Emphysema

General Illness Information

Medical Term:
EMPHYSEMA

Common Name: None Specified

Description: Emphysema is a chronic lung condition with abnormal enlargement of the air sacs (alveoli), because of destruction of their walls and with resulting loss of elasticity. The disease occurs in the distal and terminal airways and involves the airways as well as the lung parenchyma ( air sacs).

It usually affects adults between 35 and 75. Males are more affected than women.

In the United States 2 million people have emphysema. Emphysema is one of the commonest cause of chronic obstructive pulmonary disease.

Causes: Basic cause unknown, but the following are very strongly suspected:

  • Cigarette smoking;
  • Air pollution;
  • Infection;
  • Allergy;
  • Family history;
  • Hereditary factors (e.g. alpha 1-anti-trypsin deficiency).

In emphysema, the alveolar walls are destroyed and as a result the bronchioles lose their structural support. Thus, the bronchioles collapse when the air is exhaled. In emphysema the airflow narrowing is structural and permanent as opposed to asthma where it is reversible.

The main cause of damage to the alveoli is due to inflammation caused by irritants. If the inflammation is long standing, permanent damage may occur. Inflammation results in an increase in the number of white cells and they release enzymes (especially neutrophil elastase) that damage connective tissue in the walls of the alveoli. Additionally, smoking impairs the lung defenses by damaging the tiny hair-like cells (cilia) lining the airways, that normally carry mucus toward the mouth and help expel bacteria and toxic substances.

The liver produces a protein called alpha 1 anti-trypsin whose main role is to prevent neutrophil elastase from damaging the alveoli. However, in a rare hereditary condition, there is a deficiency or complete absence of this enzyme. In these people ,emphysema develops by early middle age , especially in smokers.

Prevention:

  • Avoidance of smoking is the most important preventive measure.
  • Passive smoke has also been shown to be harmful.
  • Other preventive measures are as follows:
    1. Avoid places with polluted air;
    2. Exercise moderately in fresh clean air;
    3. Prevent flu and pneumonia with immunizations;
    4. Obtain antibiotic treatment for lung infections.

Signs & Symptoms

  • May have none or very little in way of symptoms in early stages.
  • Earliest symptom is a cough and some mucus production mainly on arising in the morning. These symptoms may appear as early as after 5 to 10 years of smoking.
  • Major symptom is progressive shortness of breath.
  • Barrel chest (with little expansion) in later stages
  • Weight loss.
  • Recurrent chest infections.

Risk Factors

  • Smoking. Also passive smoking (especially adults whose parents smoked).
  • Certain occupations such as glass blowing, saxophone player, etc.
  • Repeated lung infections

Diagnosis & Treatment

In early and mild chronic obstructive pulmonary disease, a doctor may not find anything abnormal on physical examination except for a few wheezes on auscultation of the chest. At this stage chest x-ray is also normal. Pulmonary function studies Spirometry to measure forced expiratory volume in 1 second may demonstrate airflow obstruction and will help in making the diagnosis. Further pulmonary function test may be performed to determine if the airway obstruction is reversible and if the diffusing capacity is normal (if oxygen is able to enter the pulmonary blood vessels from the alveoli). Laboratory blood studies Blood test for alpha anti-trypsin in a young patient with chronic obstructive pulmonary disease. Blood tests to check oxygen and carbon dioxide levels in the arterial blood may be helpful in determining the the severity of the condition.

General Measures:

  • Overall goals of treatment are to relieve symptoms, slow progression of the disorder and prevent complications.
  • Since cigarette smoking is the most important cause of COPD, the main treatment is to stop smoking. If smoking is discontinued when the airflow obstruction is mild to moderate, it will slow the progression to development of disabling shortness of breath.
  • Avoid secondary smoke; avoid other irritants.
  • If you work in an area with severe air pollution, do all you can to decrease your exposure. Change jobs, if necessary.
  • Install air conditioning with a filter and humidity control in your home (HEPA filters are most effective).
  • Treat any accompanying allergies to minimize aggravation of emphysema.
  • Avoid higher altitudes where air is thin.
  • Floss and brush your teeth regularly to reduce the chance of oral infection.
  • Elevate the foot of your bed with 4 or 5 inch blocks. This helps prevent mucus from accumulating in the lower parts of the lungs.
  • Keep away from people with coughs or colds.
  • Supplemental oxygen may be required as the disease progresses.
  • Get pneumovax vaccine every 6 years and influenza vaccine every year.
  • Lung transplant may be considered in selected patients under age 50.
  • Join support group.
  • Exercise programs can improve the persons independence and quality of life. Oxygen may be recommended during exercise.

Medications:

  • Antibiotics to fight or prevent secondary infections.
  • Bronchodilators to relax spasms of the bronchial tubes.
  • Corticosteroid inhalers to control inflammation.
  • Arrange for immunizations against influenza and pneumonia.
  • Oxygen in later stages. Long term oxygen therapy prolongs the life of people with chronic obstructive lung disease who have very low oxygen levels in the blood. Round- the clock oxygen therapy would be the best , but 12 hours a day of oxygen would still be beneficial.
  • Patients with alpha 1 anti-trypsin deficiency- When severe, this deficiency can be treated with purified human a1-antitrypsin (60 mg/kg IV once weekly), which can maintain the serum a1-antitrypsin level above a target protective level . This treatment is very expensive and may cost as much as 25,000 dollars. Gene therapy for patients with this deficiency is under study.

Activity:

Activity will be limited, but stay as active as your strength allows. Prolonged inactivity leads to increased disability.

Diet:

  • Drink at least 8 glasses of fluid a day. This thins lung secretions so they can be coughed up more easily.
  • A well balanced high protein diet is recommended.

Possible Complications :

  • Susceptibility to lung infections.
  • Chronic obstructive pulmonary disease (COPD).
  • Respiratory failure or lung collapse.
  • Congestive heart failure.

Prognosis

  • Though the disease is incurable, symptoms can be controlled to retard progress and severity of the disease. Although emphysema reduces life expectancy, many persons live many years with it.
  • Supplemental oxygen , when indicated , has been shown to improve survival.
  • Smoking cessation is also important for improved survival.
  • Without treatment, complications can be fatal.

Other

‘Nothing Specified’.

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