Emphysema

What is emphysema?

Emphysema is an ongoing (chronic) disease that gradually destroys the lungs. The damage makes it hard to breathe.

Emphysema is 1 of the 2 main types of chronic obstructive pulmonary disease (COPD). Chronic bronchitis is the other type.

Emphysema usually gets worse slowly over months or years, making it harder to breathe. Treatment will help control your symptoms and slow down worsening of the disease.

What is the cause?

Emphysema happens when your airways are damaged. The airways are the tubes and sacs that carry air in and out of your lungs. The damage is almost always caused by irritation of the lungs over many years. Cigarette smoking is the most common cause of irritation. Other causes are exposure to secondhand smoke, air pollution, chemical fumes, dust and frequent lung infections.

The irritation damages the air sacs in the lungs. Normally, you get oxygen when you breathe in and you get rid of carbon dioxide when you breathe out. When the air sacs are damaged, it’s harder for you to breathe out carbon dioxide. This means too much carbon dioxide stays in your lungs and there isn’t as much room for the fresh air and oxygen that your body needs.

The damage to the lungs does not go away.

An inherited disorder (passed down from parents) called alpha-1 antitrypsin deficiency (A1AD) can also cause emphysema. If you have this problem, your lungs can be damaged more easily. If you are a smoker and have A1AD, the lungs are damaged more quickly. Smokers with A1AD can develop emphysema in their 30s or 40s.

What are the symptoms?

In the early stages of the disease, you may not have any symptoms even though the lungs are damaged. Early symptoms of emphysema may include:

• shortness of breath, trouble breathing
• deep, persistent cough that produces lots of mucus
• thick mucus that is hard to cough up
• wheezing

As emphysema gets worse, symptoms may include:

• fast breathing
• skin that looks blue or purple, especially the fingers, toes, and lips
• weight loss
• frequent lung infections
• swelling in the legs, ankles, and feet

How is it diagnosed?

Your healthcare provider will ask about your symptoms, medical history, family history, work history, smoking habits, and exposure to cigarette smoke. Your provider will examine you. You may have the following tests:

• lab tests of mucus to look for bacterial infection and other medical problems that might be the cause of your symptoms
• chest X-ray
• blood tests
• a breathing test called spirometry

When you have the breathing test, you will breathe into a tube to measure how well air moves into and out of your lungs. The test can show how well your lungs are working.

How is it treated?

There is no cure for emphysema, but there are treatments that can:

• Help keep the disease from getting worse.
• Relieve symptoms so you can breathe and feel better.
• Help you be more active.
• Treat infections.
• Help prevent complications.

If you are a smoker, the most important part of your treatment is to quit smoking. Talk to your healthcare provider about ways to quit. You might find it helpful to join a quit-smoking program, use nicotine patches or gum, or try one of the prescription medicines that can help you quit.

Your healthcare provider may prescribe the following medicines:

• Bronchodilator: This medicine relaxes the muscles of the airways. It makes the openings inside the airways bigger, so it’s easier to breathe. Usually you take this medicine by inhaling it (breathing it into your lungs), but it may also be taken as pills or liquid.
• Steroid: Steroid medicine helps keep down the swelling inside your airways. You may need steroids if your symptoms are severe or if you are having symptoms more often. Steroids are usually inhaled, but they may also be taken as a pill.

  Using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it.

• Antibiotic: If you have a bacterial infection, your provider will prescribe an antibiotic.

Emphysema caused or worsened by A1AD may be treated with medicine that may slow down damage to your lungs caused by this problem.

Your healthcare provider may also recommend:

• regular exercise, such as walking or riding a stationary bicycle
• breathing exercises
• a humidifier to add moisture to the air
• changes in your work environment so you are not around things that irritate your lungs
• oxygen

Rarely, in cases of severe disease, surgery may be an option. Surgery can remove the most diseased part of the lungs if enough working lung will be left after the surgery. Or, in rare cases, a lung transplant might be considered, depending on your overall health and whether you’re able to avoid the things that caused your illness.

How can I take care of myself?

Follow your healthcare provider’s instructions and recommended treatment. This includes:

• Take all of your medicine according to your provider's instructions.
• Ask your provider if a pulmonary rehab program might be helpful. Pulmonary rehab can help you with exercise training, emotional support, and even planning healthy meals.
• Take good care of your heart. Keep your blood pressure and cholesterol levels normal. This disease can damage the heart over time, so work to keep your heart healthy.
• Ask your healthcare provider what symptoms you should watch for and when you should call for help. Be sure to call your healthcare provider if your symptoms do not get better and especially if they get worse.
• Ask your provider what activities you should avoid and when you can return to your normal activities.
• Make sure you know when you should come back for a checkup. Keep your follow-up appointments.

Stay as safe and healthy as you can.

• Quit smoking. Ask your healthcare provider for help to stop smoking.
• Avoid exposure to tobacco smoke dust, fumes, chemicals and mold.
• Get a flu shot every year and avoid close contact with people who have colds or the flu. Wash your hands often and well, especially when you are in public places or around children.
• Ask about getting a pneumococcal shot to protect against a serious infection.
• Avoid extreme changes in temperature and humidity.
• If you use a humidifier, keep the humidifier clean and free of bacteria and fungus.
• Get plenty of rest and sleep.
• If you plan to travel, discuss your plans with your healthcare provider. It's good to make sure there will be no problems with high altitude, humidity, temperature, pressurized airplane cabins, or smoggy cities, especially if you are using oxygen.

Eat a healthy diet.

• Eat healthy meals. Getting the right nutrition can help your lungs work better.
• Eat high-calorie snacks between meals if you are underweight. Take vitamin and mineral supplements if recommended by your healthcare provider.
• Drink more liquids (water or tea) every day to help you cough up mucus more easily unless your provider says you need to limit fluids.

Get the exercise recommended by your healthcare provider.

• If you are able to exercise, get regular exercise according to your healthcare provider's recommendations. Exercise will help keep your heart and other muscles healthy. Don’t start an exercise program without your provider's approval.
• Do the breathing exercises recommended by your provider. They can help strengthen the muscles used for breathing. You may need a physical therapist to help you learn to do them properly.

How can I prevent emphysema?

The best way to prevent emphysema is never to smoke. If you are a smoker, quit now. The fewer years you smoke, the less likely it is that you will develop emphysema. Also stay away from others who are smoking.