This exchange of oxygen and carbon dioxide takes place via a fine mesh of capillaries.

Damaged airways and lungs

After repeated exposure to chemical irritants, such as cigarette smoke, the air passages and air sacs of the lungs become inflamed and damaged.

The airways of healthy lungs have elastic properties, but in lungs that are repeatedly exposed to irritants, the airways lose their elasticity and become thickened and swollen. This swelling means that the passageway for air becomes narrower.

If the same person also has chronic bronchitis (ongoing inflammation of the lining of the bronchial tubes), the mucus present can further contribute to narrowing of the air passages and clogging of the air sacs, further reducing their ability to function. As the number of functional air sacs reduces, the number of capillaries servicing the damaged alveoli also gradually reduces.

These changes result in:

• partial blockage of the passages carrying inhaled and exhaled breath
• reduced capacity for the lungs to extract the oxygen from inhaled air.

This means that the person has to breathe harder to get enough oxygen.

Complications of emphysema

Complications of emphysema can include:

• pneumonia – this is an infection of the alveoli and bronchioles. People with emphysema are more prone to pneumonia
• collapsed lung – some lungs develop large air pockets (bullae), which may burst, resulting in lung deflation (also called pneumothorax)
• heart problems – damaged alveoli, reduced number of capillaries and lower oxygen levels in the blood stream may mean that the heart has to pump harder to move blood through the lungs. Over time, this can place considerable strain on the heart.

Diagnosis of emphysema

Chronic obstructive pulmonary disease, including emphysema, is diagnosed mainly using a lung function test called spirometry. Other tests that may help in diagnosis of emphysema include:

• other lung function (or breathing) tests
• chest x-rays
• CT scans.

Treatment for emphysema

There is no cure for emphysema, although it is treatable. Appropriate management can reduce symptoms, improve your quality of life and help you stay out of hospital.

Management includes:

• stopping smoking immediately and completely – this is the most effective treatment for COPD and emphysema
• avoiding other air pollutants
• respiratory (pulmonary) rehabilitation programs
• oxygen treatment, in advanced cases
• medications such as
  • anti-inflammatory medications
  • medicine to widen the airways (bronchodilators) and loosen the phlegm
  • antibiotics
• stress management techniques
• gentle, regular exercise to improve overall fitness
• influenza vaccination (yearly) and pneumococcal vaccination to protect against certain types of respiratory infection.

Respiratory rehabilitation programs

A person with emphysema can take part in a respiratory rehabilitation program, commonly known as ‘pulmonary rehab’. These programs:

• provide information and education on emphysema
• introduce people to a supervised exercise program proven to improve emphysema symptoms
• improve lung function through specific breathing exercises
• teach stress management techniques
• offer advice on adapting to life with emphysema
• provide emotional support through shared experiences.

To find out about a program near you, call Lung Foundation AustraliaExternal Link on 1800 654 301.

Oxygen treatment for emphysema

If a person with emphysema is found to have exceptionally low levels of oxygen in their blood, they will be given oxygen to use at home. The oxygen is usually breathed through the nose via nasal prongs (cannulae). The person will need to use the oxygen treatment for at least 16 hours every day.

Where to get help

• Your GP (doctor)
• Lung Foundation AustraliaExternal Link Tel. 1800 654 301
• QUITlineExternal Link Tel. 13 78 48

• Yang IA, Brown JL, George J, et al. 2018, The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2018External Link, version 2.53, Lung Foundation Australia and the Thoracic Society of Australia and New Zealand

This page has been produced in consultation with and approved
by:

Emphysema – Better Health Channel

Summary

Read the full fact sheet

• Emphysema is a type of lung disease that causes breathlessness.
• Emphysema is usually caused by cigarette smoking.
• There is no cure, but the condition can be managed using medications and adjustments to lifestyle.
• If you have shortness of breath or a long-term productive cough (a cough that produces mucus or phlegm), see your doctor for a lung function test.

Emphysema and another lung condition known as chronic bronchitis (persistent cough with phlegm) are both features of a common lung disease called chronic obstructive pulmonary disease (COPD).

Emphysema is generally caused by cigarette smoking or long-term exposure to certain industrial pollutants or dusts. A small percentage of cases are caused by a familial or genetic disorder, alpha-1-antitrypsin deficiency. While damaged airways don’t regenerate and there is no cure, emphysema is preventable and treatable.

Symptoms of emphysema

The symptoms of emphysema include:

• breathlessness with exertion, and eventually breathlessness most of the time in advanced disease
• susceptibility to chest infections
• cough with phlegm production
• fatigue
• barrel-shaped chest (from expansion of the ribcage in order to accommodate enlarged lungs)
• cyanosis (a blue tinge to the skin) due to lack of oxygen.

Structure of the lungs

The lungs are sponge-like structures that lie within the chest, protected by the ribcage. They are made up of progressively branching air passages. The largest of these is the windpipe (trachea), which divides into the two bronchi, which divide into the smaller bronchioles.

Bronchioles end in minute air sacs (alveoli), where inhaled oxygen is transferred to the blood stream and carbon dioxide is transferred from the blood into the exhaled breath. This exchange of oxygen and carbon dioxide takes place via a fine mesh of capillaries.

Damaged airways and lungs

After repeated exposure to chemical irritants, such as cigarette smoke, the air passages and air sacs of the lungs become inflamed and damaged.

The airways of healthy lungs have elastic properties, but in lungs that are repeatedly exposed to irritants, the airways lose their elasticity and become thickened and swollen. This swelling means that the passageway for air becomes narrower.

If the same person also has chronic bronchitis (ongoing inflammation of the lining of the bronchial tubes), the mucus present can further contribute to narrowing of the air passages and clogging of the air sacs, further reducing their ability to function. As the number of functional air sacs reduces, the number of capillaries servicing the damaged alveoli also gradually reduces.

These changes result in:

• partial blockage of the passages carrying inhaled and exhaled breath
• reduced capacity for the lungs to extract the oxygen from inhaled air.

This means that the person has to breathe harder to get enough oxygen.

Complications of emphysema

Complications of emphysema can include:

• pneumonia – this is an infection of the alveoli and bronchioles. People with emphysema are more prone to pneumonia
• collapsed lung – some lungs develop large air pockets (bullae), which may burst, resulting in lung deflation (also called pneumothorax)
• heart problems – damaged alveoli, reduced number of capillaries and lower oxygen levels in the blood stream may mean that the heart has to pump harder to move blood through the lungs. Over time, this can place considerable strain on the heart.

Diagnosis of emphysema

Chronic obstructive pulmonary disease, including emphysema, is diagnosed mainly using a lung function test called spirometry. Other tests that may help in diagnosis of emphysema include:

• other lung function (or breathing) tests
• chest x-rays
• CT scans.

Treatment for emphysema

There is no cure for emphysema, although it is treatable. Appropriate management can reduce symptoms, improve your quality of life and help you stay out of hospital.

Management includes:

• stopping smoking immediately and completely – this is the most effective treatment for COPD and emphysema
• avoiding other air pollutants
• respiratory (pulmonary) rehabilitation programs
• oxygen treatment, in advanced cases
• medications such as
  • anti-inflammatory medications
  • medicine to widen the airways (bronchodilators) and loosen the phlegm
  • antibiotics
• stress management techniques
• gentle, regular exercise to improve overall fitness
• influenza vaccination (yearly) and pneumococcal vaccination to protect against certain types of respiratory infection.

Respiratory rehabilitation programs

A person with emphysema can take part in a respiratory rehabilitation program, commonly known as ‘pulmonary rehab’. These programs:

• provide information and education on emphysema
• introduce people to a supervised exercise program proven to improve emphysema symptoms
• improve lung function through specific breathing exercises
• teach stress management techniques
• offer advice on adapting to life with emphysema
• provide emotional support through shared experiences.

To find out about a program near you, call Lung Foundation AustraliaExternal Link on 1800 654 301.

Oxygen treatment for emphysema

If a person with emphysema is found to have exceptionally low levels of oxygen in their blood, they will be given oxygen to use at home. The oxygen is usually breathed through the nose via nasal prongs (cannulae). The person will need to use the oxygen treatment for at least 16 hours every day.

Where to get help

• Your GP (doctor)
• Lung Foundation AustraliaExternal Link Tel. 1800 654 301
• QUITlineExternal Link Tel. 13 78 48

• Yang IA, Brown JL, George J, et al. 2018, The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2018External Link, version 2.53, Lung Foundation Australia and the Thoracic Society of Australia and New Zealand

This page has been produced in consultation with and approved
by:

Emphysema: symptoms, diagnosis, treatment

Contents

• 1 Emphysema: symptoms, diagnosis and effective treatment
  • 1.1 Emphysema: concept and causes
  • 1.2 Symptoms of emphysema

  9 0005 1.3 Diagnosis of pulmonary emphysema

  • 1.4 Causes of pulmonary emphysema
  • 1.5 Factors that can increase the manifestation of pulmonary emphysema
  • 1.6 How is pulmonary emphysema treated?
  • 1. 7 Drugs for the treatment of emphysema
    • 1.7.1 Bronchodilators
    • 1.7.2 Glucocorticosteroids
    • 1.7.3 Antibiotics
  • 1.8 Procedures that help with pulmonary emphysema
    • 1.8.1 1. Oxygen therapy
    • 1.8. 2 2. Lung unloading with special devices
    • 1.8.3 3. Chest massage
    • 1.8.4 4. Respiratory gymnastics
  • 1.9 Is it possible to cure pulmonary emphysema completely?
  • 1.10 What preventive measures help prevent emphysema?
  • 1.11 Sequelae of emphysema
  • 1.12 Related videos:
  • 1.13 Q&A:
    • • 1.13.0.1 What is pulmonary emphysema?
      • 1.13.0.2 What are the symptoms of emphysema?
      • 1.13.0.3 How is emphysema diagnosed?
      • 1.13.0.4 Can smoking cause emphysema?
      • 1.13.0.5 What are the treatment options for pulmonary emphysema?
      • 1.13.0.6 Can emphysema be prevented?

Learn about the symptoms, diagnosis, and treatment of emphysema. Get useful information about the causes of the disease and effective methods of dealing with it.

Pulmonary emphysema is a chronic disease in which the firmness and elasticity of the lung tissue is lost, which leads to the expansion of air spaces and disruption of normal respiratory function.

Basically, emphysema affects older people and is a form of chronic obstructive pulmonary disease (COPD), which is also called COPD – chronic obstructive pulmonary disease combined with emphysema.

This article is devoted to the consideration of this disease, its main symptoms, causes, diagnosis and treatment methods that will allow you to understand the problem in more detail and prevent its occurrence in the future.

Emphysema: concept and causes

Emphysema is a chronic disease of the respiratory system that leads to irreversible changes in the lung tissue. As a result of such changes, the lungs lose their elasticity, expand and lose their functionality. This leads to breathing difficulties and a deterioration in the general condition of the body.

The risk of developing emphysema is significantly increased if a person leads an unhealthy lifestyle, suffers from lung disease, or frequently comes into contact with substances that affect the respiratory system. Based on this, measures should be taken to prevent the occurrence of the disease.

Important: Emphysema is a very serious disease that requires qualified treatment. The earlier the disease is detected and diagnosed, the greater the chances for its effective treatment and prevention of severe complications.

Symptoms of pulmonary emphysema

Emphysema is a chronic disease that leads to the destruction of the walls of the alveoli, preventing them from functioning properly. Patients with emphysema experience a variety of symptoms including:

• Cough – Usually dry and without sputum, the cough may be a reaction to irritants in the air, including cigarette smoke, as well as mugwort, car exhaust and other particles.
• Breathing problems – Patients with emphysema often have difficulty breathing, especially during exercise.
• Fatigue and weakness – these symptoms may be due to the fact that the body is fighting for enough oxygen, which is necessary for the proper functioning of the organs.
• Chest pain – if chest pain occurs when breathing, this may be due to emphysema, especially if accompanied by difficulty breathing.
• Weight Loss – Patients with emphysema may lose weight due to difficulty eating and absorbing nutrients.

If you experience these symptoms, especially if you are a smoker or work in an environment with high concentrations of harmful substances in the air, see a specialist for diagnosis and treatment.

Diagnosis of pulmonary emphysema

Diagnosis of pulmonary emphysema begins with anamnesis and examination of the patient for characteristic symptoms. Important signs of the disease are cough, shortness of breath, fatigue and noisy breathing.

A number of additional tests, such as x-rays, computed tomography, spirometry, and blood gas analysis, may be done to confirm the diagnosis.

1. Radiography is the first and most accessible method for diagnosing emphysema. It allows you to detect an increase in lung volume and a decrease in its density.
2. Computed tomography (CT) provides more detailed information about the condition of the lungs and can reveal small changes in lung tissue.
3. Spirometry is a method that measures the volume and flow rate of inhalation and exhalation. It allows you to determine the presence of airway obstruction.
4. Blood gas analysis measures the level of oxygen and carbon dioxide in the blood. This method allows you to determine the degree of respiratory failure.

The combination of these methods allows you to get a complete picture of the disease and determine the further tactics of treating the patient.

Causes of emphysema

Emphysema is a disease that is associated with the destruction of lung tissue and insufficient exchange of gases in the body. Emphysema can be caused by several factors:

• Smoking. This is one of the main causes of emphysema. Tobacco smoke contains a large amount of harmful substances that destroy lung tissue and disrupt their function.
• Genetic predisposition. Some people may be susceptible to the destruction of lung tissue at the genetic level, which can lead to the development of emphysema even without the involvement of other factors.
• Polluted environment. Exposure to various chemicals and toxic substances in the air may increase the risk of developing the disease.
• Professional activity. Some occupations that involve exposure to toxic substances may increase the risk of developing emphysema.

Understanding the causes of emphysema will help you take steps to prevent it and detect it early, which increases the effectiveness of treatment. It is important to maintain a healthy lifestyle and avoid unhealthy habits such as smoking to reduce the risk of disease.

Factors that can increase the manifestation of emphysema

Emphysema is a serious disease in which the alveoli responsible for gas exchange are affected. Some factors can increase the manifestations of this disease. Among them:

• Smoking is one of the most prominent and well-known aggravators of emphysema. Tobacco smoking destroys lung tissue, which can cause blisters to form on the surface of the lungs.
• Air pollution – inhalation has harmful effects on lung tissue, which may increase the symptoms of emphysema.
• Genetic factors – there is a hereditary predisposition to emphysema, so if you have relatives with this disease, your risk of developing it is also increased.
• Inflammatory diseases – such as bronchitis, may exacerbate emphysema.
• Non-specific airway obstruction – this can also affect the development of emphysema, as it is associated with impaired gas exchange in the lungs.

Avoiding these factors is important for those at risk of developing emphysema. In addition, regular medical monitoring will help to identify the disease in a timely manner and start treatment according to the recommendations of doctors.

How is emphysema treated?

Treatment for emphysema depends on the severity of the disease and may include medication, exercise, and, in severe cases, surgery.

In addition, exercise can also help reduce the symptoms of emphysema, improve quality of life, and improve lung function. Surgical intervention can be used only in severe cases, when conservative treatment does not give the desired effect.

It is also very important to avoid smoking and exposure to toxic substances, as they can worsen the condition of the lungs. Regular monitoring by a doctor and compliance with all the recommendations of medical personnel are also important aspects of the successful treatment of emphysema.

• Drug therapy
• Physical exercise
• Surgery

Drugs for the treatment of emphysema

Emphysema is a chronic disease and treatment is aimed at improving the quality of life of the patient and preventing disease progression. For this, various groups of drugs are used.

Bronchodilators

These medicines help to relax the muscles in the bronchial tubes, widening them, making it easier to breathe. They can be presented as inhalation preparations in the form of sprays, aerosols or powders for inhalation. The main drugs in this group are beta-agonists, anticholinergics and methylxanthines.

Glucocorticosteroids

These inhaled sprays or tablets can help reduce inflammation in the lungs and reduce mucus, which can improve breathing and reduce flare-ups. However, long-term use of glucocorticosteroids is associated with a number of side effects such as osteoporosis, weight gain, and immune system deterioration.

Antibiotics

Antibiotics may be used to treat infections that can aggravate emphysema. However, their use should only be carried out under the direction of a physician after confirmation of the presence of a bacterial infection, so as not to produce antibiotic resistance in the patient.

The main principle of the treatment of pulmonary emphysema is an individual approach to each patient. Medicines can be combined depending on the severity of the disease, the presence of concomitant diseases and other factors. Treatment should be carried out only under the supervision of a physician who regularly assesses the patient’s condition and adjusts the treatment regimen.

Procedures that help with pulmonary emphysema

1. Oxygen therapy

One of the main symptoms of pulmonary emphysema is oxygen starvation. Oxygen therapy is a way to maintain the optimal level of oxygen in the patient’s body with the help of oxygen equipment. The main goal of oxygen therapy is to maintain oxygen saturation of at least 90% and reduce the degree to which the lungs have to work to pump air.

2. Unloading lungs with special devices

Typically, patients with emphysema experience the same kind of difficulty breathing and fatigue as an athlete exercising in a high altitude area. Therefore, for the treatment of such patients, special devices are used to unload the airways. They allow you to keep the most open position of the larynx and airways, thus reducing the degree of difficulty in breathing.

3. Chest massage

Chest massage is a technique in which the massage therapist gently manipulates the patient’s chest. It helps to soften and relax the muscles of the chest and therefore may improve the respiratory function of emphysema. However, before applying this procedure, it is necessary to consult a specialist and recommend a pulmonologist.

4. Respiratory exercises

One of the main causes of pulmonary emphysema is a deterioration in the ability of the lungs to bear the load. Regular respiratory exercises help to increase the level of physical activity and improve the quality of life of patients with emphysema. The results of such gymnastics may be few, but in general, it improves the quality of life of patients.

Can emphysema be completely cured?

Emphysema is a chronic disease that destroys lung tissue. As a result, the lungs lose their elasticity and cannot function properly.

Emphysema is often treated with drugs that dilate the bronchi and improve lung function. Physiotherapy and rehabilitation courses may also be prescribed.

In some cases, surgery may be required, such as pulmonary resection growth. However, such operations are performed only in the most severe cases and the choice of treatment always depends on the individual situation of the patient.

In any case, regular monitoring of the condition of the lungs and following all the doctor’s recommendations will help improve the life of a patient with pulmonary emphysema.

What preventive measures can help prevent emphysema?

Pulmonary emphysema is a serious disease that leads to a deterioration in the patient’s life. However, there are preventive measures that help prevent the development of this disease.

• Smoking cessation . This is one of the most important measures to prevent emphysema. Smoking is the main cause of the disease.
• Strengthening the immune system . This helps prevent the development of infections that can lead to emphysema.
• Avoiding polluted air . Harmful substances in the air can adversely affect lung health.
• Healthy lifestyle . Regular exercise, proper nutrition and enough sleep help maintain the health of the lungs and the whole body as a whole.

If you follow these preventive measures, you can prevent the development of emphysema and keep your lungs healthy for many years.

Sequelae of emphysema

Emphysema is a chronic disease that leads to destruction of the retina of the lung vesicles. This can cause a decrease in the functional state of the lungs and restriction of respiratory capacity.

Among the main consequences of pulmonary emphysema are:

• Oxygen starvation. Complete or partial destruction of the walls of the bubbles in the lungs reduces their ability to exchange oxygen and carbon dioxide, which leads to hypoxia of tissues and organs.
• Respiratory failure. In pulmonary emphysema, a bulky number of small vesicles function, which reduces cell turnover and has a negative effect on lung reserve capacity.
• Emphysematous bullous pneumothorax. The entry of air into the pleural cavity causes pressure on the lung tissue and contributes to the compression of the cor pulmonale.
• Increased risk of respiratory infections. Lung tissue with a light structure is the conditions for the penetration of bacteria and viruses into the body.

Emphysema is a serious and progressive disease that requires immediate treatment. Regular medical examinations and adherence to the doctor’s recommendations are the main ways to prevent this disease.

Related videos:

Q&A:

What is pulmonary emphysema?

Emphysema is a chronic disease in which the walls of the alveoli collapse, leading to reduced gas exchange surfaces and poor lung function.

What are the symptoms of emphysema?

The main symptoms of emphysema are shortness of breath, cough, copious sputum, fatigue, chest enlargement and weight loss.

How is emphysema diagnosed?

Diagnosis of emphysema includes chest x-ray, computed tomography, physical tests, and blood tests.

Can smoking cause emphysema?

Yes, smoking is one of the most important causes of emphysema.

What are the treatment options for emphysema?

Treatment for emphysema includes medication, oxygen therapy, physical rehabilitation, lifestyle changes, and surgery in extreme cases.

Can emphysema be prevented?

Emphysema can be prevented by avoiding smoking, a healthy lifestyle, and regular medical check-ups to detect early lung disease.

Emphysema: causes, symptoms and recommendations for the treatment of the disease. Dr. Peter

Alveoli are the smallest structural units of the lungs, they are surrounded by a dense network of the finest blood vessels (capillaries). Here gas exchange occurs: with each breath, air passes through the trachea and bronchi into the alveoli. There, oxygen from the air enters the blood through the walls of the alveoli. In this case, carbon monoxide (CO2) is released from the blood into the air of the alveoli and exhaled.

With emphysema, gas exchange is worse: the affected walls of the alveoli lose their elasticity, are excessively stretched by the air entering with each breath. They may even break. The adjacent ruptured alveoli then coalesce into larger blisters that collapse on exhalation. Due to hyperventilation of the alveoli, the smallest bronchi (bronchioles) narrow and also easily collapse. All this makes it difficult to exhale: the patient can no longer fully exhale the inhaled air. Some of it stays in the little bubbles that are still open, so there’s less room for new, oxygen-rich air when you breathe in. As a result, oxygen deficiency increases.

Causes

One of the global causes of emphysema is smoking, inhalation of polluted oxygen, dust, gases, genetic factors.

With this pathology, the walls of the alveoli are irrevocably destroyed. Certain proteins play a critical role in the development of emphysema. With each breath, pathogens and other harmful substances enter the lungs along with the air. The immune system normally neutralizes pathogens: defense cells in the alveoli regularly release proteases that destroy pathogens. They can neutralize penetrating microbes and foreign substances. However, proteases do not distinguish between foreign and self tissues. Therefore, they can also attack and destroy sensitive lung tissue (more precisely, the elastic fibers in the walls of the alveoli). To prevent this from happening, an appropriate amount of a protective substance is needed; so-called protease inhibitors are secreted in the lungs. Their most important representative is alpha-1 antitrypsin.

The balance between proteases and protease inhibitors can be disturbed by smoking, chronic inflammation and alpha-1 antitrypsin deficiency. As a result, there is an increase in the destruction of lung tissue and emphysema develops. Other possible causes include re-breathing of pollutants, aging, and scar tissue in the lungs.

Smoking is the most common cause of emphysema. It inhibits protective protease inhibitors (such as alpha-1 antitrypsin). Consequently, they cannot prevent the attack of proteases on the alveoli – pulmonary emphysema develops.

Chronic inflammation in the lungs can cause destructive proteases in the alveoli to take over. Therefore, chronic bronchitis and chronic obstructive pulmonary disease (COPD) can pave the way for emphysema.

Approximately one percent of patients develop pulmonary emphysema due to a genetic deficiency of alpha-1-antitrypsin, the main representative of protease inhibitors. Thus, patients are more susceptible to emphysema than the general population. How high the risk of the disease in individual cases depends on the severity of the hereditary disease. Emphysema develops especially easily when people with congenital alpha-1 antitrypsin deficiency also smoke or have a chronic lung disease (such as COPD).

Congenital deficiency of alpha-1 antitrypsin can have other consequences besides emphysema. This includes the progressive destruction of liver cells (liver cirrhosis).

Connective tissue elasticity generally decreases with age. Age also reduces the elasticity of the alveolar septum. This occasionally leads to the development of age-related emphysema. This so-called senile emphysema is not a disease, but a consequence of the natural aging process. Affected people usually have no symptoms. Therefore, emphysema usually does not need to be treated.

Scar tissue often develops in the lungs after pneumonia or tuberculosis, and also after operations on the lungs (for example, removal of a lobe of the lung). It is more unstable than normal lung tissue and therefore more easily stretched. This is the so-called cicatricial emphysema.

Rarely, emphysema is caused by inhalation of irritating gases or dusts. Quartz dust, cotton and grain dust, welding fumes, chemicals such as ozone or chlorine gas are especially dangerous. General air pollution in large cities can also contribute to the development of emphysema. This is especially true for people who already have another lung disease.

Symptoms of emphysema

The upper lung fields are especially affected, while the lower ones are intact. Doctors attribute this to the fact that pollutants and cigarette smoke first reach the upper lungs and damage them.

The symptoms of emphysema develop slowly and insidiously. The type and severity of symptoms depend on the stage of the disease.

In the early stages, patients with emphysema usually experience shortness of breath on exertion. There is also a sporadic cough and decreased performance. Many patients get tired quickly even with slight exertion.

Frequent respiratory infections such as bronchitis and pneumonia are also typical accompanying symptoms of emphysema. Susceptibility to infection is the result of progressive destruction of the ciliated epithelium that lines most of the airways. Ciliary cells resemble small hairs. They move in waves and thus carry out the smallest particles of a foreign body from the lungs (mucociliary clearance). However, tobacco smoke and other pollutants destroy the ciliated epithelium, which disrupts the cleaning mechanism. This makes it easier to get infected.

In people with advanced emphysema, shortness of breath occurs even at rest, i.e. even without physical exertion. In addition, many patients suffer from cough with mucous sputum, especially if chronic bronchitis is present.

The shape of the chest may change over time due to progressive overinflation of the lungs: in the case of emphysema, the chest muscles are more tense when breathing and remain in the inspiratory position for a long time. The ribs then run horizontally instead of slanting downward, and the ribcage appears “barrel-shaped.” The two skin pits above the clavicles disappear – in many patients they also seem to be excessively swollen.

The general condition of the patient often worsens. As a result of shortness of breath, victims move less, so that the body loses muscle mass. This can further increase shortness of breath.

Persistent lack of oxygen in the blood often results in blue lips and fingers (cyanosis). In addition, overinflated lungs can cause excessive stress on the right side of the heart. This is how a special form of heart failure develops: right-sided. The overloaded right half of the heart cannot adequately transport the incoming blood. It returns to the systemic circulation. This stasis of blood is manifested, among other things, in the swelling of the veins in the neck. Other signs of right heart failure are water retention in the legs (edema).

Possible complications and risks

Emphysema cannot be cured. This means that pathological changes in the lung tissue are irreversible. However, with proper treatment, the progression of the disease can be slowed down or even stopped.

Patients with emphysema should stop smoking immediately and permanently.

People with this pathology are more prone to respiratory infections. Therefore, doctors recommend that they be vaccinated against pneumococcus and influenza. You should be vaccinated against the flu every year because flu viruses change all the time.

Fever and cough with greenish-yellow sputum suggest a bacterial respiratory infection. If patients with emphysema show these symptoms, they should definitely be treated by a doctor with antibiotics. This can prevent a serious course of the disease.

Diagnosis

If you suspect emphysema, you should see a pulmonologist. First, he will talk to you in detail to collect your medical history (medical history). Possible questions in this conversation:

• Are you short of breath?

• Do you often cough? Is the cough dry or associated with phlegm?

• Do you have other complaints?

• Do you smoke? If yes, how much and for how long?

• How many flights of stairs can you climb without a break?

• Do you already have a lung disease (asthma, chronic bronchitis, etc. )?

• Do you have any relatives with emphysema, COPD or alpha-1 antitrypsin deficiency?

Physical examination follows history. A doctor can recognize typical changes that may indicate emphysema. A barrel chest indicates persistent overinflation of the lungs. This is a clear hallmark of emphysema.

Instinctive pursing of the lips during exhalation is also characteristic. The patient exhales through loosely compressed lips. This breathing technique makes exhaling easier as it increases air pressure in the bronchi.

Blue lips and fingers are also serious signs of emphysema. The same applies to the so-called drumstick-shaped fingers and watch-glass nails.

Swollen legs and swollen neck veins are also important signs. They indicate that the right side of the heart is under increased stress. The reason for this may be emphysema.

When listening to the lungs with a stethoscope (auscultation) with emphysema, dry rales (buzzing or whistling) are often heard. When tapping on the chest (percussion), the sound is loud and deaf. The reason is the increased amount of air in the over-inflated lungs. On the other hand, heart sounds can often be heard very quietly with a stethoscope due to increased lung capacity.

To assess how far the emphysema has progressed, your doctor may take a chest x-ray.

Computed tomography (CT) can examine emphysema in more detail.

Blood gas and lung function tests can help your doctor assess the severity of your condition.

How to treat emphysema

Which drugs are used for emphysema depends on the stage of the disease and the severity of the symptoms. The following active ingredients are available (in principle, the same as those used in the treatment of asthma and COPD):

• The first and most important thing in treatment is quitting smoking, stopping contact with dust, aerosols, and chemicals.

• Beta-2 sympathomimetics: have a bronchodilator effect and are administered by inhalation; there are short-acting agents (such as salbutamol, reproterol) and long-acting agents (such as salmeterol).

• Anticholinergics: They also have a bronchodilator effect and are administered by inhalation.

• Glucocorticoids, which have an anti-inflammatory effect, are sometimes used. They are also mostly inhaled; only in severe cases, cortisone tablets are prescribed.

• In case of congenital deficiency of alpha-1 antitrypsin, the missing protein can also be replenished with drugs. Such alpha-1 antitrypsin substitutes are routinely administered as an infusion.

• Patients with severe emphysema often receive long-term oxygen treatment: pure oxygen is inhaled through a mask for at least 16 hours a day. This may improve the prognosis and improve the quality of life of those affected.

• Patients learn special techniques to make breathing easier. Strong abdominal muscles also contribute to proper breathing technique. Therefore, the therapy also includes targeted training of the abdominal muscles. In addition, victims should drink plenty of fluids and inhale saline regularly to help cough up sputum.