Emphysema life: Emphysema: Stages and Life Expectancy
Emphysema: Stages and Life Expectancy
Doctors describe how bad your emphysema is by using what they call “stages.” They use two main methods to come up with this information — the GOLD Emphysema Staging System and the BODE Index. Read on to learn more about each of them.
The GOLD Emphysema Staging System
This is a set of guidelines established by the Global Initiative for Chronic Obstructive Lung Disease (GOLD).
It measures how much air you can blow out of your lungs in 1 second. Doctors call this the forced expiratory volume (FEV1).
If you have emphysema, your doctor will look at your FEV1. They’ll also look at your other symptoms, as well as how many times you’ve been hospitalized in the past year because of them. Doctors call this an “exacerbation.” It means your symptoms flare up or suddenly get worse.
Your doctor may also do a CT scan of your lungs. They’ll then use all of this information to place you into one of the following four groups (they tell you how severe your emphysema is):
Group A (GOLD 1 or 2): Your symptoms are very mild. Your FEV1 is 80% or more. You might have had no flare-ups over the past year, or perhaps just one. You weren’t hospitalized for your symptoms.
Group B (GOLD 1 or 2): Your FEV1 is between 50% and 80%. You have more symptoms than people in Group A. This is the stage where most people see their doctor for coughing, wheezing, and shortness of breath.
You might have had one major flare-up, but you haven’t been in the hospital for your symptoms within the past year.
Group C (GOLD 3 or 4): Air flow into and out of your lungs is severely limited. Your FEV1 is between 30% and 50%.
You’ve had more than two flare-ups in the past year, or you’ve been admitted to the hospital at least once.
Group D (GOLD 3 or 4): It’s extremely hard for you to breathe in or out. You’ve had at least two flare-ups in the past year, or you’ve been hospitalized at least once.
Doctors call this “end-stage” COPD. That means you have very little lung function. Any new flare-ups could be life-threatening.
The BODE Index
This staging system measures how much emphysema impacts your daily life. It looks at four main areas:
Body mass index(B). This describes how much body fat you have compared to your height and weight.
Airflow limitation(O for obstruction). Your doctor can tell how damaged your lungs are by how well you do on pulmonary (lung) function tests.
Breathlessness(D – doctors call it “dyspnea”). Your doctor will ask you a series of questions about how often you feel like you’re out of breath, and when.
Exercise capacity (E). This measures how far you can walk in 6 minutes.
Studies show that the BODE Index gives doctors a better idea about your outcome (what they call a “prognosis”) than FEV1. And they can use those findings to see how well you’ll respond to medications, lung rehab therapy, and other treatments.
Emphysema gets worse over time, and it affects everyone differently. That means there’s no way doctors can know for sure who long you can expect to live if you have it.
Your doctor will use information about the stage of your disease to come up with the best treatment plan for your special case.
Living With End-Stage Emphysema | Franciscan Health
Every breath we take is often taken for granted. But for the 3.8 million Americans living with emphysema, each shortened breath, cough and wheeze is a reminder of this devastating lung disease.
End-stage emphysema, or stage 4 emphysema, can mean living with a decade or more of breathing problems, tiredness, heart problems or other health concerns that impact your ability to live your life to your fullest.
Because emphysema, like other forms of COPD, reduces the amount of oxygen that can reach your bloodstream, the heart works harder to spread oxygen throughout the body. A person with severe emphysema may get tired easily, may have chest pains or palpitations, or experience headaches, sleep problems, and irritability.
“There is no cure for emphysema or COPD, but our goal is to help slow the progression of the disease,” said Faisal Khan, MD, a Greenwood pulmonologist who practices at Franciscan Health Indianapolis.
What Is Emphysema?
Emphysema is a lung disease that damages the air sacs in the lungs, leading to shortness of breath and reducing how much oxygen is delivered into the bloodstream.
Emphysema permanently damages the alveoli, or air sacs, in your lungs, making it harder for your body to breathe. Emphysema weakens and ruptures these air sacs. With less air sacs there is less area for oxygen to reach your bloodstream.
Although treatment may slow progression of the condition, it can’t reverse the damage.
What Is The Difference Between Emphysema And COPD?
Emphysema, along with chronic bronchitis, falls under a group of lung diseases known as COPD (chronic obstructive pulmonary disease). These lung diseases cause airflow blockage and breathing problems.
How Common Is End-Stage Emphysema?
Stage 3 emphysema is when you have less than 50% lung function remaining, and stage 4 (or end-stage emphysema) is when you have less than 30% lung function left.
More than 140,000 people in Indiana and about 65,000 people in Illinois have emphysema, and about one-third of those patients have severe emphysema (stage 3 and 4).
In all, COPD is the third-leading cause of death in the US and affects 373,000 people in Indiana.
What Causes Emphysema?
Smoking is the leading cause of emphysema, which makes it one of the most preventable respiratory diseases. Emphysema is most common in men between 50 and 70 years of age. Cigarette smoking is the cause in about 9 in 10 people with emphysema. A smoker is 10 times more likely to die from COPD than a nonsmoker.
If a smoker quits before emphysema develops, the decline levels off until it is nearly normal for the person’s age. Smokers who quit also see an improved life expectancy.
Scientists believe that other factors are involved in the disease, because only 3 in 20 to 1 in 5 smokers develops emphysema. Other factors that may contribute to emphysema include air pollution, fumes, and dust in the workplace.
There is also 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 Emphysema?
Emphysema usually comes on slowly, as the disease destroys lung tissue gradually. Early emphysema symptoms include occasional shortness of breath and fatigue, but the lung disease is often not diagnosed for years, until it has damaged more than half of your lungs’ air sacs.
Symptoms of emphysema include:
- Shortness of breath, particularly during light exercise
- Long-term cough
- Feeling of not getting enough air
- Mental fog
- Ongoing mucus production
- Constant fatigue
- An enlarged heart because of damaged lungs
- Swelling of the ankles, legs or abdomen
- A bluish tinge to skin, lips and nails due to poor oxygen supply.
How Do You Treat Emphysema In The Lungs?
“Our goal when treating people with severe emphysema is to help them live more comfortably with emphysema, control emphysema symptoms, and prevent emphysema from advancing to a later stage, or getting worse,” Dr. Khan said. Oftentimes antibiotics, inhalers or other medications can help relieve shortness of breath.
There is no way to repair or regrow the damaged lung tissue.
Depending on the severity of your emphysema, your treatment plan may include:
- A pulmonary rehabilitation program to strengthen the muscles you use for breathing and exercise the rest of your body. “It’s tempting to not exercise when you have emphysema, but regular physical activity can actually improve your health,” Dr. Khan said.
- Antibiotics for bacterial infections
- Staying away from the smoke of others and removing other air pollutants from your home and workplace
- COPD medicines (bronchodilators) that widen the airways of the lungs, and can be either taken by mouth or inhaled
- Getting the flu and pneumococcal vaccines
- Nutritional support since you may develop malnutrition and lose weight
- Other types of oral and inhaled medicines that are used to treat symptoms such as coughing and wheezing
- Oxygen therapy when medications are not doing enough for you.
- Quitting smoking, whether from traditional cigarettes, cigars or vaping.
How Do You Treat End-Stage Emphysema?
As emphysema becomes more severe and the disease progresses to later stages, surgical options may be considered. These include surgery to remove the damaged area of the lung or a lung transplant if lungs are too damaged to benefit from surgery. However, lung reduction surgery and lung transplants are only helpful in a small group of patients with end-stage emphysema, and there is severe risk in these surgeries. There is no way to repair or regrow damaged lung tissue.
However, a new, less invasive procedure is now available for people with severe or end-stage emphysema (stage 3 or stage 4 emphysema). Franciscan Health now offers an endobronchial valve system to treat breathing problems. The Zephyr® valve procedure is for people with severe emphysema. Patients report being able to take full breaths immediately after the procedure and within a few days are back to doing everyday tasks with ease.
Can Emphysema Be Cured?
Emphysema cannot be cured, as lung tissue cannot be regrown, but treatment may slow the progression of the disease.
Emphysema | Emphysema Symptoms | Emphysema Treatment
What is emphysema?
Emphysema is a type of COPD (chronic obstructive pulmonary disease). COPD is a group of lung diseases that make it hard to breathe and get worse over time. The other main type of COPD is chronic bronchitis. Most people with COPD have both emphysema and chronic bronchitis, but how severe each type is can be different from person to person.
Emphysema affects the air sacs in your lungs. Normally, these sacs are elastic or stretchy. When you breathe in, each air sac fills up with air, like a small balloon. When you breathe out, the air sacs deflate, and the air goes out.
In emphysema, the walls between many of the air sacs in the lungs are damaged. This causes the air sacs to lose their shape and become floppy. The damage also can destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones. This makes it harder for your lungs to move oxygen in and carbon dioxide out of your body.
What causes emphysema?
The cause of emphysema is usually long-term exposure to irritants that damage your lungs and the airways. In the United States, cigarette smoke is the main cause. Pipe, cigar, and other types of tobacco smoke can also cause emphysema, especially if you inhale them.
Exposure to other inhaled irritants can contribute to emphysema. These include secondhand smoke, air pollution, and chemical fumes or dusts from the environment or workplace.
Rarely, a genetic condition called alpha-1 antitrypsin deficiency can play a role in causing emphysema.
Who is at risk for emphysema?
The risk factors for emphysema include
- Smoking. This the main risk factor. Up to 75% of people who have emphysema smoke or used to smoke.
- Long-term exposure to other lung irritants, such as secondhand smoke, air pollution, and chemical fumes and dusts from the environment or workplace.
- Age. Most people who have emphysema are at least 40 years old when their symptoms begin.
- Genetics. This includes alpha-1 antitrypsin deficiency, which is a genetic condition. Also, smokers who get emphysema are more likely to get it if they have a family history of COPD.
What are the symptoms of emphysema?
At first, you may have no symptoms or only mild symptoms. As the disease gets worse, your symptoms usually become more severe. They can include
- Frequent coughing or wheezing
- A cough that produces a lot mucus
- Shortness of breath, especially with physical activity
- A whistling or squeaky sound when you breathe
- Tightness in your chest
Some people with emphysema get frequent respiratory infections such as colds and the flu. In severe cases, emphysema can cause weight loss, weakness in your lower muscles, and swelling in your ankles, feet, or legs.
How is emphysema diagnosed?
To make a diagnosis, your health care provider
- Will ask about your medical history and family history
- Will ask about your symptoms
- May do lab tests, such as lung function tests, a chest x-ray or CT scan, and blood tests
What are the treatments for emphysema?
There is no cure for emphysema. However, treatments can help with symptoms, slow the progress of the disease, and improve your ability to stay active. There are also treatments to prevent or treat complications of the disease. Treatments include
- Lifestyle changes, such as
- Quitting smoking if you are a smoker. This is the most important step you can take to treat emphysema.
- Avoiding secondhand smoke and places where you might breathe in other lung irritants
- Ask your health care provider for an eating plan that will meet your nutritional needs. Also ask about how much physical activity you can do. Physical activity can strengthen the muscles that help you breathe and improve your overall wellness.
- Medicines, such as
- Bronchodilators, which relax the muscles around your airways. This helps open your airways and makes breathing easier. Most bronchodilators are taken through an inhaler. In more severe cases, the inhaler may also contain steroids to reduce inflammation.
- Vaccines for the flu and pneumococcal pneumonia, since people with emphysema are at higher risk for serious problems from these diseases
- Antibiotics if you get a bacterial or viral lung infection
- Oxygen therapy, if you have severe emphysema and low levels of oxygen in your blood. Oxygen therapy can help you breathe better. You may need extra oxygen all the time or only at certain times.
- Pulmonary rehabilitation, which is a program that helps improve the well-being of people who have chronic breathing problems. It may include
- An exercise program
- Disease management training
- Nutritional counseling
- Psychological counseling
- Surgery, usually as a last resort for people who have severe symptoms that have not gotten better with medicines. There are surgeries to
- Remove damaged lung tissue
- Remove large air spaces (bullae) that can form when air sacs are destroyed. The bullae can interfere with breathing.
- Do a lung transplant. This is might be an option if you have very severe emphysema.
If you have emphysema, it’s important to know when and where to get help for your symptoms. You should get emergency care if you have severe symptoms, such as trouble catching your breath or talking. Call your health care provider if your symptoms are getting worse or if you have signs of an infection, such as a fever.
Can emphysema be prevented?
Since smoking causes most cases of emphysema, the best way to prevent it is to not smoke. It’s also important to try to avoid lung irritants such as secondhand smoke, air pollution, chemical fumes, and dusts.
NIH: National Heart, Lung, and Blood Institute
Emphysema – Lung Health A-Z
There is no treatment to repair the damage to your lungs that emphysema causes. The most important thing you can do is to quick smoking and avoid breathing in “bad air.” If you can do these two things, you may be able to prevent your emphysema from getting worse.
There are treatments, however, that can improve shortness of breath and reduce the risk of an exacerbation (worsening of breathing symptoms usually because of a respiratory infection).
Inhaled Bronchodilator Medications
These medications are the cornerstone of emphysema treatment. These medications open the breathing tubes in your lungs to make it easier to get all the air out and thus easier to breathe. There are 2 types of inhaled bronchodilators, and they work in different ways to open your breathing tubes.
- Long-acting inhalers. You typically use these inhalers once or twice a day.
- Short-acting inhalers. You typically use these inhalers every 4 to 6 hours and as needed.
These inhaler types are frequently used together for greatest effect.
If the amount of oxygen in your blood falls below 88%, your provider may prescribe oxygen. (Your provider can measure the amount of oxygen in your blood by putting a clip called an oximeter on your finger.)
Starting a pulmonary rehabilitation program is the one of the best ways to improve shortness of breath, quality of life, and your ability to exercise.
Depending on your situation, your provider may consider surgical treatments. For example, parts of your lung that are damaged or destroyed can interfere with more normal parts of your lung. A surgical procedure can remove these damaged parts.
Another surgical procedure used for people with advanced emphysema is to insert little one-way valves—called endobronchial valves—into the breathing tubes in your lungs. The lung specialist or surgeon uses a long, flexible tube, called a bronchoscope, with a camera and tools on the end to place the valves. The valves allow air to exit the healthy parts of your lungs and collapse the areas of your lungs that are damaged. Your lungs deflate, which helps your diaphragm muscle work better so that you can breathe better.
Living with Emphysema
If you have emphysema, it’s important to focus on what you can do, not on what’s difficult to do. Make sure that you know as much as possible about your condition so that you can function at the highest possible level. Know the names of the medicines you take for emphysema and how long they’re supposed to work. Also, create an action plan in case your breathing gets worse.
You can expect your emphysema to get worse if you continue to smoke or inhale second-hand smoke and other irritants in the air. Many people with emphysema find that they reduce their activities to avoid breathing difficulty. Over time, however, lack of exercise can make shortness of breath worse because less activity leads to being “out of shape” and possible weight gain.
You can expect that using inhaled medications will open your airways and make it easier to breathe. You can also expect to be able to be more active if you exercise regularly, either on your own or by participating in a pulmonary rehabilitation program. If you follow recommended treatments, your breathing may remain stable for a long time.
Ideally, you should lead a healthy life style that includes not smoking, eating healthy foods, maintaining a normal body weight, exercising regularly, getting 7 to 8 hours of sleep each night, and avoiding too much stress. Get a yearly flu shot to reduce the chances of getting the flu. Also, you should get the two pneumonia shots to prevent the most common bacterial cause of pneumonia.
Be sure to use your inhaled medications correctly and as prescribed by your health care provider. Use your albuterol inhaler if you have difficulty breathing. This medicine opens the breathing tubes in your lungs quickly, but it lasts only 3 to 4 hours.
Finally, make sure that you get a written action plan from your health care provider. Keep it with you in case your breathing gets worse. Most action plans recommend using your rescue inhaler every 2 to 4 hours as needed and calling your health care provider if you have a chest cold or start to cough up yellow or green mucus. Call your provider if you experience any major change in your breathing, Regular appointments with your health care provider are important for monitoring your emphysema and discussing treatments.
Symptoms, stages, causes, treatments, and outlook
Emphysema is a type of chronic obstructive pulmonary disease (COPD). In this condition, the air sacs in the lungs become damaged and stretched. This results in a chronic cough and difficulty breathing.
Smoking is the most common cause of emphysema, but other factors can also cause it. There is currently no cure, but quitting smoking can help improve the outlook.
In the United States, around 3.8 million people (1.5% of the population) have received a diagnosis of emphysema. In 2017, 7,085 people (2.2 people in every 100,000) died with the condition.
Keep reading to learn more about emphysema, including the causes, symptoms, and treatment options.
Emphysema is a type of COPD. With emphysema, lung tissue loses elasticity, and the air sacs and alveoli in the lungs become larger.
The walls of the air sacs break down or are destroyed, narrowed, collapsed, stretched, or over-inflated. This means that there is a smaller surface area for the lungs to take oxygen into the blood and remove carbon dioxide from the body.
This damage is permanent and irreversible, but there are ways of managing the condition.
The key symptoms of emphysema include:
- shortness of breath, or dyspnea
- a chronic cough that produces mucus
- wheezing and a whistling or squeaky sound when breathing
- tightness in the chest
At first, a person may notice these symptoms during physical exertion. However, as the condition progresses, they can also start to happen during rest.
Emphysema and COPD develop over a number of years.
In the later stages, a person may have:
- frequent lung infections and flare-ups
- worsening symptoms, including shortness of breath, mucus production, and wheezing
- weight loss and reduced appetite
- fatigue and a loss of energy
- blue-tinged lips or fingernail beds, or cyanosis, due to a lack of oxygen
- anxiety and depression
- sleep problems
Learn more about late stage COPD here.
The Emphysema Foundation of America have expressed concern about how COVID-19 might affect people with emphysema.
They urge people with COPD to familiarize themselves with the symptoms of COVID-19. These can resemble the symptoms of COPD and emphysema. A person should contact their doctor if they have any unusual symptoms or a high fever.
They recommend taking full precautions to avoid exposure to the virus, including:
- frequently washing the hands and encouraging others to do the same
- avoiding people who may have had contact with the virus
- frequently wiping surfaces
- wearing a face covering such as a mask in public places
- avoiding crowded gatherings
They also advise:
- maintaining at least a 30-day supply of medication
- keeping a stock of household necessities, including food and other basics
- checking with local providers about plans to maintain oxygen supplies
- making a plan in case of sickness
Learn more about CODID-19 and COPD here.
The Global Initiative for Chronic Obstructive Lung Disease sets out the stages of COPD.
Generally, the stages are based on a combination of airflow limitation, symptoms, and exacerbations.
A doctor can use a breathing test to measure lung capacity. The test measures the forced expiratory volume in 1 second (FEV1).
Based on FEV1, the stages are as follows:
- Very mild, or stage 1: FEV1 is about 80% of normal.
- Moderate, or stage 2: FEV1 is 50–80% of normal.
- Severe, or stage 3: FEV1 is 30–50% of normal.
- Very severe, or stage 4: FEV1 is less than 30% of normal.
The stages help describe the condition, but they cannot predict how long a person is likely to survive. Doctors can carry out other tests to learn more about how serious a person’s condition is.
In most cases, emphysema and COPD result from cigarette smoking. However, up to 25% of people with COPD have never smoked.
Other causes appear to be genetic factors, such as an alpha-1 antitrypsin deficiency, and exposure to environmental irritants, including secondhand smoke, workplace pollutants, air pollution, and biomass fuels.
People with small airways in proportion to their lung size may be more at risk than those with wider airways, according to a 2020 study.
In addition, not all people who smoke develop emphysema. It may be that genetic factors make some people more susceptible to the condition.
Emphysema is not contagious. One person cannot catch it from another.
Treatment cannot cure emphysema, but it can help:
- slow the progress of the condition
- manage the symptoms
- prevent complications
- boost a person’s overall health and well-being
Supportive therapy includes oxygen therapy and help with quitting smoking.
The sections below will look at some specific treatment options in more detail.
The main medications for emphysema are inhaled bronchodilators, which can help relieve symptoms. They relax and open the airways, making it easier for a person to breathe.
The inhaler delivers the following bronchodilators:
- beta-agonists, which relax bronchial smooth muscle and help clear mucus
- anticholinergics, or antimuscarinics, such as albuterol (Ventolin), which relax bronchial smooth muscle
- inhaled steroids, such as fluticasone, which help reduce inflammation
If a person uses them regularly, these options can improve lung function and increase exercise capacity.
There are short-acting and long-acting drugs, and people can combine them. Treatment may also change over time and as the condition progresses.
People can take steps to manage their symptoms, improve their quality of life, and slow the progression of emphysema. The sooner a person takes these steps, the more helpful they will be.
Some things to try include:
- quitting or avoiding smoking
- avoiding places where there are air pollutants, if possible
- following or developing an exercise program
- consuming a healthful diet
- drinking plenty of water, to loosen mucus and help keep the airways open
- breathing through the nose in cold weather or using a face covering to keep out cold air
- practicing diaphragmatic breathing, pursed-lip breathing, and deep breathing
Pulmonary rehabilitation is a program of care that encourages people with emphysema to learn about and manage their condition. There is a focus on developing and maintaining healthful lifestyle choices.
Making these changes may not alter the overall course of the condition, but it can help people manage the symptoms, improve their exercise capacity, and boost their quality of life.
People should also ensure that they meet with their healthcare provider regularly and receive their routine vaccinations, including those for flu and pneumonia.
In time, breathing can become more difficult, and a person may need oxygen therapy some or all of the time. Some people use oxygen overnight, for example.
Various devices are available, including large tanks for home use and portable oxygen kits for traveling.
People should discuss the most suitable options with their healthcare provider.
People with severe emphysema may sometimes need to undergo surgery to remove damaged lung tissue and reduce large spaces that develop in the lungs due to the condition.
Transplantation of one or both lungs can improve a person’s quality of life. However, there are some risks involved, such as the chance of infection.
A healthcare provider will help the person decide whether or not surgery is a good idea for them.
Other treatment options can help during a flare-up or if complications arise. These options may include:
- oxygen therapy, to relieve worsening symptoms
- antibiotics, to treat a bacterial infection
- corticosteroid drugs, to reduce inflammation
- other medications, to relieve severe coughing and pain
The outlook for a person with emphysema will depend on individual factors and how well they manage their condition. It takes several years to progress to the final stages of COPD or emphysema, but lifestyle factors play a role.
Quitting smoking can significantly improve the outlook. According to the National Heart, Lung, and Blood Institute, COPD can progress quickly in people with alpha-1 antitrypsin deficiency who also smoke.
Research suggests that for those who have never smoked, COPD will modestly reduce their life span. People who do smoke, however, can expect their life span to be significantly shorter.
Emphysema and COPD affect not only life span, but also a person’s quality of life. Taking lifestyle measures to manage the condition can help a person maintain a good quality of life for longer.
How does COPD affect life expectancy? Learn more here.
Emphysema is a type of COPD, and there are different types of emphysema, depending on which part of the lungs it affects.
- paraseptal emphysema
- centrilobular emphysema, which affects mainly the upper lobes and is most common in people who smoke
- panlobular emphysema, which affects both the paraseptal and centrilobular areas of the lungs
During diagnosis, a CT scan can show which type of emphysema is present. The type does not affect the outlook and treatment.
A doctor will carry out a physical examination and ask about the person’s symptoms, lifestyle habits, and medical history.
They may also recommend tests to confirm the diagnosis and rule out other conditions.
If the person has never smoked but appears to have emphysema, the doctor may suggest testing for an alpha-1 antitrypsin deficiency.
The following sections will look at some diagnostic tests for emphysema in more detail.
Lung function tests
Lung function tests measure the lungs’ capacity to exchange respiratory gases. They can:
- confirm a diagnosis of emphysema
- monitor disease progression
- assess response to treatment
Spirometry is one type of lung function test. It assesses airflow obstruction by measuring FEV.
For this test, a person blows as fast and hard as they can into a tube. The tube is attached to a machine that measures the volume and speed of the air that they blow out. FEV1 determines the stages of emphysema.
Other tests include imaging, such as a chest X-ray or CT scan of the lungs, and arterial blood gas analysis, to assess oxygen exchange and carbon dioxide levels.
Avoiding or quitting smoking is the best way to prevent emphysema from developing or getting worse.
Other strategies include:
- eating a healthful diet
- establishing and maintaining a moderate weight
- avoiding air pollution, if possible
- taking steps to prevent infection, such as receiving routine vaccinations
Emphysema involves irreversible damage to the lungs, which can eventually be life threatening. It mostly affects people who smoke, but people who do not smoke can develop it, too.
Seeking early treatment and taking measures to manage the condition can help enhance a person’s health and well-being and may improve their life span.
Emphysema – Better Health Channel
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
- 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.
- 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
- 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 Australia 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
6 Keys to Living Well With Emphysema
One of smoking’s many adverse effects is the risk of developing emphysema and COPD, or chronic obstructive pulmonary disease.
Emphysema is one of two types of COPD; the other is chronic bronchitis. If you have emphysema, it is likely that the air sacs, or alveoli, in your lungs are damaged. As a result, your body is not getting the oxygen it needs to function properly.
“Think of COPD as a spectrum of disease, with chronic bronchitis on one end and emphysema on the other,” says Jeffrey Michaelson, MD, a pulmonologist with Piedmont Hospital in Atlanta. “COPD-related disease is most frequently caused by smoking cigarettes and first starts to manifest symptoms usually by the mid-fifties in continuous smokers.”
Telltale Emphysema Symptoms
Emphysema affects your body in many ways. Typical emphysema symptoms include having a hard time catching your breath — especially while exercising — and a chronic cough. “Symptoms of emphysema deal with progressive shortness of breath that limits activity,” says Dr. Michaelson.
Many people with emphysema also have chronic bronchitis, so an emphysema diagnosis may include chronic bronchitis symptoms as well. Chronic bronchitis brings with it the continual production of sputum associated with cough and chest congestion. Michaelson notes that the majority of patients fall somewhere in the middle of the COPD spectrum and display symptoms of both diseases.
Finding the Right Emphysema Treatment
Emphysema and COPD can’t be cured, but the right treatment can improve your emphysema prognosis as well as your overall health and well-being. Taking these steps will help:
- Get a diagnosis. If you’re unsure if you have emphysema and COPD, start by getting a diagnosis. Only then can your doctor begin to help you. “If you feel that you or someone you know over the age of 35 may be experiencing symptoms, a brief, five-question screener will help determine if that person might be at risk for COPD,” says Michaelson.
- Start emphysema treatment. Your doctor needs to be your primary source for getting a handle on emphysema treatment, says Michaelson. “It is important to seek treatment once diagnosed since COPD is a progressive disease. It can lead to frequent hospital admissions, poor quality of life, the need for supplemental oxygen, or a ventilatory assist device worn at night to help maintain effective breathing while asleep,” he says. Treatment — especially quitting smoking — along with using inhalers, helps lessen symptoms, delays disease progression, and enables patients to maintain an active lifestyle.
- Quit smoking. If you want to have a better emphysema prognosis and prevent the progression of emphysema symptoms, no step is more important than to quit smoking. “Stopping smoking reduces the inflammation and lung damage that leads to worsening of COPD and emphysema,” says Michael S. Nolledo, MD, an attending pulmonologist at the Deborah Heart and Lung Center in Browns Mills, N.J.
- Avoid other irritants. Tobacco smoke isn’t the only irritant that can exacerbate emphysema and COPD. “Most COPD in this country is related to smoking, but only 20 percent of smokers develop significant COPD,” says Byron Thomashow, MD, medical director at NewYork–Presbyterian Hospital in New York City and chairman of the COPD Foundation. “This suggests that other genetic or environmental factors must also play roles.” Some potential irritants include cold air or poor air quality days in your region.
- Keep immunizations up to date. Michaelson says that this is a critical step for avoiding complications to emphysema and COPD. Flu and pneumonia immunizations are especially important.
- Do the right exercises. Both breathing exercises and regular cardiovascular exercise like walking are critical to curbing symptoms and having a good emphysema prognosis. Get started by doing these exercises in a program led by a trained professional before you branch out on your own. “Exercises are best managed under the guidance of a pulmonary rehabilitation program that involves not just specific exercises, but disease counseling as well,” says Dr. Nolledo. “COPD patients who complete these programs have been shown to have significant improvement in their shortness of breath.”
Because emphysema symptoms will worsen without treatment, it’s vital that you work with your doctor to manage your condition. Taking care of yourself and taking control of your symptoms will give you the best possible prognosis.
90,000 Modern concept of surgical treatment of diffuse pulmonary emphysema
Lung emphysema are anatomical changes in the lungs characterized by pathological expansion of air spaces located distal to the bronchioles, and accompanied by destructive changes in the alveolar walls.
Pulmonary emphysema mainly affects chronic smokers or representatives of specialties with harmful working conditions (drivers, welders, etc.) who have symptoms of respiratory failure in middle or older age, that is, patients with chronic obstructive pulmonary disease.
Despite modern conservative therapy and rehabilitation, the quality of life and prognosis in patients with severe diffuse pulmonary emphysema remain poor, and the three-year survival rate does not exceed 60%. This makes us look for new ways in the treatment of severe stages of diffuse pulmonary emphysema.
Currently, the number of patients with diffuse pulmonary emphysema, as an outcome of chronic obstructive pulmonary disease, is steadily increasing in the world, which is associated with the negative influence of harmful environmental factors and smoking.In Russia, there are about 11 million patients with chronic obstructive pulmonary disease.
Clinically diffuse emphysema is manifested by shortness of breath, unproductive cough, decreased exercise tolerance. Respiratory failure develops, eventually leading to death.
When emphysema is characterized by: shortness of breath, a barrel-shaped chest, a decrease in its respiratory excursions, widening of the intercostal spaces, swelling of the supraclavicular regions, boxed percussion sound, weakened breathing, a decrease in the area of relative dullness of the heart, a low standing of the diaphragm and a decrease in its mobility, an increase in the transparency of the pulmonary fields on roentgenogram.
Primary emphysema, to a much greater extent than secondary emphysema, is characterized by severe shortness of breath (without a previous cough), with which the disease begins. Even at rest, patients have an extremely large ventilation volume, so their exercise tolerance is very low.
Known for patients with primary emphysema, the symptom of “panting” (covering the mouth opening during exhalation with swelling of the cheeks) is caused by the need to increase the intrabronchial pressure during exhalation and thereby reduce the expiratory collapse of the small bronchi, which interferes with the increase in ventilation volume.
Diagnosis of diffuse pulmonary emphysema is based on: X-ray examination, computed tomography and multispiral computed tomography of the chest organs, spirometry data (respiratory function tests), bodyplethysmography, blood gas composition, ventilation and perfusion scintigraphy.
In the early stages, when the diagnosis of diffuse emphysema is established, conservative therapy is carried out, including treatment of the underlying disease and therapy aimed at arresting respiratory and heart failure. Due to the fact that with emphysema ventilation of the lung tissue is significantly affected and the functioning of the mucociliary escalator is disrupted, the lungs become much more vulnerable to bacterial aggression.
Infectious diseases of the respiratory system in patients with this pathology often turn into chronic forms, foci of persistent infection are formed, which greatly complicates treatment. In the presence of such a pathology, special attention should be paid to antibiotic therapy of even minor respiratory infections in order to prevent their chronicity.
Modern conservative treatment does not always lead to an improvement in the quality of life and an increase in the physical endurance of patients. With an extremely severe stage of diffuse emphysema, the mortality rate within the next three years is 40%. Diffuse pulmonary emphysema is a disease traditionally treated by therapists and pulmonologists. The only radical operation for this disease can be a lung transplant, but the number of patients exceeds the real possibilities of transplantation. This forces us to look for new ways of treatment. There are various approaches to performing this type of surgery.
The experience accumulated to date in the surgical treatment of diffuse pulmonary emphysema has made it possible to outline certain criteria for selecting patients for surgery – surgical reduction of lung volume. Traditional “open” surgical approaches are used – sternotomy, lateral thoracotomy or video-assisted thoracoscopy (VATS).
Depending on the prevalence of bullous-cystic degeneration of the lung tissue, both open and endoscopic operations are performed.Open surgery (thoracotomy) is performed in cases of pronounced adhesions and with large volumes of lung tissue resection, which requires diaphragm plasty in order to reduce the volume of the residual pleural cavity.
Videothoracoscopic operations are used in all volumes. The only contraindication is the total adhesion process in the pleural cavities.
All operations for diffuse pulmonary emphysema are high-tech methods of treatment.
Since postoperative respiratory failure occurs much less frequently with VATS and less mortality is observed, VATS may be the operation of choice, especially in elderly patients.
From 20 to 40% of the most altered lung tissue is removed, which by weight is 50-100 g.
Evaluation of the effectiveness of the operations performed
Long-term observation of patients who underwent surgical reduction of lung volume shows that after surgery there is a slow decrease in the degree of dyspnea, improvement in functional parameters, pulmonary elastic response and exercise tolerance.All this together leads to an improvement in the quality of life.
Effects of surgical reduction of lung volume in relation to functional parameters are divided into short-term (3-6 months) and long-term (1 year or more). Decompression of relatively healthy lung tissue is one of the pathogenetic mechanisms for improving lung volumes after surgery. Persistent positive results were noted after 4 years or more after the operation.
After removal of non-functioning lung volumes, secondary bronchial obstruction is eliminated at the level of small distal bronchioles, which are devoid of a cartilaginous framework.
Tambov Regional Clinical Hospital named. V.D. Babenko is the only institution in the region where surgical treatment of patients with diffuse pulmonary emphysema is performed. In the period from 2015 to 2017 in the 1st surgical department of the State Budgetary Healthcare Institution “TOKB im. VD Babenko “performed more than 30 operations on patients with various forms of diffuse pulmonary emphysema.
A multidisciplinary multilevel approach is effectively implemented using modern diagnostic and therapeutic capabilities of a multidisciplinary hospital and performing modern videothoracoscopic operations using modern high-tech, high-energy equipment and stapling endosteplers.
As a result of the performed surgical interventions in patients with severe diffuse pulmonary emphysema, breathing mechanics are significantly improved, blood oxygen saturation and physical endurance increase, which leads to a decrease in shortness of breath, an improvement in the quality of life and enhances the effect of drug therapy.
The accumulated vast experience, continuous improvement of knowledge and skills, as well as the introduction of new techniques with the use of modern instrumentation allows successfully performing thoracoscopic operations in patients with diffuse pulmonary emphysema.
90,000 Pulmonary emphysema – prices for treatment, symptoms and diagnosis of pulmonary emphysema in the “CM-Clinic”
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Emphysema of the lungs is a chronic progressive disease that relatively often leads to disability. Emphysema belongs to the group of chronic obstructive pulmonary diseases along with bronchial asthma, chronic obstructive bronchitis, cystic fibrosis and bronchoectatic disease.
The terminal sections of the respiratory tract are represented by terminal bronxeoli and alveoli, where oxygen and carbon dioxide gas exchange during respiration. Emphysema is an irreversible enlargement of the end sections of the lungs due to destruction.
Factors leading to the onset of pulmonary emphysema:
- long-term smoking,
- the risk of developing this disease increases after 60 years,
- harmful impurities in the inhaled air,
- occupational hazards,
- respiratory tract infections,
- bronchial asthma,
- chronic obstructive pulmonary disease (COPD)
Symptoms of pulmonary emphysema
The clinical picture of emphysema does not have vivid signs inherent only to it, and this is one of the reasons why there is a concept of chronic obstructive lung diseases, which unites such closely related diseases as obstructive bronchitis, bronchial asthma and emphysema. The symptoms of obstructive bronchitis and emphysema are especially similar. As a rule, the main symptom of emphysema is shortness of breath, which occurs at rest or with little exercise.
If you experience these symptoms, we advise you to make an appointment with your doctor. Timely consultation will prevent negative consequences for your health. Phone for appointment +7 (495) 292-39-72
Treatment of pulmonary emphysema
There is no specific treatment for pulmonary emphysema.Treatment is directed at the underlying disease causing emphysema and improving quality of life. Smoking cessation is of great importance.
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Emphysema of the lungs | University Hospital Freiburg
Pulmonary emphysema is a chronic disease, which is based on an imbalance of enzymes (proteases – antiproteases or protective proteins) in the lungs. In this case, the alveoli, which make up the lung tissue, expand and lose the ability to sufficiently contract, as a result of which the flow of oxygen into the blood and the removal of carbon dioxide from it is disrupted.With emphysema, there is a pathological increase (swelling) of the lung tissue. Currently, there are three main types of the disease:
- centrilobular emphysema, which mainly affects the upper part of the lungs,
- panlobular, caused by a deficiency of the enzyme alpha-1 protease (it affects the lower parts of the lungs, forming scars and scars on the lung tissue ),
- and senile emphysema caused by natural age-related changes in the vessels of the lungs and impaired elasticity of the alveoli.
In the initial stages of the disease, signs of emphysema can appear with significant physical exertion in the form of shortness of breath, and at a later stage, respiratory failure occurs even at rest. Then dry cough with phlegm is added to shortness of breath. At the same time, the supply of oxygen to the body is disrupted due to stretching of the tissues of the alveoli, which, increasing in volume, cannot fully contract, therefore air accumulates in them.The patient experiences in this case:
- rapid fatigability,
- a general deterioration in well-being,
- his working capacity decreases.
Causes and risks
The main reasons leading to the development of pulmonary emphysema are:
- penetration into the respiratory tract of dust particles, vehicle exhaust gases, other pollutants, the inhalation of which is often associated with professional activities (miners, construction workers, etc. )
- tobacco smoke when smoking also aggressively affects the alveoli, gradually destroying them with toxins,
- frequent respiratory infections,
- hereditary predisposition to the disease.
Pulmonary emphysema often occurs on the basis of excessive smoking in the course of chronic obstructive bronchitis, which is currently included in the diagnosis of COPD (Chronic Obstructive Pulmonary Disease).
Examination and diagnosis
The standard examination procedures include, first of all:
- general medical examination of the patient
- and study of the medical history.
Further diagnostics in case of suspected emphysema includes a study of the function of external respiration using, first of all, spirometry and bodyplethysmography. These procedures also measure the volume of air in the lungs remaining after exhalation. In order to clarify the diagnosis of emphysema, an analysis of the so-called diffusion capacity of the lungs can be carried out. To perform this test, the patient must inhale a mixture with a low content of CO2 gas and hold his breath for 10 seconds, during which the gas enters the blood.In this case, the amount of CO2 in the alveoli is measured before and after holding the breath. Changes in lung tissue are determined using computed tomography (CT), and chest x-ray or magnetic resonance imaging, along with other methods, serve to increase the information content of the diagnosis. Based on a general blood test, it is possible to identify the presence of an inflammatory process, as well as a deficiency of the enzyme alpha-1 protease as a possible cause of pulmonary emphysema.By examining the gas composition of arterial blood (quantitative content of oxygen, carbon dioxide, pH value), it is possible to determine the degree of impairment of the patient’s respiratory capacity.
Therapy of emphysema should be aimed mainly at improving the patient’s quality of life and slowing the progression of the disease. Treatment includes many different methods used depending on the severity and individual parameters of the disease.
- Unconditional smoking cessation is of prime importance here.
- Inhalation of dust, exhaust fumes, etc. should be avoided, if possible.
- Drugs (bronchodilators) are prescribed as medical therapy to help widen the airways to improve oxygen supply to the body, as well as cortisone drugs as anti-inflammatory drugs.
- Physiotherapy procedures, breathing exercises, also help to increase the functionality of the lungs and improve the patient’s well-being.
- In case of advanced stage of the disease, a long course of oxygen therapy is recommended
- or, in extreme cases, surgery to reduce the volume or even to transplant lungs.
Emphysema is an incurable disease. However, a timely visit to a doctor and a quick start of the course of treatment counteract the development of the disease.
Along with pulmonary emphysema, it is often necessary to treat such concomitant diseases as chronic bronchitis, diabetes mellitus, heart failure.Complex therapy of pulmonary emphysema should also include additional preventive measures to prevent infectious respiratory diseases. This includes the annual vaccination against influenza and pneumococcal viruses.
Pulmonary emphysema: symptoms, treatment, diagnosis
Emphysema of the lungs is associated with impaired gas exchange and pathological expansion of air spaces against the background of significant morphological changes in the tissues of the alveoli. These reasons give the characteristic appearance of the lungs: they swell, acquire a pale shade, the edges are rounded, the elasticity of the tissues is reduced.The formation of plugs with mucous or purulent contents in the bronchi is possible.
The factors that can cause this disease are conventionally divided into two groups:
- The first group includes phenomena that contribute to the loss of elasticity and strength by tissues. These are pathological microcirculation, the consequences of inhalation of tobacco smoke, birth defects, severe pollution of the inhaled air and the presence of caustic or corrosive gaseous substances in them;
- the second group includes factors that provoke an increase in pressure in the respiratory part of the lungs.At the same time, there is a stretching of the alveoli, an increase in the size of the bronchioles and alveolar passages. This also includes chronic obstructive bronchitis, which creates favorable conditions for the development of the disease. There is a high probability of the spread of the inflammatory process to the alveoli with the subsequent development of alveolitis and the destruction of the partitions separating them.
Most of the symptoms of pulmonary emphysema are associated with shortness of breath and coughing up phlegm, which are caused by abnormal changes in the tissues of the lungs.
- At the initial stage of emphysema, shortness of breath appears only with intense physical exertion and active movement, and the cough contains a small amount of mucous secretions.
- At the second stage, or stage of pulmonary insufficiency, the patient has severe shortness of breath, cough with a small volume of sputum, changes in the shape of the fingers, hemoptysis, noticeable cyanosis of the face and extremities.
- At the third stage, called the stage of pulmonary heart failure, there is severe shortness of breath, cough with a large amount of purulent-mucous discharge.In the patient, due to constant tension in the throat, the cervical veins and the size of the liver increase, edema is noticeable, and the venous pressure rises. The face becomes swollen, the chest becomes rounded and convex.
Often, on the basis of pulmonary emphysema, one can judge the nature of the disease:
- in violation of bronchial patency, patients complain of shortness of breath, dry cough, feeling of lack of air, wheezing and whistling when breathing, forced participation in inhalation and exhalation of the abdominal and shoulder muscles;
- with an increase in pulmonary volume in patients, there is an expansion of the chest, weakening of breathing, protrusion of the intercostal spaces and a characteristic “box” sound when breathing;
- in persons with respiratory failure, shortness of breath, cutaneous cyanosis, deformity of the fingers, enlargement of the right ventricle of the heart, tachycardia, swelling of the cervical veins, shallow breathing with a short sigh and prolonged exhalation are noted.
Complications of pulmonary emphysema
The rapid progression of the disease in the absence of treatment can cause serious complications. It:
- pulmonary dysfunction, making it impossible to breathe properly;
- problems of gas exchange, causing changes in the kidneys, liver and other organs.
90,088 circulatory disorders;
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An accurate diagnosis can be made for the patient:
- X-ray, in the image of which transparent areas filled with air are visible in the lungs;
- spirometry, which allows you to determine the volume of inhaled and exhaled air. In emphysema, the second indicator is much greater than the first;
- peak flowmetry helps to clarify the expiratory flow rate with and without bronchodilator drugs.
An additional method for diagnosing pulmonary emphysema is a blood test, which can be used to track the presence of an inflammatory process in the body and its intensity.
The set of necessary diagnostic measures depends on the condition of a particular patient and the need to detail the picture of his health.
The list of the main tasks of the treatment course for pulmonary emphysema includes the elimination of complications, the elimination of the infectious process and its symptoms, the restoration of normal function of the lungs and respiratory tract.Therefore, when developing a course of treatment, preference is given to the following groups of drugs:
- compositions for restoring bronchial patency;
- means of eliminating respiratory failure;
- medicines to restore heart function;
- preparations for combating an associated infection.
90,088 preparations for sputum removal;
Among the main recommendations for reducing the risk of developing the disease:
- timely treatment of colds, viral and bacterial infections;
- control of the condition of the received injuries of the neck and chest;
- rejection of bad habits;
- measures for cleaning polluted air from dust and toxic chemical compounds;
- active lifestyle, sports.
Questions and Answers
How is pulmonary emphysema treated?
Patients with emphysema are shown a conservative course of treatment that allows them to cope with symptoms, ensure the normal functioning of the airways and eliminate possible complications. The duration of treatment depends on the severity of the patient’s condition and the symptomatic picture. It is possible to adjust the previously chosen tactics in the direction of supplementing or canceling some of the drugs taken.
Is pulmonary emphysema treated?
It is possible to speak about the chances of curing the disease only on the basis of research results and the timeliness of seeking medical help. In the early stages, it is possible to almost completely eliminate the signs of pathology and return the patient to the ability to breathe fully. In advanced cases, with numerous complications, it will not be possible to cope with the disease without consequences.
What is the main symptom of pulmonary emphysema?
The disease is indicated by shortness of breath after exercise or without it (in the later stages), as well as a cough with a large volume of sputum with purulent or mucous contents.Other symptoms – wheezing and whistling, protrusion of the chest, swelling and swelling of the face – may vary depending on the nature of the pathology.
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Emphysema of the lungs | LRC. Treatment and Rehabilitation Center of the Ministry of Economic Development of Russia
We will start our conversation not with what is emphysema of the lungs, but with how the lungs are arranged and what happens to their tissue with age.
Why would I start with this topic? Everything is very simple. I have little doubt that you opened this article after receiving a description of your chest x-ray. In the conclusion of the radiologist, it is most likely written: “No focal and infiltrative shadows were detected. Signs of emphysema and diffuse pneumosclerosis.” To understand what the radiologist, who wrote such a conclusion, meant, it is necessary to recall the structure of the lung.
The lungs consist of airways (bronchi and bronchioles) and air sacs (alveoli).It is easiest to imagine the structure of the lungs as a tree. The branches of which are bronchi of different diameters, which branch out into small branches (bronchioles). At the ends of the bronchioles are air sacs – alveoli, which look like bunches of grapes. The alveoli have a very thin wall and are braided by a network of blood vessels. It is through the thin wall of the alveoli that oxygen enters the bloodstream, and carbon dioxide is removed from the body.
What happens to the lung tissue during the development of pulmonary emphysema
During life, under the influence of various harmful factors (primarily smoking) and with age, the walls of the alveoli thicken to a greater or lesser extent, cease to be as elastic as before.The partitions between some air bubbles collapse and form one large bubble or bulla. These phenomena of restructuring of lung tissue are called emphysema. In fact, the word emphysema comes from the Greek word emphysao- “to inflate.” Just the degree of “swelling” of the lungs is a manifestation of emphysema. Imagine an old rubber toy. It is impossible to squeeze out all the air from it, as before, and it no longer straightens out at such a speed when you stop squeezing it. The same thing happens in the lung tissue with emphysema: part of the air that was previously easily exhaled remains in the lungs, which means that the amount of “fresh” air with a new portion of oxygen will be less during the next inhalation. The same situation occurs with the lung tissue as in the Starostitak and with certain lung diseases.
Age-related emphysema of the lungs
With age, the elasticity of the lungs slowly decreases. According to the calculations of scientists, it should reach minimum values by the age of 140–150.
When performing an X-ray of the chest organs in a patient 60-70 years old, the doctor-radiologist almost always sees slightly “swollen lungs” and thickened alveolar walls. Most often these are the so-called “age-related” changes in the lung tissue.This is where the radiologist’s conclusion comes from: Emphysema. Diffuse pneumosclerosis.
If you still have doubts about the need to treat the identified changes in the lung tissue, then in order to get an accurate answer to the question: does the lung condition correspond to your age, you just need to ask the doctor to conduct the function of external respiration, or even better bodyplethysmography and study the diffusion ability lungs. When carrying out bodyplethysmography, not only the volume of the lungs is determined, but also how much air remains in them after exhalation.Please note that when you do this test, your doctor will ask your age, weight and height. This is necessary because for people of a certain age, height, body weight and gender, the indicators of respiratory function have their own individual indicators of the norm, which, unfortunately, decrease with age.
Pulmonary emphysema as a disease
Pulmonary emphysema can be an independent disease. In this case, the same processes develop in the lungs that we talked about, only – much faster.In this case, the lungs can no longer effectively supply oxygen to the blood, therefore, respiratory failure develops. At first, a person feels shortness of breath when running, then a lack of air appears already at rest.
The cause of pulmonary emphysema can be smoking, lack of certain enzymes (for example, alpha1-antitrypsin), congenital pathology of lung development, some immune diseases of the lungs.
Only a doctor can establish the cause of emphysema and prescribe treatment. It is better if you consult a pulmonologist.
Treatment of pulmonary emphysema
First of all, it is smoking cessation and breathing exercises
Of course, it is necessary to treat the underlying disease that led to the development of emphysema.
For bullous emphysema, surgical treatment is recommended, in which swollen and non-functioning areas of the lungs are removed, which leads to a decrease in shortness of breath, allowing healthy areas of the lung tissue to work.
EVALUATION OF THE QUALITY OF LIFE STANDARD IN PATIENTS WITH BULLOUS PULMONARY EMphysema AFTER SURGICAL TREATMENT | Drobyazgin
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90,000 Emphysema of the lungs. New treatments.
Emphysema is a condition in which the air sacs in the lungs (alveoli) are partially destroyed, which leads to a decrease in the total surface of the lung tissue and is manifested by progressive shortness of breath.
Causes of emphysema:
- Tobacco smoking and / or smoking marijuana
- air pollution, including tobacco smoke (the so-called “passive smoking”)
- occupational hazards (inhalation of dust and harmful substances at work: miners, grinders, welders, etc.)
- deficiency of alpha-1-antitrypsin (this substance “protects” the alveoli from destruction). In this case, emphysema usually occurs before the age of 40.
Emphysema most commonly occurs in smokers as part of chronic obstructive pulmonary disease (COPD).
What Happens With Emphysema?
Lungs in a healthy person consist of airways (trachea, bronchi and bronchioles) and air sacs (alveoli). The easiest way to imagine the structure of the lungs in the form of a tree with large branches (trachea and bronchi), which continuously branch and turn into small branches (bronchioles). At the ends of the bronchioles there are hollow air sacs – alveoli (like bunches of grapes).
Alveoli have a very thin wall (0.5 micrometers) and are enveloped in a network of small vessels (capillaries). It is through the thin wall of the alveoli that oxygen enters the bloodstream, and carbon dioxide enters the bronchioles and is removed from the body. Even the lungs can be thought of as a very finely porous sponge. So, the total number of alveoli in both lungs of a person is 600-700 million. The diameter of one alveoli is 280 micrometers (for comparison, the thickness of a human hair is about 100 micrometers).The total surface area of the alveoli varies from 40 m² when exhaling to 120 m² when inhaling. This is a huge area! It is this feature that helps the lungs to easily “extract” oxygen from the air and deliver it to the blood.
With the progression of emphysema, a fine-pored sponge turns into a large-pore one. The walls of adjacent alveoli are destroyed, the alveolar sacs become larger. Thus, the diameter of one alveoli increases, but as a result, the total number of alveoli decreases, due to which the total surface area of the lung tissue decreases.
The lungs can no longer effectively “extract” oxygen from the air, therefore, shortness of breath appears and progresses. None of the existing drugs can restore the normal structure of the alveoli and increase the total surface area of the lungs, which is why dyspnea with emphysema is so difficult to treat. One of the effective ways to reduce shortness of breath is to increase the concentration of oxygen in the inhaled air from 21% to 90%, then it will be easier for the lungs to “extract” it from the air.
Symptoms of emphysema.
The main symptom of emphysema is shortness of breath. The biggest problem with early diagnosis is that shortness of breath increases gradually, very slowly. Even when you already have emphysema, you will not feel short of breath and do not consult a doctor in a timely manner. At first, shortness of breath worries only with severe physical exertion, and with the progression of the disease, it occurs with minimal effort (talking, washing, dressing, etc.) or even at rest. Many patients unconsciously limit their physical activity, adapt to shortness of breath until it completely disrupts their lifestyle.Unfortunately, only then there is an incentive to go to the doctor.
Later, other signs may join:
- weight loss
- change in the shape of the chest (“barrel chest”)
- cyanosis (bluish staining of the skin and mucous membranes)
- edema on the lower extremities (not all appear)
Since emphysema most often occurs within the framework of a specific disease, symptoms of the underlying disease are observed in parallel with the progression of shortness of breath.For example, in COPD, it is a cough.
Complications of emphysema.
In the presence of emphysema, often occur:
- giant bulls. Bulls are areas of the lung that are filled with air, but do not participate in gas exchange. Essentially large but useless air sacs in the lungs
- pneumothorax (collapse of the lung, most often due to ruptured bullae)
- chronic cor pulmonale (thickening of the wall and expansion of the cavity of the right half of the heart).
Diagnosis of emphysema.
If you experience shortness of breath, be sure to see a doctor. Not a single experienced and competent doctor will explain your shortness of breath with age features or overweight until a complete examination is carried out.
Minimum survey plan:
- patient examination
- complete blood count (to exclude anemia as a cause of shortness of breath)
- spirometry (lung function test)
- Electrocardiography (ECG, to rule out shortness of breath associated with heart disease)
- chest x-ray.
In many cases, additional examination is required to confirm the diagnosis:
- bodyplethysmography (very accurate examination of lung function)
- Echocardiography (to rule out or confirm a complication of emphysema such as chronic cor pulmonale, or to rule out other heart conditions that cause dyspnea)
- computed tomography of the lungs. Computed tomography of the lungs is the most accurate method for diagnosing pulmonary emphysema.Because this study allows you to very accurately assess the structure of the lung tissue, measure its density and identify complications of emphysema (bulla).
- pulse oximetry (to determine blood oxygen saturation, with emphysema it may decrease)
- study of the gas composition of blood (to detect hypoxemia – low oxygen content in the blood).
Treatment of emphysema.
Treatment of emphysema consists of two components – conservative and surgical.
- Stopping smoking will stop lung damage. This is the most effective treatment. If you are regularly treated with drugs, but continue to smoke, the effect of the treatment will be so insignificant that you will not even feel it. In the presence of occupational hazards, rational employment is very important in order to exclude contact with harmful vapors, gases, and dust.
- Treatment of the underlying disease.Emphysema is an essential component of COPD. COPD treatment is discussed in a separate article. In case of alpha-1-antitrypsin deficiency, injections of a drug containing this substance are prescribed (not registered in Russia).
- Long-term oxygen therapy. Many people with severe emphysema have hypoxemia (low oxygen in the blood) due to ineffective lung function. The only way to eliminate it is long-term oxygen therapy using an oxygen concentrator. Treatment should be carried out indefinitely, daily at least 15-18 hours a day.Long-term oxygen therapy for emphysema in the context of COPD can reduce shortness of breath, increase physical activity, improve sleep, and most importantly, prolong life by 5-10 years or wait for lung transplantation.
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