emphysema symptoms, causes and treatment

Emphysema: Symptoms, causes and treatment

Emphysema is an obstructive pulmonary disease. It is a chronic condition. It causes difficulty in breathing and is identified by symptoms like coughing and wheezing. It is usually caused by damage to the air sacs in the lungs. Smoking causes emphysema in most people. However, non-smokers can have this condition owing to other factors too. There is no cure yet for emphysema, though stopping to smoke can help greatly.

What is emphysema?

Emphysema can be defined as a chronic obstructive pulmonary disease (COPD). In a patient with emphysema, the lungs are larger because lung tissue has lost its elasticity and the air sacs and alveoli have been affected. Specifically, in such patients, the air sacs have undergone significant change. They have broken down or are over-inflated or have narrowed, collapsed or are stretched and destroyed. Because of these changes to the air sacs, there is lesser surface area available in the lungs to take oxygen to the blood and remove carbon dioxide. 

The damage caused by emphysema usually cannot be reversed. It is permanent. But managing the condition in a patient is possible. 

Symptoms of emphysema

Medical practitioners will look for these symptoms to zero in on whether a patient has emphysema:

• Dyspnea or shortness of breath.
• Chronic cough with mucus.
• Tightness in the chest.
• Wheezing, accompanied by a whistling or a squeaky sound while breathing.

In most cases, even before visiting a doctor, the patient may notice these symptoms. They normally occur when the patient has physically exerted themselves. Over time, as the condition begins to be more pronounced, these symptoms may appear even when the patient is resting. 

Emphysema and COPD are conditions that develop over a period of time. Sometimes over years.

As the condition progresses, the following symptoms may also begin to appear:

• Weight loss and loss of appetite.
• Fatigue; low energy levels.
• Blue-tinged lips or fingernail beds. This is called cyanosis. This is caused due to a lack of oxygen supply to those regions.
• Lung infections and flare-ups occurring at more frequent intervals.
• Wheezing, mucus production and shortness of breath becoming more chronic.
• Sleep getting affected.
• Anxiety and depression.

Causes of emphysema

Most people with emphysema are smokers. In an overwhelmingly large percentage of cases, cigarette smoking has been found to be the primary cause for emphysema and COPD.

However, research has revealed that 25% of emphysema patients are non-smokers. In some of these people, the cause has been found to be genetic factors, such as alpha-1 anti-trypsin deficiency. In some others, exposure to environmental factors have caused the condition. This may include passive (secondhand) smoking, pollutants at their workplace, overall air pollution and exposure to fumes from biomass fuels. A study done in 2020 also pointed to the possibility that people with smaller airways compared to their lung size were at high risk for having emphysema. Importantly, not all smokers develop emphysema. This only strengthens the view that genetic factors do play a significant role. 

Being in close contact with a patient does not lead to transmission of the disease. Emphysema is not contagious. 

Diagnosis and tests

Only a certified medical practitioner can diagnose emphysema. 

While knowing the symptoms will be important, a diagnosis cannot be arrived at purely based on the symptoms. The doctor will conduct a physical examination through a process called auscultation, which is, listening to lung sounds with a stethoscope. 

After the physical exam is completed, the doctor may order a few more tests. Primary among them is a breathing test to determine lung capacity. This test with tell the doctor the patient’s forced expiratory volume in 1 second; FEV1. This test can help categorize the emphysema condition as follows:

• FEV1 is 80% of normal: Very mild or stage 1. 
• FEV1 is 50%-80% of normal: Moderate or stage 2.
• FEV1 is 30%-50% of normal: Severe or stage 3.
• FEV1 is less than 30% of normal: Very severe or stage 4. 

These stages are not necessarily a determinant of the patient’s chances of survival. Additional tests will be required to decide on the treatment plan. The doctor may order:

• A chest X-ray.
• A CT scan.
• A spirometry test.
• Arterial blood gas test.
• Electrocardiogram test.
• Other blood and genetic tests.

Treatment options

Emphysema is a degenerative condition. It usually worsens over time. So the best approach for treatment is to slow down the progress of the disease. Additionally, the doctor will also focus on improving the functioning of the remaining healthy part of the patient’s lungs.

• Firstly, the doctor will advise the patient to quit smoking. This is one sure way to slow down the disease. The patient will have to collaborate with the doctor to stop smoking.
• The doctor will also administer bronchodilators. These are drugs that will help relax the muscles around the airways. This, in turn, helps the lungs pump more air in and out. Bronchodilators are usually used to treat asthma and other lung conditions. They are more effective than other oral medications.
• The doctor may also advise the use of inhaled corticosteriods. These reduce the swelling the airways and also reduce the amount of mucus being produced. The patient may have to use inhaled corticosteroids daily to keep emphysema symptoms under check.
• To manage flare-ups, the doctor may additionally prescribe oral corticosteroids. 
• In order to prevent or treat bacterial infections and pneumonia or bronchitis, the patient may be put on antibiotics too. 
• To reduce the inflammation in the airways, anti-inflammatory drugs may be used.
• In some cases, a lung volume reduction surgery is undertaken. This is the procedure through which the diseased portion of the patient’s lung is removed and the healthy tissues are joined together. 
• Another procedure called bronchoscopic lung volume reduction is also attempted in some cases. This is to place a one-way valve into the airways. This allows for air to leave some sections of the lung but not enter. This significantly reduces the amount of air that is trapped in the lung and makes breathing easier. 
• A lung transplant may be attempted for the most severe cases. The doctor will advise this when the lungs are not responding to any other treatment. This procedure involves replace a damaged lung or lungs with a donor’s healthy lung or lungs. 

Living with emphysema

The first, and the most critical, step for patients who smoke and who have been diagnosed with emphysema, is to stop smoking. Immediately and urgently. Then, as an ongoing mechanism to prevent infections, the following actions are recommended:

• Washing hands at frequent intervals. 
• Keeping the house and surroundings clean and free of dust.
• Keeping all breathing apparatus clean.
• Brushing and flossing teeth twice daily. Using an antibacterial mouthwash after every meal.  
• Start an exercise routine.            
• Avoid environmental pollutants like car fumes, dust, strong perfumes, pollen, varnish and paints, cleaning products and any smoke. 

Conclusion

Emphysema cannot be reversed. Understanding the disease and managing its symptoms can slow down the progress of the disease. Emphysema is a chronic condition. It is an obstructive pulmonary disease that damages the air sacs in the lungs and makes breathing difficult. An early diagnosis always helps. Also, if the patient is a smoker, quitting smoking can really, really help. All treatment plans focus on managing the symptoms and the keeping infections away. Having a positive outlook and collaborating with the doctor and following their advice can greatly benefit patients. 

Frequently Asked Questions

1.What is emphysema?

It is a chronic obstructive pulmonary disease. 

2.What are the symptoms of emphysema?

Symptoms include shortness of breath, chronic cough with mucus, tightness in the chest and wheezing accompanied by a whistling or a squeaky sound while breathing. 

3.How is emphysema diagnosed?

The doctor will undertake a physical exam after reviewing the symptoms. This may be followed by a breathing test to determine lung capacity. Additionally, a chest X-ray, a CT scan, a spirometry test and other blood and genetic tests may be ordered. 

4.What are the treatment options?

Emphysema is a degenerative condition. It usually worsens over time. So the best approach for treatment is to slow down the progress of the disease. Specifically, the doctor will focus on improving the functioning of the remaining healthy part of the patient’s lungs.

5.Can a patient live with emphysema?

Yes. Understanding the disease and managing its symptoms can slow down the progress of the disease. An early diagnosis always helps. Also, if the patient is a smoker, quitting smoking can really, really help. All treatment plans focus on managing the symptoms and the keeping infections away. Having a positive outlook and collaborating with the doctor and following their advice can greatly benefit patients.