What are the primary causes of COPD and emphysema. How are these respiratory conditions diagnosed. What treatment options are available for patients with COPD and emphysema. How does lung volume reduction surgery work for severe cases.

Understanding COPD and Emphysema: An Overview

Chronic obstructive pulmonary disease (COPD) encompasses a group of lung conditions that impair normal breathing, leading to breathlessness and decreased respiratory function. COPD develops when airflow is obstructed due to damage to the alveoli, or air sacs, in the lungs. This damage can result in the air sacs being destroyed, narrowed, collapsed, stretched, or overinflated. Unfortunately, the harm done to these air sacs is irreversible, leaving permanent “holes” in the lower lung tissues.

Emphysema, along with chronic bronchitis, is one of the two most common forms of COPD. According to the American Lung Association, over 12 million Americans have been diagnosed with COPD, with an additional 12 million potentially having impaired lung function. Alarmingly, COPD has become the third leading cause of death in the United States.

Risk Factors and Causes of COPD and Emphysema

While the exact causes of COPD are not fully understood, several risk factors have been identified:

• Cigarette smoking: This is widely considered the most significant cause of chronic bronchitis and emphysema.
• Air pollution exposure: Chemical fumes, dust, and other airborne substances can contribute to COPD development, especially when combined with smoking.
• Genetic factors: A rare, inherited form of the disease called alpha 1-antitrypsin (AAT) deficiency-related pulmonary emphysema can lead to early onset pulmonary emphysema.

Is there a way to prevent COPD and emphysema? The most effective prevention method is to avoid smoking and exposure to secondhand smoke. Additionally, minimizing exposure to air pollutants and maintaining good overall lung health through regular exercise and a healthy diet can help reduce the risk of developing these conditions.

Recognizing the Symptoms of COPD and Emphysema

Emphysema develops gradually over time, and symptoms may vary from person to person. However, some common signs and symptoms include:

Early Symptoms:

• Shortness of breath
• Persistent cough

Advanced Symptoms:

• Fatigue
• Weight loss
• Anxiety and depression
• Sleep disturbances
• Heart problems

Why do these symptoms occur? As the air sacs in the lungs become damaged, it becomes increasingly difficult for the body to efficiently exchange oxygen and carbon dioxide. This leads to the feeling of breathlessness and can cause strain on other bodily systems, resulting in the various symptoms associated with COPD and emphysema.

Diagnostic Procedures for COPD and Emphysema

Accurate diagnosis of COPD and emphysema is crucial for effective treatment. Healthcare providers may use a combination of the following diagnostic tools:

1. Pulmonary function tests: These measure lung capacity and function, helping to determine the severity of lung disease.
2. Blood tests: Analysis of blood gases can reveal the levels of oxygen and carbon dioxide in the bloodstream.
3. Chest X-rays: These imaging tests can show signs of lung damage and overinflation.
4. Sputum culture: This test checks for the presence of infections in the material coughed up from the lungs.
5. Chest CT scan: Provides detailed images of the lungs, allowing for a more comprehensive evaluation of lung damage.
6. Video-assisted thoracic surgery (VATS): A minimally invasive procedure that can be used for both diagnosis and treatment.

How does VATS differ from traditional surgical methods? VATS uses small incisions and a tiny camera (thoracoscope) to perform procedures without spreading the ribs. This approach typically results in less pain and faster recovery for patients compared to open surgery.

Comprehensive Treatment Approaches for COPD and Emphysema

The primary goals of COPD and emphysema treatment are to improve quality of life, increase independence, and enhance overall physical, emotional, and social well-being. Treatment plans are typically tailored to individual needs and may include:

• Smoking cessation: This is the single most important factor in maintaining lung health and slowing disease progression.
• Medications:
  • Antibiotics for bacterial infections
  • Bronchodilators to relax airway muscles and improve breathing
  • Inhaled or oral medications to manage symptoms
• Vaccinations: Annual flu shots and pneumonia vaccines to prevent infections that can exacerbate symptoms
• Pulmonary rehabilitation: A program that includes exercise, breathing techniques, and nutritional counseling
• Oxygen therapy: Supplemental oxygen can help improve oxygen levels in the blood
• Nutritional support: Proper nutrition is essential, as COPD patients may experience weight loss and malnutrition

How does pulmonary rehabilitation benefit COPD patients? Pulmonary rehabilitation programs are designed to improve lung function, increase exercise tolerance, and teach patients how to manage their condition effectively. These programs often lead to improved quality of life and reduced hospitalizations for COPD patients.

Surgical Interventions for Severe COPD and Emphysema

In cases where conservative treatments are not sufficient, surgical options may be considered. One such procedure is lung volume reduction surgery (LVRS):

LVRS is a minimally invasive technique that removes damaged portions of the lung, allowing healthier lung tissue to expand and improve breathing. This procedure can be performed using either a videoscope or an endoscope, resulting in less trauma to the body compared to traditional open surgery.

Who is a candidate for LVRS? Typically, patients with severe emphysema who have not responded well to other treatments may be considered for this procedure. However, careful evaluation is necessary to determine if the potential benefits outweigh the risks for each individual patient.

Advancements in COPD and Emphysema Research

Ongoing research in the field of COPD and emphysema is continually advancing our understanding and treatment of these conditions. Some areas of current focus include:

• Gene therapy: Researchers are exploring ways to correct the genetic defects that can lead to conditions like alpha-1 antitrypsin deficiency.
• Stem cell therapy: Studies are investigating the potential of using stem cells to regenerate damaged lung tissue.
• New drug therapies: Novel medications are being developed to target specific aspects of COPD and emphysema, such as inflammation and mucus production.
• Improved lung volume reduction techniques: Researchers are working on less invasive methods to achieve lung volume reduction, including bronchoscopic approaches.

How might these advancements impact future treatment options? As research progresses, we may see more personalized treatment approaches that can target the specific underlying causes of an individual’s COPD or emphysema, potentially leading to better outcomes and improved quality of life for patients.

Living with COPD and Emphysema: Coping Strategies and Support

Managing COPD and emphysema extends beyond medical treatments. Patients can benefit from various strategies to cope with their condition and maintain a good quality of life:

1. Join support groups: Connecting with others who have similar experiences can provide emotional support and practical advice.
2. Practice stress management techniques: Techniques such as meditation, deep breathing exercises, or yoga can help reduce anxiety and improve overall well-being.
3. Maintain a healthy lifestyle: Eating a balanced diet, getting regular exercise (as recommended by a healthcare provider), and avoiding triggers like smoke or air pollution can help manage symptoms.
4. Develop an action plan: Work with healthcare providers to create a plan for managing exacerbations and knowing when to seek medical attention.
5. Stay informed: Keep up-to-date with the latest information about COPD and emphysema to be an active participant in your healthcare.

How can family members support loved ones with COPD or emphysema? Family support is crucial for patients managing these chronic conditions. Family members can help by:

• Encouraging adherence to treatment plans
• Assisting with daily tasks when needed
• Creating a smoke-free environment
• Accompanying patients to medical appointments
• Providing emotional support and understanding

COPD and emphysema are complex conditions that require comprehensive management approaches. While they present significant challenges, advancements in treatment options and support strategies continue to improve outcomes for many patients. By working closely with healthcare providers, staying informed about the latest developments, and actively participating in their care, individuals with COPD and emphysema can often achieve a better quality of life and effectively manage their symptoms.

COPD and Emphysema – Brigham and Women’s Hospital

Chronic obstructive pulmonary disease (COPD) refers to a large group of lung diseases that can interfere with normal breathing, causing breathlessness and a decrease in respiratory functioning. COPD develops when there is an obstruction of airflow because the alveoli, or air sacs, are destroyed, narrowed, collapsed, stretched or overinflated. Damage to the air sacs is irreversible and results in permanent “holes” in the tissues of the lower lungs.

According to the American Lung Association, more than 12 million Americans have COPD, and an additional 12 million may have impaired lung function. It is the third leading cause of death in the U.S. The two most common conditions of COPD are chronic bronchitis and emphysema.

The Lung Center’s COPD and Emphysema Program at Brigham and Women’s Hospital (BWH) provides specialized services for COPD, including lung volume reduction surgery and video-assisted thoracic surgery (VATS), a safe and effective alternative to open surgery. In collaboration with pulmonologists, chest radiologists and interventional pulmonologists, thoracic surgeons offer innovative endoscopic therapy for tracheomalacia and other complications of COPD and emphysema.

What are the risk factors for COPD and emphysema?

The causes of COPD are not fully understood. It is generally agreed that the most important cause of chronic bronchitis and emphysema is cigarette smoking. Other causes are:

• Exposure to air pollution (chemical fumes, dust and other substances), especially when combined with smoking)
• A rare, inherited form of the disease called alpha 1-antitrypsin (AAT) deficiency-related pulmonary emphysema, or early onset pulmonary emphysema.

What are the symptoms of COPD and Emphysema?

Emphysema does not develop suddenly, but occurs very gradually. Each individual may experience symptoms differently. The following are the most common symptoms for pulmonary emphysema:

Early symptoms may include:

• Shortness of breath
• Cough

Other symptoms may include:

• Fatigue
• Weight loss
• Anxiety
• Depression
• Sleep problems
• Heart problems

How are COPD and emphysema diagnosed?

In addition to a complete medical history and physical examination, your care team at The Lung Center may request the following tests:

• Pulmonary function test measures how well your lungs are functioning as well as the severity of your lung disease.
• Blood tests analyze the amount of carbon dioxide and oxygen in your blood.
• Chest X-ray uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film or digital media.
• Sputum culture, a test performed on the material that is coughed up from the lungs to determine if an infection is present.
• Chest CT scan
• Video-assisted thoracic surgery (VATS), a minimally invasive procedure that involves the insertion of a thoracoscope (tiny camera) and surgical instruments into the chest.
• VATS uses small incisions without any spreading of the ribs. This minimally invasive approach allows patient to experience less pain and a quicker recovery. As well as being used for diagnosis, lung biopsy via VATS allows the surgeon to remove damaged parts of the lung, providing relief from symptoms. View video-assisted thoracic surgery (VATS).

What are the treatment options for COPD and emphysema?

The goals of COPD treatment programs include helping you return to the highest level of function and independence possible, while improving the overall quality of your physical, emotional and social life. Attaining these goals help people with COPD live more comfortably by improving endurance, providing relief of symptoms, and preventing progression of the disease with minimal side effects.

The Lung Center specialists will work in conjunction with your primary care physician and/or pulmonologist to determine specific treatment for your COPD. Treatment includes:

• Quitting smoking, which is the single most important factor for maintaining healthy lungs
• Antibiotics for bacterial infections
• Bronchodilators, an inhaled medication that relaxes the smooth muscles of the airways and relieves constriction of the bronchi
• Other medications, inhaled or taken orally
• Vaccinations for pneumonia and influenza (these infections can worsen emphysema symptoms)
• Exercise for physical conditioning and improved endurance
• Breathing exercises to strengthen lung muscles
• Supplemental oxygen (portable)
• Nutritional support, since patients may experience malnutrition and weight loss

What are the surgical treatments available for COPD and emphysema?

In more severe cases of COPD and emphysema, surgery may be necessary.

Minimally invasive surgery options include:

Lung volume reduction surgery, in which a newer, less-invasive technique using a videoscope or sometimes the endoscope removes the damaged area of the lung allowing for the normal lung to expand and improve breathing.

Does the Brigham perform lung transplants?

In the rare situation when COPD and emphysema has severely damaged your lungs, organ transplantation may be necessary. The Brigham and Women’s Hospital Lung Transplant Program, the largest in New England, provides the most innovative and compassionate care to our patients with advanced lung disease. Our program has been the source of several transplant milestones, including the first adult lung transplant in Massachusetts and the first bilateral (double) lung transplant in New England. Thoracic surgeons at the BWH Lung Center evaluate patients for single and double lung transplant.

What can I expect?

When you become a patient of The Lung Center you will meet many members of the team who will carefully review your medical history and studies. In addition, you will receive a thorough diagnostic examination where you will receive a recommendation for a therapy tailored just for you based on your specific diagnosis.

Team-based care

COPD and emphysema patients benefit from the wide range of specialists at The Lung Center, including thoracic surgeons, oncologists, pulmonologists, cardiovascular medicine physicians and imaging experts. This collaboration ensures comprehensive diagnosis and targeted treatment for patients.

Any surgery recommended will be performed by an experienced, board-certified surgeon, in collaboration with the treatment team including nurses and physician assistants, all of whom specialize in taking care of patients with COPD or emphysema. Meet Our Lung Center Team.

How do I book an appointment?

• Request Lung Center Appointment

Where are you located?

• Lung Center Locations

What are some resources I can use to learn more?

Go to our online health library to learn more about thoracic diseases and tests.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Access a complete directory of patient and family services.

What Is Emphysema? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Emphysema is one of the two main types of chronic obstructive pulmonary disease (COPD), a group of progressive respiratory diseases that block airflow and make breathing difficult.

Most people with COPD experience both emphysema and chronic bronchitis, the other main form of COPD, according to the National Heart, Lung, and Blood Institute (NHLBI).

More than three million people in the United States have been diagnosed with emphysema.

Historically, emphysema has been more common among men than women. Over the past two decades, however, rates have come closer together as incidence in men has gone down and incidence in women has increased.

What Is Emphysema?

Emphysema occurs when the tiny air sacs of the lungs (alveoli) become damaged and enlarged, causing breathlessness.

Each lung has an average of 480 million alveoli, according to research.

When you breathe in, the alveoli expand and stretch, taking in oxygen and transporting it to the blood in the small capillary vessels within their thin walls. At the same time, carbon dioxide waste moves into the air sacs from the capillaries. The process is called gas exchange.

When you breathe out, the alveoli deflate, expelling the carbon dioxide out of the body through the airways.

But for people with emphysema, the walls of the alveoli are damaged and the air sacs lose their normal elasticity. As a result, the alveoli are no longer able to support the airways to the lung (bronchial tubes). The tubes collapse and cause a blockage (obstruction), which traps air inside the lungs and makes it feel hard to breathe.

In addition, emphysema can cause some of the alveoli to rupture or burst, resulting in fewer, larger alveoli and ultimately reducing the surface area available for gas exchange. This also contributes to shortness of breath.

RELATED: 7 Ways to Ease Emphysema Symptoms

What Causes Emphysema?

Emphysema is considered one of the most preventable respiratory diseases because cigarette smoking is its leading cause.

About 85 to 90 percent of all COPD cases are caused by cigarette smoking, according to the American Lung Association (ALA).

Some people who have COPD, however, never smoked cigarettes. Other risk factors for emphysema include:

• Exposure to air pollution
• Secondhand smoke
• Workplace chemicals, dust, and fumes
• A history of childhood respiratory infection

In rare cases, emphysema is caused by a genetic disorder called alpha-1 antitrypsin (AAT) deficiency. If your body doesn’t make enough of the protein AAT, the lungs can be more easily damaged from smoking and environmental pollution, notes the NHLBI.

How Is Emphysema Diagnosed?

A doctor will generally diagnose emphysema via a series of tests, including:

• Listening With a Stethoscope One simple test is to tap on your chest and listen with a stethoscope for a hollow sound. This can indicate that air is trapped in your lungs.
• Pulse Oximetry Also called an oxygen saturation test, this is used to measure the oxygen content of the blood and is often done by clipping a monitor to your finger, forehead, or earlobe.
• Spirometry This is one of the most useful tests, and it evaluates lung function by having you take a deep breath and then blow into a tube that is hooked up to a machine that measures airflow.
• X-Rays Though X-rays are generally not useful for detecting early stages of emphysema, a plain chest X-ray or a CAT (computer-aided tomography) scan can help diagnose moderate or severe cases.
• Electrocardiogram (ECG) ECGs check heart function and are used to determine if heart disease is a cause of shortness of breath.
• Arterial Blood Gas Often performed as emphysema gets worse, this test measures the amount of oxygen and carbon dioxide in blood from an artery. It can be used to determine if you need extra oxygen or are retaining carbon dioxide, a common finding in advanced emphysema.

RELATED: What Are the Four Stages of COPD and the Gold System for Grading?

How Can You Prevent Emphysema From Getting Worse?

The most important step you can take to curb the disease’s progress is to quit smoking, says the ALA.

In addition, there are a number of lifestyle changes that can help ease your symptoms and slow down your emphysema. Here are some strategies that can help improve your quality of life.

• Eat a healthy diet. Your body uses food to fuel all its activities, and that includes breathing. Talk to your doctor and a registered dietitian about diet changes that may help ease your emphysema symptoms and increase your energy.
• Maintain your ideal body weight. Being overweight will make breathing even more difficult. Being underweight, on the other hand, can leave you feeling weak and tired, and can also increase your risk of chest infections.
• Avoid lung irritants. Smoking isn’t the only thing that exacerbates emphysema. Avoid secondhand smoke, exhaust fumes, strong perfumes, cleaning products, paint and varnish, excessive dust, and other pollution.
• Stay active. Regular exercise can reduce shortness of breath by improving the body’s use of oxygen and strengthening your respiratory muscles. Talk to your doctor about the amount and type of exercise you should do.
• Get vaccinated. Stay up-to-date on vaccinations, including those for the flu, COVID-19, and pneumonia, to prevent chest infections, which can be dangerous — even life-threatening — for people with COPD.

Additional reporting by Julia Califano.

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Emphysema – diagnosis and treatment at 100med

Pulmonary emphysema is a pathology that has a chronic course, slowly leading to disability. It often develops against the background of chronic bronchitis, bronchial asthma and is accompanied by an increase in the terminal sections of the lungs as a result of destruction.

Symptoms

Symptoms do not have characteristic clinical features and are often combined with manifestations of other chronic pathologies of the respiratory system with a chronic course. The symptoms of obstructive bronchitis and emphysema are especially similar. The main symptom of emphysema is shortness of breath that occurs at rest. It is progressive in nature, occurring first under load.

Patients with emphysema in advanced cases are thin, often have a cachectic appearance.

Causes

The likelihood of developing emphysema is associated with the following factors:

• inhalation of tobacco smoke, toxic substances;

• violation of microcirculation in bronchopulmonary tissue;

• bronchial asthma and chronic obstructive pulmonary disease in history;

• inflammatory processes in the alveoli, etc.

Diagnostics

On examination, the following signs are noted:

• barrel chest;

• dilated intercostal spaces;

• protrusion of the supraclavicular fossae;

• shallow breathing with the help of accessory respiratory muscles.

Confirm the diagnosis:

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Our expert’s opinion

The lack of adequate treatment leads to the progression of the disease, early disability, as respiratory and heart failure develops. Timely contacting the clinic will help to avoid the development of the disease and improve the quality of life. The appointment is conducted by an experienced pulmonologist. He should be the one to sign up for.

Treatment

Conservative attraction does not involve the use of special methods. It is important to exclude factors contributing to the progress of pathology. Drug therapy for emphysema is symptomatic. Operative treatment of emphysema consists of an operation to reduce the volume of the lungs.

Prophylaxis

It is important to avoid smoking tobacco. Early detection and treatment of patients with bronchial asthma, obstructive bronchitis is necessary. Patients suffering from the disease are subject to the supervision of a pulmonologist.

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Pulmonary emphysema is a chronic disease manifested by swelling of the lung tissue. Alveoli pathologically expand, their walls change. Emphysema is experienced by patients suffering from diseases of the bronchopulmonary system.

Causes of pulmonary emphysema

Pathology complicates the course of chronic bronchopulmonary diseases. The likelihood of development increases if the patient:

• genetic predisposition,
• smoking,
• work related to factors harmful to the lungs,
• most of the time passes in an ecologically unfavorable area.

Symptoms of pulmonary emphysema

Shortness of breath – at first only during exertion, and later – at rest.

All organs and tissues suffer from oxygen starvation.

The patient is losing weight, the color of the skin changes.

Diagnosis of pulmonary emphysema

The doctor immediately draws attention to the patient’s characteristic appearance and behavior. Notes abnormalities on physical examination. Assigns additional research methods:

• X-ray or CT OGK,
• assessment of the function of external respiration,
• pulse oximetry.

Treatment of pulmonary emphysema

Symptomatic therapy is carried out. Bronchodilators are prescribed in the form of inhalations. In severe cases, low-flow oxygen therapy is connected.

In extremely severe cases, lung transplantation or volumetric reduction of lung tissue is indicated.

Massage, physiotherapy exercises, FZT are used.