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What Is Emphysema?

Emphysema can best be characterized as the progressive destruction of the grape-like air sacs (alveoli) that perform the lung's basic function of exchanging oxygen in the air for carbon dioxide in the cardiovascular system.

The small air sacs are unable to completely deflate (over inflation) and unable to fill with fresh air for adequate ventilation. Emphysema is not reversible, but the disease is manageable through medications, exercise and good nutrition.

In emphysema caused by smoking, which constitutes the majority of cases, the very small airways (bronchioles) that join the alveoli are damaged and the walls lose elasticity.

Pockets of dead air form in the damaged lung areas restricting the ability to exhale, reducing normal lung function. Inhalation is not usually impaired in the early stages, but in the late stages of the disease, oxygen and carbon dioxide levels are abnormal and breathing becomes labored.

Emphysema patients have typically lost between 50% and 70% of their lung function by the time symptoms begin to appear.

Experts believe the process leading to emphysema is mostly due to an imbalance in chemicals that protect the lungs from infection and damage. Any condition that causes an imbalance in these substances may trigger emphysema.

Cigarette smoke contains irritants that inflame the air passages, setting off these biochemical events that damage cells in the lung, thus increasing the risk both for emphysema and lung cancer.

Because smoking is overwhelmingly the cause of emphysema and chronic bronchitis, they often develop together and frequently require similar treatments.

In a rare, inherited form of emphysema known as alpha-1-antitrypsin deficiency, both the walls of the bronchioles and alveoli to which they connect, usually in the lower lungs, are diseased.

What is the cause of emphysema?

Cigarette smoking is, by far, the most common cause of both emphysema and chronic bronchitis. It is responsible for 82 percent of the deaths attributed to emphysema. A smoker is 10 times more likely to die of emphysema than a non-smoker. Other causes, such as environmental pollution and occupational exposures, also have been implicated in the development of emphysema. Heredity plays a role in one form of emphysema that is due to a genetically linked enzyme (alpha-1-antitrypsin) deficiency.

How Is Emphysema Treated?

Emphysema does not have a cure. The goals of treatment are to provide relief of symptoms and prevent progression of the disease. Your physician may recommend any of the following treatments depending on your symptoms and clinical findings:

Stop smoking. If patients who are diagnosed with emphysema are still smoking, the first and best form of treatment is to stop. Cigarette smoking causes the disease to worsen in spite of any other efforts that can be used to improve the symptoms of emphysema.

Environmental control. Environmental control is another factor in treating emphysema. Many people with emphysema notice their symptoms worsen when they are exposed to air pollution, dust or secondhand smoke. Avoid exposure to these agents whenever possible.

Bronchodilating medications. Your physician may prescribe drugs that act by opening up and relaxing the air passages in the lungs. The most commonly prescribed medications for emphysema include a class of drugs known as B2-agonists. The action of these drugs often leads to improved breathing. These drugs can be taken orally or they can be delivered as aerosol sprays through an inhaler. Sometimes, they are also administered through an aerosol nebulizer, which is a liquid form of a drug given through a special machine set up at your home. Some examples of these medications include albuterol, pirbuterol, isoetherine, metaproteranol, terbutaline and salmeterol.

Anti-inflammatory medications. Since emphysema involves a chronic inflammation of the lung tissue, your physician may prescribe a steroid-containing medication in an attempt to reduce lung irritation. Usually these drugs are given when the disease flares up and symptoms get worse but some patients are required to take steroids every day. Take these drugs exactly as they are prescribed and not to discontinue them without a physician's order. A commonly prescribed oral steroid medication is prednisone, but lately inhaled steroids are used much more often because of their greater effectiveness and safety.

Supplemental oxygen. If patients are unable to maintain acceptable oxygen levels on their own, the physician may prescribe supplemental oxygen that is delivered through a tube leading into the nostrils. This oxygen is usually portable and can be taken as needed or worn continuously. Patients experiencing a severe attack of emphysema may require hospitalization and mechanical ventilation (respirator) to assist their breathing. This assisted breathing device often can be removed once the patient recovers from the acute episode.

Lifestyle modification. Emphysema can limit a person's ability to carry out activities of daily living (hygiene, eating, socializing). Patients who have severe symptoms are encouraged to take frequent rest periods during even modest activity so that they can conserve energy necessary for breathing. Avoiding extreme weather conditions is also helpful in controlling symptoms for some people with emphysema. Air conditioners and humidifiers can sometimes improve symptoms.

Pulmonary rehabilitation. This is one of the newly recognized areas of rehabilitation. In a pulmonary rehabilitation program patients can be treated either in an inpatient or outpatient setting. The goal of pulmonary rehabilitation is to return patients to the highest functional level possible within the limits of their disease. In pulmonary rehabilitation, many medical disciplines (physicians, nurses, physical and respiratory therapists, dietitians, psychologists, to name a few) work together with the patient to develop a comprehensive program that is aimed at maximizing patient function.

Maintain overall good health habits. Adequate sleep and proper nutrition, along with regular exercise within your level of tolerance, can help maintain stamina and resist infections that often make emphysema symptoms worsen. Many physicians recommend influenza and pneumonia vaccines for patients with emphysema.

Are there any new advances in the treatment of emphysema?

For some types of patients with emphysema, a newer type of surgery called lung reduction surgery may lead to improvement in lung function. The surgery involves the removal of diseased and damaged regions of the lungs so that the normal tissue can function better. Because this procedure is relatively new, researchers are still gathering data about which patients benefit the most from lung reduction surgery. Insurers, including Medicare, are beginning to pay for this procedure.

Lung transplant surgery is being performed for a select group of patients with late-stage emphysema. Like other organ transplants, there is a long waiting list for lung transplantation. The criteria for receiving a lung transplant are very strict due to the complexity of the procedure, the possible complications and the limited supply of donor organs.