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.