Pulmonary Emphysema | Johns Hopkins Medicine

What is pulmonary emphysema?

Emphysema is a chronic lung condition in which the air sacs (alveoli) may be:

• Collapsed
• Destroyed
• Narrowed
• Overinflated
• Stretched

Overinflation of the air sacs is a result of a breakdown of the alveoli walls. It
causes a decrease in respiratory function and breathlessness. Damage to the air sacs
can’t be fixed. It causes permanent holes in the lower lung tissue.

Pulmonary emphysema is part of a group of lung diseases called COPD (chronic
obstructive pulmonary disease). COPD lung diseases cause airflow blockage and breathing
problems. The 2 most common conditions of COPD are chronic bronchitis and emphysema.

What causes pulmonary emphysema?

Pulmonary emphysema occurs very slowly over time. It’s caused by:

• Smoking (the main cause)
• Exposure to air pollution, such as chemical fumes, dust, and other substances
• Irritating fumes and dusts at work
• 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 pulmonary emphysema?

Symptoms may be slightly different for each person. The following are the most common symptoms for pulmonary emphysema.

Early symptoms of pulmonary emphysema may include:

• Cough
• Rapid breathing
• Shortness of breath, which gets worse with activity
• Sputum production
• Wheezing

Other symptoms may include:

• Anxiety
• Depression
• Extreme
  tiredness (fatigue)
• Heart problems
• Over-inflation of the lungs
• Sleep problems
• Weight loss

The symptoms of pulmonary emphysema may look like other lung conditions or health problems. See a healthcare provider for a diagnosis.

How is pulmonary emphysema diagnosed?

Along with a complete health history and physical exam, your healthcare provider may
request pulmonary function tests. These tests help measure the lungs’ ability to
exchange oxygen and carbon dioxide. The tests are often done with special machines into
which you breathe. They may include:

Spirometry

A spirometer is a device used to check lung function. Spirometry is one of the simplest, most common tests. It may be used to:

• Determine the severity of a lung disease
• Find
  out if the lung disease is restrictive (decreased airflow) or obstructive
  (disruption of airflow)
• Look for lung disease
• See how well treatment is working

Peak flow monitoring

This device measures how fast you can blow air out of your lungs. Cough, inflammation, and mucus buildup can cause the large airways in the lungs to slowly narrow. This slows the speed of air leaving the lungs. This measurement is very important in seeing how well or how poorly the disease is being controlled.

Blood tests

These are done to check the amount of carbon dioxide and oxygen in the blood.

Chest X-ray

This test takes pictures of internal tissues, bones, and organs.

CT scan

This test uses a combination of X-rays and computer technology to make images of
the body. CT can show details such as the width of airways in the lungs and the
thickness of airway walls.

Sputum culture

This test is done on the material that is coughed up from the lungs and into the mouth. A sputum culture is often used to see if an infection is present.

ECG

This is a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias), and can help find heart muscle damage.

How is pulmonary emphysema treated?

The goal of treatment for people with pulmonary emphysema is to live more comfortably with the disease, control symptoms, and prevent the disease from getting worse, with minimal side effects. There is no way to repair or regrow the damaged lung tissue.

Treatment may include:

• A
  pulmonary rehab program. This may include breathing exercises to strengthen the
  muscles you use for breathing, and exercises for the rest of your body.
• Antibiotics for bacterial infections
• Staying
  away from the smoke of others and removing other air pollutants from your home and
  workplace
• Medicines (bronchodilators) that widen the airways of the lungs, and can be either
  taken by mouth (oral) or inhaled
• Getting the flu and pneumococcal vaccines
• Lung transplant
• 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 from portable containers
• Quitting smoking
• Surgery to remove the damaged area of the lung

Key points about pulmonary emphysema

• Pulmonary emphysema is a chronic lung condition. It’s often part of COPD, a group of
  lung diseases that cause airflow blockage and breathing problems.
• It
  develops very slowly over time. It’s most often caused by smoking.
• It
  causes shortness of breath that often gets worse with activity and many other
  symptoms, such as wheezing, cough, anxiety, and heart problems.
• There is
  no way to repair or regrow the damaged lung tissue. The goal of treatment for people
  with pulmonary emphysema is to live more comfortably, control symptoms, and prevent
  the disease from getting worse.
• A key
  part of treatment is to quit smoking.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions.

What is emphysema? Symptoms & treatment

When you’re healthy, you don’t really give breathing a second thought, let alone a first. Sure, it’s one of life’s essential functions, but breathing in and out is so automatic (and hardwired into our brains) that it doesn’t really give you a reason to think about it. That is, until something goes wrong, and it gets harder to take air in and out.

One condition that can make breathing a challenge is emphysema, where damage in your lungs makes it more difficult to bring oxygen into your body. It’s a serious disease that affects over 3 million people in the U.S. – it’s also one of the most preventable.

We’ll go over what emphysema is and how it relates to chronic obstructive pulmonary disease (COPD). We’ll also tell you the main causes, symptoms and stages of emphysema, and give you a rundown on available treatments.

What is emphysema?

Pulmonary emphysema is a long-term lung health condition that causes shortness of breath. Over time, the air sacs in the lungs, also called alveoli, become damaged. The inner walls of these air sacs weaken and rupture, which creates larger air spaces in the lungs. When this happens, the surface area of the lungs is reduced, and so is the amount of oxygen that makes it to the bloodstream.

Emphysema is a chronic illness, and it can develop slowly over time. There isn’t a way to repair or regrow the damaged lung tissue, but there are ways to treat it to live more comfortably with the disease. These treatments can also help control symptoms and slow the progression of the disease.

Types of emphysema

There are several different types of emphysema that can affect different areas of the lungs, as well as the body:

• Centrilobular emphysema (CLE) – CLE is the most common type of emphysema, and it occurs in the upper sections, or lobes, of the lungs.
• Panlobular emphysema (PLE) – PLE affects the lungs as a whole but can affect the lower section of the lungs more severely.
• Paraseptal emphysema (PSE) – PSE damages the air sacs in the outermost part of the lungs, but with more severe forms of PSE, damage can occur in other parts of the lungs too.
• Bullous emphysema – This form of emphysema occurs when giant, bubble-like cavities filled with fluid or air develop in the lungs.
• Subcutaneous emphysema – This is a rarer form of emphysema, where air or gas gets under skin tissue. It commonly occurs in the chest, neck or face, but it can also develop in other areas of the body. This form of emphysema isn’t typically caused by smoking or other lung irritants but brought on by certain medical procedures or injuries to the body, among others.

What is the difference between emphysema and COPD?

First, what exactly is COPD? Chronic obstructive pulmonary disease, or COPD, is a group of lung diseases that make breathing difficult, and gradually worsens over time. COPD typically occurs in people who have a history of smoking, but it can also occur with long-term exposure to lung irritants like secondhand smoke or air pollution.

Emphysema and chronic bronchitis, where the lining of airways is constantly irritated and inflamed, are the two most common conditions that contribute to COPD. Both conditions make breathing harder, leading to shortness of breath, coughing or wheezing. People diagnosed with COPD are frequently diagnosed with both emphysema and chronic bronchitis, but they can occur separately.

What causes emphysema?

Emphysema can be caused by several things, but the four most common are:

Smoking

This is the number one cause of emphysema. Smoking destroys lung tissue and irritates airways, causing inflammation and damage that results in swollen airways, difficulty clearing airways and increased mucus production.

Long-term exposure to lung irritants

Some examples of lung irritants include air pollution, secondhand smoke and occupational lung irritants, such as coal or exhaust fumes.

Age

Emphysema is most commonly seen in people 40 years of age or older, especially in those who smoked early on in life, still smoke or had long-term exposure to lung irritants. Emphysema can occur in young adults, but as emphysema generally develops slowly, older adults are more at risk.

Genetics

It’s rare, but an inherited genetic condition called alpha-1 antitrypsin deficiency that weakens the lungs, can cause emphysema. Also, people with a history of smoking are more likely to develop emphysema if they have a family history of COPD.

Symptoms of emphysema

Because emphysema usually progresses slowly, symptoms can take a while to appear – a person can actually have emphysema for years and not know it. Early symptoms are generally mild and become more severe as the disease progresses. Symptoms or signs of emphysema can include:

• A frequent and persistent cough
• A cough that produces a lot of mucus
• Frequent respiratory infections, like colds or the flu
• Shortness of breath during daily activities and physical activity
• Wheezing while breathing
• Chest tightness or pain
• Loss of appetite
• Sleep problems
• Depression
• Unexplained weight loss

What does emphysema feel like?

Some of the first symptoms that can appear are shortness of breath and ongoing fatigue. These symptoms alone can be dismissed as minor or related to other illnesses, so when should you see your doctor? If breathing becomes more difficult even while not being physically active, or lung sounds change – from typical breathing to wheezing, clicking or crackling – it may be time to schedule a visit.

Diagnosing emphysema

A visit to the doctor will help diagnose emphysema with a few steps. Your doctor may recommend a chest X-ray, but an X-ray doesn’t always confirm a diagnosis. It can, however, rule out other causes of shortness of breath, such as pneumonia or asthma, and help diagnose advanced stages of emphysema.

Since an X-ray doesn’t always confirm diagnosis, your doctor may also recommend a computerized tomography (CT) scan. A CT scan takes X-ray images from multiple directions to create many different views of internal organs, helping to detect and diagnose emphysema.

Another step your doctor may take is to order a lab blood test, where blood is tested to determine how well lungs are transferring oxygen to your bloodstream, and how well they’re removing carbon dioxide.

Finally, your doctor may order lung function tests, called pulmonary function tests (PFTs). PFTs, such as spirometry, nitric oxide tests and arterial blood gas tests, are noninvasive tests that measure lung capacity, how well air flows in and out of the lungs, and how well lungs deliver oxygen to the bloodstream.

Why early detection of emphysema is important

Since emphysema can’t be reversed like other lung conditions, early detection is important. Emphysema symptoms worsen over time, and early detection can slow progression of symptoms and the disease, leading to improved quality of life. It can also help identify causes of the disease so you can limit exposure to them.

The four stages of emphysema

Emphysema is classified into four stages: early, moderate, severe and very severe. Doctors use these stages to describe the progression of the disease and provide the appropriate treatment for each stage.

Early emphysema

If someone is at risk for emphysema, like those with a history of smoking, it’s important to keep an eye out for symptoms such as a nagging cough or shortness of breath, even if it’s mild. Although it’s easy to dismiss the early warning signs. But catching emphysema in this stage may help slow progression, allowing you to maintain your health for longer.

Moderate emphysema

This stage occurs when symptoms such as frequent coughing, feeling tired, shortness of breath, trouble sleeping and wheezing affect daily life. Flare-ups of symptoms, where they intensify for a few days, may occur.

Severe emphysema

In this stage, symptoms become more severe: intensified shortness of breath, tiredness and coughing, and more frequent flare-ups. Also, there may be new signs of emphysema progression, such as more frequent respiratory infections, like a cold or the flu, tightness of the chest, trouble catching your breath and others.

Very severe emphysema

Emphysema likely will be affecting every activity in day-to-day life, and it may be difficult to breath even when not being physically active. Chronic respiratory failure may occur – which means not enough oxygen is moving from the lungs to blood, and when the lungs aren’t taking enough carbon dioxide out of the blood.

Treatments for emphysema

While there isn’t a cure for emphysema, there are treatments that may help slow the progression of the disease and help people with the disease to live more comfortably.

Pulmonary rehabilitation

The goal of pulmonary rehabilitation is to promote healthy lifestyle changes –using exercise, lifestyle education and diet to help improve quality of life and ability to exercise.

Oxygen therapy

If emphysema causes low levels of oxygen in the blood, oxygen therapy may help. With oxygen therapy, supplemental oxygen can help deliver more oxygen to the lungs and bloodstream.

Emphysema medications

These may include bronchodilators to relax airways and help breathing problems, inhaled steroids, aerosol sprays that reduce inflammation and help shortness of breath, and antibiotics to treat bacterial infections.

Surgery

If the disease has progressed to the later stages, doctors may recommend lung volume reduction surgery, where damaged lung tissue is removed. If the damage is severe and other treatments haven’t worked, a lung transplant may be an option.

Lifestyle changes

Making changes to your lifestyle is easier said than done, but it’s the most important way to manage emphysema and keep living your life. Don’t be afraid to reach out for help – it’s a sign of strength, not weakness.

Stop smoking the right way for you

The number one priority is to figure out the best way to stop. Talk to your doctor about smoking cessation strategies – they may be able to prescribe gum, inhalers, patches or prescription medicines to help.

Avoid inhaled irritants

Avoiding air pollution, smoke from wood-burning fireplaces and dust may help you breathe a little easier.

Defend against infections

Washing your hands frequently when out in public, using hand sanitizer, avoiding people with respiratory illnesses, such as a cold or the flu, and getting an annual flu vaccination may help.

Stay active

Talk to your doctor, if necessary, to figure out a fitness regimen that works for you. Regular exercise can help decrease emphysema symptoms, improve circulation and help your body better use oxygen, strengthen your heart, improve mental health and so much more.

Eat well

This is an easy way to keep your immune system strong. Cutting back on red meat, processed foods and sugar, and eating a diet with more fruits, vegetables, nuts, whole grains, fish and olive oil may help reduce inflammation. Nutritional supplements may also be helpful – talk to your doctor about your options and what fits for your lifestyle.

When should you talk to your doctor?

Early detection is the best way to control your symptoms and the progression of emphysema. If you have shortness of breath or a history of smoking, reach out to your doctor sooner rather than later. They care about your respiratory health and will help you come up with a plan so you can live your best life.

Make an appointment

3 main causes of pulmonary emphysema

Emphysema is one of the diseases that, together with chronic bronchitis and other disorders, is a representative of chronic obstructive pulmonary disease. In people with this disease, the bronchial tubes and air sacs, called alveoli, are damaged in the lungs. Over time, their inner walls weaken and rupture. The surface area of ​​the lungs decreases, which in turn reduces the amount of oxygen that reaches the bloodstream.

A person can live for many years and not notice any signs of illness. The main symptom of this disorder is gradually manifesting shortness of breath.

Some people avoid exercise or any activity at the time of the onset of shortness of breath. This is not surprising, because with emphysema, breathing becomes difficult and a person has a lack of air. Thus, this disorder becomes a problem only when it interferes with the performance of daily tasks associated with physical activity. A sign of emphysema in the later stages is shortness of breath, which worries even at rest.

When to run to the doctor?

If you have had unexplained shortness of breath for several months, especially if it interferes with daily tasks, you should see a doctor. Don’t ignore this symptom of emphysema by telling yourself that shortness of breath is just a consequence of aging or being out of shape.

Seek immediate medical attention if you have the following signs of emphysema:

• Shortness of breath so severe that you are unable to climb stairs,
• Lips and nails become blue or gray during physical exertion.
• You feel as if you are about to pass out.

The main cause of this disease is long-term exposure to irritants in the respiratory tract. These irritants include:

1. Tobacco smoke,
2. Polluted air,
3. Chemical fumes and dust.

Rarely, this disease is caused by an inherited deficiency of a protein that protects the elastic structures of the lungs. In this case, the disorder is called alpha-1 antitrypsin deficiency emphysema.

So, among the risk factors:

• Smoking, including passive smoking. This includes not only smoking regular cigarettes, but also pipes and cigars. The longer and more often a person smokes, the higher the risk of developing emphysema.
• Work in factories where a person inhales fumes or dust. If a person regularly inhales chemicals, as well as dust from grain, cotton, wood or rocks, he is at great risk of getting sick. The risk is even higher if the person also smokes.
• Exposure to polluted air – inhalation of vapors from the combustion process of fuel, as well as automobile exhaust gases.

What are the complications of emphysema?

If left untreated, the patient is more likely to experience the following complications:

• Lung collapse (pneumothorax). It is a life-threatening condition that affects some patients with a severe form of the disease.
• Heart problems. Emphysema can increase pressure in the arteries that connect the heart and lungs. In this case, the right ventricle of the heart expands and weakens.
• Formation of large holes in the lungs. In some patients, empty spaces called bullae form in the lungs. Sometimes they occupy half of the lung. In addition to reducing the space available for lung expansion, giant bullae increase the risk of pneumothorax.

How is emphysema diagnosed?

Doctors prescribe various procedures to diagnose this disease, including:

• Chest x-ray. This diagnostic method helps to detect the disease at later stages, as well as to exclude other causes of shortness of breath. However, x-rays can show a normal result even if the person has emphysema.
• Computed tomography. This method helps to detect the disease at different stages.
• Lung function test – spirometry. This non-invasive method measures how much air the lungs can hold. It also shows how well air moves in and out of the lungs.
• Blood test. This procedure is performed to determine how well the lungs carry oxygen and remove carbon dioxide from the bloodstream.

How to treat emphysema ?

None of the chronic obstructive pulmonary diseases is curable. Medication and other treatments help control symptoms and slow the progression of the disorder. Depending on the severity of symptoms, doctors may prescribe one or more drugs:

• Bronchodilators. These medicines help relax the muscles in the narrowed airways. Due to this, cough, shortness of breath and other breathing problems are alleviated.
• Inhaled steroids. Corticosteroid medications, inhaled as aerosol sprays, reduce inflammation and help with shortness of breath.
• Antibiotics. If the patient has a bacterial infection, such as acute bronchitis or pneumonia, in this case, he is prescribed antibiotics.

Additional treatments for emphysema include:

• Pulmonary rehabilitation with a set of breathing exercises. The purpose of this rehabilitation is to reduce shortness of breath and improve the ability to perform physical exercises.
• Diet therapy. In the early stages of the disease, many patients need to lose weight. But in the later stages of emphysema, patients often need to gain weight. Here you will need the help of a dietitian.
• Oxygen therapy. In a severe form of the disease with a low concentration of oxygen in the blood, a person is shown oxygen therapy. This procedure involves inhaling oxygen-enriched air through a special mask or nasal catheter.

Surgical treatment of emphysema

lung volume. During this procedure, the surgeon removes small pieces of damaged lung tissue. Removal of the pathological tissue allows the “healthy” tissue to straighten out. As a result, the lungs begin to do their job more efficiently, and the patient’s breathing improves.

How to relieve emphysema?

In order to slow the progression of the disease and protect against complications, it is recommended:

• Avoid cigarettes and avoid secondhand smoke. This is the most important and the only measure that can stop the progression of emphysema.
• Avoid other respiratory irritants. These include fumes from paint and car exhaust, perfume, dust, burning candles and incense. Air conditioner filters should also be changed regularly.
• Move more often. Shortness of breath should not stop you, because regular exercise can significantly increase lung capacity.
• Protect airways from cold air. Cold air provokes spasms in the bronchial passages, which makes breathing even harder. In the cold season, before going outside, fasten a soft scarf over your mouth and nose. Thanks to this trick, the air will already be warmed up before it enters the lungs.
• Get vaccinated. Be sure to get annual flu and pneumonia shots.
• Watch out for respiratory infections. Do your best to avoid contact with people who have colds. If you have to communicate with large groups of people during colds and flu epidemics, wear a mask. It is also recommended that you wash your hands often and have an alcohol-based hand sanitizer spray on hand.

Sources:

1. Emphysema, Mayo Clinic,
2. Learn about Emphysema, American College of Chest Physicians,
3. Emphysema, American Lung Association.

shortness of breath

therapist

cough

What is pulmonary emphysema – meds.ru with carbon dioxide. Occurs against the background of bronchial lesions, destroys the structure of the lungs, impairs blood circulation. Pathology leads to an increase in intrapulmonary pressure, which causes compression of the pulmonary artery. The heart experiences significant stress, which leads to respiratory failure.

Causes of the disease

There are diffuse and bullous emphysema. In the first case, the lung tissues are completely affected. In the second variant, the affected areas are interspersed with healthy ones. The probability of pathology development is increased by such factors:

• congenital anomalies;
• inhalation of toxic substances;
• smoking;
• disorder of microcirculation in alveolar tissue;
• history of chronic obstructive disease;
• acute inflammation in the bronchi;
• occupational diseases accompanied by increased air pressure in the lungs.

Emphysema develops as an independent disease and as a complication of other pathological conditions. The disease is classified according to the degree of distribution:

• panlobular;
• centrilobular;
• perilobular;
• uneven;
• bullous.

Pulmonologists distinguish McLeod’s syndrome of unknown etiology, in which only one lung undergoes a pathological change.

Emphysema: symptoms

Irreversible destructive processes in the respiratory system are constantly progressing. This is expressed as:

• gradually increasing dyspnoea;
• asthma attacks;
• decreased breathing;
• decrease in blood pressure;
• reduced diaphragm movement;
• tachycardia;
• cardiac arrhythmia;
• fatigue;
• general weakness of the body;
• headache;
• changes in blood gases.

To make an accurate diagnosis, a therapist or pulmonologist performs percussion, auscultatory listening, prescribes X-ray of the lungs, computed tomography, spirometry, peak flowmetry, clinical blood gas analysis.

Treatment prospects and preventive measures

Therapy begins with the elimination of harmful influencing factors. The patient takes medications and inhalations for the rest of his life. Hyperbaric oxygen therapy shows a good effect. Surgical resection of a part of the lung tissue is used. If a donor is available, lung transplantation is possible to treat emphysema. The prognosis for patients receiving adequate timely therapy is favorable. Without effective treatment, destructive processes progress, which leads to disability and disability.

It is recommended to stop smoking, do breathing exercises, use medical oxygen masks.

Pay attention to doctors:

Pay attention to clinics:

Useful information for patients

• Silicosis: a common occupational respiratory disease

  Silicosis is included in a number of occupational diseases of the respiratory system. This is one of the varieties of pneumoconiosis, which occurs from prolonged inhalation of industrial dust containing a high dose of free silicon dioxide.

• Secondary and primary pulmonary hypertension

  Pulmonary arterial hypertension develops gradually, in the initial stages of the disease, blood circulation in the lungs gradually worsens. Fatigue gradually accumulates, cardiac activity becomes more difficult.

• What is dangerous thromboembolism

  Thromboembolism is an accomplished process of thrombus formation and blockage of a vessel, a serious consequence of pathologies.

• What is dangerous pneumosclerosis

  The normal state of the lung tissue is elastic, soft, allowing a sufficient amount of air to pass through and supporting the functioning of the entire respiratory system.

• What are the types of alveolitis

  The name alveolitis refers to a group of inflammatory diseases occurring in the respiratory section of the lung and affecting the alveoli.