Aging Begins at 30

Lungs That Won't Collapse

Emphysema in Greek means puffed up. Inflated lungs from lack of recoil, not increased inside pressure. Air goes in but getting it out is the problem. Almost all emphysema is caused by smoking. Various smoke particles draw white blood cells to the air sacs where they release chemicals (elastases) which digest the elastic coils surrounding the air sacs. As digestion continues, air exchange membrane is also lost. Getting rid of lubricating mucus can also cause difficulty and normal lung bacteria or invaders grow excessively in this protein-rich environment.

Emphysema takes many years of smoking to develop and strikes people in the 50's or 60's. It may take 40 pack years or more of smoking to produce emphysema, a pack of cigarettes a day for 40 years or 4 packs a day for 10 years. About 20% of heavy smokers develop emphysema also called COPD (chronic obstructive pulmonary disease).

Loss of elasticity leads to a diagnostic test called forced expiratory volume in one second (FEV1), which should be 2.5 liters or more. FEV1 is lost in emphysema at twice or more the age loss rate. Loss of air exchange membrane is the basis of a single breath diffusing capacity for carbon monoxide (DLCO) test. Breathe in the gas and measures the unabsorbed CO which is expired.

Don't confuse emphysema with asthma where the difficulty in expiration is spasm of the muscles around the air sac exit tubes. Both diseases, of course, can occur together in asthmatic smokers - a bad combination. The major symptom is breathlessness on exertion and varying degrees of coughing, difficult breathing, wheezing, and recurrent lung infections with increased purulence in the thicker and gunkier sputum Once diagnosed, the treatments are to stop smoking (an absolute imperative) and manage the occasional overgrowth of bacteria with antibiotics.

An ancient Chinese herbal remedy is now known to be a methylxanthine called theophylline (or its derivative aminophylline), which helps a few but not most emphysema patients. It's related to caffeine in tea and coffee and can keep you awake. In addition, some patients benefit from an oral or inhalation anti-inflammatory steroid (prednisone), and it should be tried for two weeks and only continued if significant improvement is obtained. Inhaled drugs such as beta agonists (metaproterenol or albuterol) or anticholinergics (Atrovent) may also benefit some patients.

Emphysema patients need protection against pneumonia (once in a lifetime vaccine) and influenza (yearly vaccinations). Also guidance by the physician, in conjunction with a physical therapist, more effective breathing is useful. General rehabilitation through regular walking and climbing stairs can do wonders.

In severe cases, blood oxygen levels are low with high blood pressure in the lungs, the overproduction of red cells, and eventually heart failure. These contribute to a dusky florid appearance in some advanced emphysema patents. Home oxygen can temporarily improve these problems and add to the quality of life by reversing defects in mentation motor coordination and endurance. Stopping smoking will lengthen life.

Careful attention to treatment can reduce days in hospital six-fold and can help patients retain their employment or their daily hobbies.

Section Top | Title Page

See related Patient Topics COPD (Chronic Obstructive Pulmonary Disease) or Lungs and Breathing.

See related Provider Topics COPD (Chronic Obstructive Pulmonary Disease) or Lungs and Breathing.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

http://www.vh.org/adult/patient/internalmedicine/aba30/1993/emphysem.html