A long-lasting (chronic) condition that causes shortness of breath is called emphysema. It also causes damage to the thin walls of the air sacs (alveoli) in the lungs over time. In normal circumstances, alveoli stretch and fill with air when you breathe in. Thereafter, the air leaves the alveoli because of the elastic material it is made when you breathe out. If these air sacs become damaged, it becomes hard to move air out of the lungs. As a result, oxygen-rich air cannot enter the lungs.
Commonly, people with this condition experience breathing problems, a wheezing sound when breathing out. The most common cause of emphysema is smoking. While treatment may reduce the speed of how fast the condition worsens, it cannot reverse the damage.
Symptoms
There are many people who do not know they have this condition because the symptoms appear gradually. Check below some emphysema symptoms:
- Cough
- Tiredness
- Chest heaviness or tightness
- Wheezing, whistling, or squeaking sound when breathing out
- Trouble breathing, especially during physical activity
- Weight loss
- Swelling of the ankles
Commonly, people begin to avoid activities that cause shortness of breath but this condition may lead to breathing problems even when you rest.
There are two common types of chronic obstructive pulmonary disease (COPD). These include emphysema and chronic bronchitis. The second condition causes the tubes that carry air to the lungs to become swollen and irritated. As a result, the amount of air that goes in and out of the lungs is limited. Moreover, chronic bronchitis and emphysema usually happen at the same time.
What are Exacerbations?
In some cases, people may notice worsening of the symptoms for days or even weeks even with treatment. This process is called an acute exacerbation and it may lead to lung failure if is not treated. The most common causes of exacerbations include inflammation, air pollution, respiratory infections, and others. However, it is advised to seek emergency care if you notice worsening cough, extra mucus, or breathing problems.
It is advised to see a doctor if you experience shortness of breath for a few months without any obvious reason.
Causes
This lung condition often occurs due to long-term exposure to airborne irritants. For example smoking (the most common cause), chemical fumes, vapors, and dust, especially in the workplace.
However, some people may experience emphysema due to a gene change that often runs in families. It causes reduced protein levels (alpha-1-antitrypsin or AAT). This is a specific protein produced by the liver to protect the lungs from damage caused by smoke, fumes, and dust. A condition that causes low AAT levels is called alpha-1-antitrypsin deficiency and it may cause lung conditions (such as emphysema) and liver damage.
Risk Factors
Damage to the lungs caused by emphysema occurs gradually and most people begin to experience symptoms after 40 years old. Check below some factors that may elevate your risk of developing emphysema and other lung conditions:
- Smoking – If you smoke cigarettes, or smoked in the past, it increases significantly increases the risk of emphysema. However, those who smoke pipes, marijuana, or cigars also are at risk.
- Secondhand smoke – When you breathe smoke from someone who smokes cigarettes, it is called secondhand smoke. Persistent secondhand smoke also increases the risk of emphysema.
- Long-term exposure to fumes, vapors, or dust also elevates the risk of emphysema. It often occurs at work.
- Indoor and outdoor pollution – The risk of emphysema increases due to certain pollutants including fumes from heating fuel, smog, car exhaust, and others.
- Genetics – A rare condition (AAT deficiency) increases the risk of emphysema.
What Are The Possible Complications of Emphysema?
There are some complications that may occur in people with emphysema, especially without treatment. For example:
- Pulmonary hypertension – This lung condition may cause increased blood pressure in the lung arteries (pulmonary hypertension). This is a serious condition that may cause the right side of the heart to weaken.
- Other heart problems – People with emphysema may also experience other heart conditions including myocardial infarction.
- Large air spaces in the lungs – It occurs when the walls located inside the alveoli are destroyed. Therefore, it leaves a very large air sac instead of many small ones. Large air spaces are called bullae and they may lead the lung to expand and increase the risk of pneumothorax.
- Pneumothorax (also called collapsed lung) – This is a serious health condition that happens in people with severe emphysema.
- Lung cancer – Those who have emphysema and smoke are at higher risk of developing lung cancer.
- Mental health problems – People with emphysema often cannot do activities they previously enjoyed. Therefore, it may lead to anxiety or depression.
How to Prevent Emphysema?
Check below some tips that may help prevent this condition or symptoms from getting worse:
- Quit smoking or never start and stay away from secondhand smoke as well
- If you are working in places where you are exposed to different chemicals, you should wear a protective mask and consider other protective measures
- Avoid air pollution and other irritants when it is possible
Diagnosis
First, physicians will ask you questions about your medical history and symptoms. Then, they may perform additional tests to confirm the condition and exclude other lung diseases that cause similar symptoms. For example:
Imaging Tests
These include:
- Chest X-ray – This test helps doctors determine lung changes that cause emphysema and exclude other conditions that cause similar symptoms. However, this test may not show whether you have emphysema.
- CT (computerized tomography) scan – This test is used to get detailed images of the lungs, heart, and other organs. It helps confirm emphysema, lung cancer, and other lung diseases.
Lung Function Tests
These tests are also known as pulmonary function tests and help doctors determine how much air you can breathe in and breathe out and if the lungs deliver enough oxygen to the blood.
One of the most common tests used to diagnose emphysema is spirometry. It involves a large tube that is connected to a machine. It measures the amount of air your lungs can hold and how fast you can blow the air out of the lungs.
Other tests include a six-minute walk test, pulse oximetry, and measurement of lung volumes.
Laboratory Tests
Doctors usually perform blood tests but not to diagnose emphysema. These tests help get more information about the condition, find the cause of the symptoms, and exclude other conditions that cause similar symptoms. They perform arterial blood gas analysis, and blood tests to check for AAT deficiency.
Treatment
The treatment usually is different among people with emphysema because it depends on different factors. For example, the severity of the condition, how often you have exacerbations, existing health problems, and others. The following treatments may help reduce the symptoms and risk of complications and improve your quality of life.
Smoking Cessation
One of the most important steps in emphysema treatment is to quit smoking. If you face problems with smoking cessation, consult with your healthcare professional for nicotine replacement products or medicines.
Medications
There are several medications available to treat emphysema complications and symptoms. Most medications for this lung disease are taken using an inhaler (a small device that delivers the medication directly into the lungs while you breathe in powder or fine mist). Check below some medicines:
- Bronchodilators – These medicines usually come in inhalers and help relax muscles around the airways. There are two types of bronchodilators (such as short-acting and long-acting) that are used either before activities or daily.
- Inhaled steroids – These medicines can help reduce inflammation of the airways and prevent exacerbations. The most common adverse reactions include bruising, mouth infections, and hoarseness.
- Combination inhalers – There are inhalers that contain both bronchodilators and inhaler steroids.
- Antibiotics – Doctors may prescribe this group of medicines for people who experience bacterial infections (such as bronchitis, pneumonia, and others).
- Oral steroids – Sometimes, doctors recommend short-term oral corticosteroids to lessen the symptoms and exacerbations. Do not use them for long periods because you may have serious negative effects. For example osteoporosis (brittle bones), cataracts, diabetes, weight gain, and increased risk of infections.
Lung Therapies
- Pulmonary rehabilitation – This therapy includes counseling, nutrition advice, education, and exercise training.
- Nutritional therapy – This treatment option involves a dietician who helps people lose weight, or gain weight for people with late-stage emphysema.
- Oxygen therapy – This procedure is recommended for people with severe emphysema and reduced blood oxygen levels. It helps improve sleep and breathing during physical exercise. Furthermore, many people with this lung condition use oxygen 24 hours a day, even during rest.
Surgery
Physicians may recommend either one or more of the following procedures depending on the severity of the condition. For example:
- Lung volume reduction surgery – This procedure involves the removal of the damaged lung parts and making extra space in the chest to allow the healthy lung to expand and work better.
- Endobronchial valve surgery – This is a minimally invasive procedure used to treat emphysema. It helps shrink the damaged part of the lung, which allows the healthy lung to expand and work better.
- Bullectomy – To allow more air flow, surgeons will remove the bullae from the lungs, which may cause breathing problems when growing too large.
- Lung Transplant – This surgery is recommended by doctors when other treatment options are ineffective. However, this procedure involves multiple risks such as organ rejection that requires medicines that weaken the immune system for the rest of their lives.
Frequently Asked Questions
What are the primary causes of emphysema?
Commonly, people develop this condition due to long-term cigarette smoking or exposure to certain chemicals. However, in some cases, this condition may occur due to a familial or genetic disorder (Alpha-1-antitrypsin deficiency).
What are the possible emphysema complications?
People with this lung condition may experience certain complications. For example:
- Pneumonia
- Collapsed lung
- Heart conditions
- Pulmonary hypertension
- Bullae
- Acute exacerbations
- Type 2 diabetes
- Mental disorders (such as anxiety and depression)
- Osteoporosis (brittle bones)
- Chest infections
- Lung cancer
If you suspect any of the previous complications happen, immediately contact your healthcare professional.
What are the most common emphysema symptoms?
- Tiredness
- Chest heaviness or tightness
- Weight loss
- Wheezing
- Cough
- Swelling in the lower limbs
- Cyanosis
Seek immediate care if any of the previous symptoms occur. If you have additional questions, ask your healthcare provider.
