Emphysema

What Is Emphysema?

Emphysema is a lung disease that reduces the ability of the lungs to expel air, a process which depends upon the natural rubber-band-like quality or elastic properties of the lungs. Damage occurs to the tiny airways in the lungs called bronchioles. Bronchioles are joined to alveoli, tiny grape-like clusters of sacs in the lungs where oxygen from the air is exchanged for carbon dioxide from the body. The elastic properties of the lung reside in the tissue around the alveoli.

In emphysema:

  • Because the lungs lose elasticity they become less able to contract.
  • This prevents the alveoli from deflating completely, and the person has difficulty exhaling.
  • Hence, the next breath is started with more air in the lungs.
  • The trapped “old” air takes up space, so the alveoli are unable to fill with enough fresh air to supply the body with needed oxygen.

A person with emphysema may feel short of breath during exertion and, as the disease progresses, even while at rest.

Emphysema is one of several irreversible lung diseases that diminish the ability to exhale. This group of diseases is called chronic obstructive pulmonary disease (COPD). The two major diseases in this category are emphysema and chronic bronchitis, which often develop together.

For more information about bronchitis, go to Bronchitis.

Facts About Emphysema

  • Nearly two million Americans have emphysema.
  • Emphysema ranks 15th among chronic conditions that force people to limit their activities.
  • Cigarette smoking is the primary cause of emphysema.
  • Most people with emphysema are older men. As with lung cancer and other smoking-related diseases, however, the incidence of emphysema is increasing among women.
  • Emphysema doesn’t develop suddenly. Instead, it comes on gradually, usually after years of exposure to cigarette smoke or some other inhaled irritant.
  • Typically, symptoms of emphysema appear only after 30 to 50 percent of lung tissue is lost.
  • Emphysema rates are highest for men age 65 and older.
  • More people in the Midwest have emphysema than in any other region in the country.
  • Emphysema is an irreversible disease that can be slowed but not reversed or stopped.

 

What Causes Emphysema?

Generally, lungs become damaged because of reactions to irritants entering the airways and alveoli. Researchers continue to investigate the factors that may make some people more susceptible to emphysema than others. But there are some clear causes for emphysema:

Cigarette Smoking

Cigarette smoking is the major cause of emphysema. When exposed to cigarette smoke, the air sacs of the lungs produce defensive cells, called macrophages, which “eat” the inhaled particles. But macrophages are stimulated to release materials which can destroy the proteins that let the lungs expand and contract, called elastin and collagen.

Cigarette smoke also damages the cilia, tiny hair-like projections in the bronchi that “sweep” foreign bodies and bacteria out of the lungs.

Alpha-1 Antitrypsin Deficiency

People who a deficiency of a protein called alpha-1 antitrypsin (AAT) are at a higher risk of developing severe emphysema. Alpha-1 antitrypsin deficiency (AAT deficiency) is an inherited condition and occurs in varying degrees.

AAT is thought to protect against some of the damage caused by macrophages. In AAT deficiency-related emphysema, the walls of the bronchial tubes and the alveoli are both damaged, often leading to severe disease.

Need To Know:

About 2 out of every 1,000 people have an alpha-1 antitrypsin deficiency. People who smoke and have AAT deficiency are almost certain to develop emphysema.

 

What Are The Symptoms Of Emphysema?

The first sign of emphysema is shortness of breath when you are exerting yourself. Eventually, this shortness of breath may occur even when you are at rest.

As the disease progresses, the following symptoms which are related to one of the other major lung diseases also caused by smoking – bronchitis – may occur:

  • Difficulty breathing (dyspnea – this can also be caused by emphysema)
  • Coughing (with or without sputum)
  • Wheezing (this can also be caused by emphysema itself)
  • Excess mucus production
  • A bluish tint to the skin (cyanosis)

Nice To Know:

If wheezing occurs, it helps to know whether it is found while breathing in or out (or both). Wheezing at the end of a complete exhalation is usually due to bronchitis. Wheezing that begins early in expiration is usually due to emphysema or the combination of bronchitis and emphysema – COPD.

If you only wheeze when you breathe in, you probably have asthma (or, very rarely, a narrowing of your windpipe in your neck). Asthma and emphysema sometimes are confused with each other. One way to tell the difference is to try asthma medications prescribed by your doctor and see if they make a difference. While people with asthma often respond dramatically to medications, people with emphysema usually do not respond to asthma medications and those with COPD may respond somewhat. In some people bronchitis may lead to asthma which is difficult, even for physicians, to distinguish from asthma due to allergy.

Nice To Know:

Emphysema may affect the brain, too. Low oxygen levels in the blood may mean that the brain is not getting enough oxygen. The end result can be grumpiness, irritability, impaired mental ability. High carbon dioxide levels in the blood can lead to headaches and sleeplessness.

 

How Is Emphysema Diagnosed?

If your doctor suspects emphysema, he or she will use the following methods to diagnose and determine the severity of the disease:

History And Physical Examination

The doctor’s examination will include a review of your symptoms and a discussion of your medical history, including whether you smoke or have smoked in the past. The doctor also will ask about the type of work to do, to determine if you might be breathing any harmful chemicals on the job.

A physical examination will include an examination of your chest and breathing patterns. The doctor will:

  • Look for nasal flaring and other signs that you are working very hard to breathe.
  • Check for over-inflation of your lungs.
  • Listen to your chest with a stethoscope to hear the airflow in and out of the lungs
  • Listen to heart sounds to determine rate, rhythm and any signs of heart strain that are seen in the later stages of emphysema.

X-Ray and/or CT of the Chest

Chest x-rays deliver very little radiation to the body and are very safe. Chest x-rays are a very useful tool to evaluate anatomy of the lung. In emphysema, there is evidence of increased air in the chest and destruction of some of the lung tissue. Bronchitis can be suspected on a chest x-ray by presence of thickening of the tissue around the large airways (bronchi). Chest x-rays are also useful as screening for lung cancer and heart disease.

Computerized axial tomography or CAT scans indicate lung anatomy in greater detail. In some cases, this information is needed to fully evaluate lung disease. These studies, however, deliver more radiation and are considerably more expensive.

For more information about CT Scan, go to CT Scan.

Lung Function Tests

Routine lung function tests can help define the kind and amount of damage to the lungs. The following tests can identify various stages of emphysema:

  • Spirometry measures breathing capacity. A common measure of breathing capacity is the forced expiratory volume in one second (FEV1), or the amount of air that can be forced out of the lungs in one second. This is a common way to determine the amount of airway obstruction.
  • Frequently, your physician will ask that spirometry and body plethysmography (see below) be repeated after administration of an inhaled bronchodilator (see below). This test will help your physician determine if there is an asthmatic component present; if so, your physician will probably suggest that you use bronchodilator medication (see below)
  • Lung Volumes measures the amount of air in the lungs. This increases markedly in emphysema.
  • Diffusing Capacity measures the ability of the lung to transfer the gases from the air to the blood and vice versa. Decrease in diffusing capacity allow fairly accurate estimation of amount of emphysema.
  • Body Plethysmography is a rapid way of evaluating both degree and type of obstruction and lung volumes. It is an useful adjunct to understanding the mechanism of airway obstruction – e.g., asthma vs emphysema.
  • Arterial blood gases (ABG) analyzes blood from an artery for amounts of carbon dioxide and oxygen. This test is often used in more advanced stages of emphysema to help determine if a person needs supplemental oxygen.

Tests For Alpha-1 Antitrypsin Deficiency

The symptoms of alpha-1 antitrypsin deficiency-related emphysema tend to appear between the ages of 30 and 40. The symptoms and diagnostic tests are basically the same in any kind of emphysema except that, in this disease, emphysematous changes are greatest in the lower lung. However, if AAT deficiency is suspected, a special blood test can confirm the diagnosis.

Need To Know:

Emphysema almost never occurs in people who don’t smoke. When it does, it’s usually because of AAT deficiency.

In people who have AAT deficiency, emphysema will occur much later in life if they do not smoke.

 

How Is Emphysema Treated?

There is no cure for emphysema. The goal of treatment is to slow the development of disabling symptoms. The most important step to take is to stop smoking.

Treatments for emphysema caused by smoking include medication, breathing retraining, and surgery.

People with inherited emphysema due to alpha-1 antitrypsin deficiency can receive alpha 1-proteinase inhibitor (A1PI), which slows lung tissue destruction.

This medication is administered weekly through an intravenous (IV) infusion. In an IV, the medication will drip from a plastic bag into a narrow tube and through a needle inserted in a vein in your arm so that it can reach your bloodstream. It usually takes about 30 minutes for the medication to be administered.

An IV may be uncomfortable when the needle is inserted, but the administration of the medication will not be painful. Side effects of this treatment are rare and, if they do occur, are mild. They include fever, light-headedness, dizziness, and flu-like symptoms.

Need To Know:

The long-term effects of this therapy are not known. A1PI is not recommended for those who develop emphysema as a result of cigarette smoking.

Nice To Know:

Breathing Retraining

Some patients with emphysema develop breathing patterns which may make the feeling of breathlessness worse. While it is natural and effective for a person with normal lungs to breathe rapidly when short of breath, it is counterproductive in emphysema. This is because emphysematous lungs, lacking the normal elasticity which is so important in exhalation, require much longer amounts of time to empty. Rapid breathing does not allow enough time for emphysematous lungs to empty. Breathing retraining consists of a rapid inspiration (a count of one or two) followed by slow exhalation (count of six or more). Learning how to slowly exhale can be made easier by narrowing the lips to a small hole (pursed lip breathing). Following this slow exhalation, the next breath is much larger (since the lungs have emptied much more completely with the slow exhalation) and more oxygen in brought into the lungs.

The Value of Exercise

Physicians now recognize that physical activity, such as a progressive walking program, may be beneficial for people with emphysema. While exercise doesn’t improve lung capacity, it does help the body from becoming weak from reduced use. Also, unused muscles use available oxygen less efficiently. However, the beneficial effects of exercise are quickly lost if a person stops exercising.

Some hospitals offer pulmonary rehabilitation programs that are designed to help improve breathing in people with chronic obstructive pulmonary disease and other lung problems. These programs combine breathing retraining with carefully monitored exercise.

 

Medications To Treat Emphysema

Emphysema cannot be cured and does not respond to any medication other than oxygen. However, emphysema is frequently associated with bronchitis and asthma and the symptoms associated with these processes often can be alleviated with medication (hence, you can see the value of pulmonary function and other tests designed to discover if there is asthmatic component present:

Need To Know:

Often people with emphysema become suddenly worse. Increasing symptoms which include cough productive of discolored sputum, fever, and increased shortness of breath suggest the presence of an infection and are often treated with antibiotics, though this is still somewhat controversial. Some physicians treat these attacks with corticosteroids and do not administer antibiotics.

Bronchodilator Medication

Bronchodilator medication may be prescribed for airway tightness. Bronchodilators open the airways by relaxing the muscles around the airways. Many people with emphysema find that breathing is easier when they use bronchodilators.

The most commonly prescribed bronchodilators are beta2 agonists, the anti-cholinergic drug ipatropium bromide, and theophylline.

  • Beta2 agonists are usually inhaled and include short-acting drugs whose effects last from three to six hours such as albuterol (Ventolin), terbutaline (Brethine, Brethaire, Bricanyl), metaproterenol (Alupent, Metaprel) and pirbuterol (Maxair); these agents should be used only for those occasions when immediate relief is necessary. There are also very short-acting (one to two hours) not-beta2 agonists such as isoproterenol (Isuprel, Norisodrine, Medihaler-Iso); these drugs have little use and probably should be avoided. More recently, quite long acting agents (about 12 hours) have been introduced. These new agents are salmeterol (Serevent) and formoterol (Foradil). Because they are long acting and prevent asthmatic attacks, they are typically taken twice a day. Salmeterol should not be used for an acute attack because it requires at least 30 minutes before it is active but formoterol can be used for an acute attack.
  • The anticholinergic drug ipratropium (Atrovent) acts to relax the bronchial muscles. It is a slow-acting drug with virtually no side effects. The beneficial effects of Atrovent may be difficult to appreciate because, like salmeterol, it requires about 30 minutes before any significant change occurs. Anticholinergic drugs, are often more effective in the asthma that is associated with COPD than beta-2 agonists; the opposite is true in asthma associated with allergy.
  • Theophylline (Theodur, Slo-bid, Uniphyl, Theo-24) also acts as a bronchodilator, relaxing the muscles around the bronchioles and stimulating the breathing process. Theophylline should be taken only as prescribed, however, because overdoses of the drug can be toxic (poisonous to the body). Signs of toxicity include nausea, vomiting, headache, insomnia and seizure. A doctor should be contacted immediately if any of these symptoms occur. Because theophylline is a relatively weak bronchodilator with potential serious side effects and many interactions with other drugs and with foods, it is used relatively infrequently.

    Need To Know:

    Coffee drinkers need to use caution if they take theophylline to treat their emphysema. Caffeine intake should be limited to the equivalent of no more than six cups of coffee per day, because caffeine is chemically similar to theophylline and could increase theophylline activity, causing toxic side effects. Caffeine is found not only in coffee, but also in chocolate, cola, and certain teas.

Corticosteroids

The potent anti-inflammatory medications known as corticosteroids – commonly called steroids – may be used to help lessen the inflammation that often accompanies emphysema. These may be taken by mouth or inhaled.

Corticosteroids can help people withchronic obstructive pulmonary disease by inhibiting many of substances that cause airways to narrow. Generally, these medications are more effective for people with chronic bronchitis with or without emphysema, and less effective for people with emphysema alone.

For more information about bronchitis, go to Bronchitis.

Long-term use of corticosteroids that are taken by mouth may produce a variety of side effects that worsen as the dose increases. Side effects include the bone disease osteoporosis in both men and women, weight gain and fat redistribution, high blood pressure, loss of lean muscle mass, and, possibly, cataracts. As with all drugs, side effects are less with inhaled forms, since the dose is much lower. Short term administration of corticosteroids for 7-10 days during an attack is often very useful and usually without significant side effects. If it is necessary for corticosteroids to be administered longer, many physicians feel that doubling the daily dose and giving that as a single dose every other morning achieves the same benefits with fewer side effects.

How-To Information:

Both beta2 agonists and corticosteroids usually come in a metered-dose inhaler (MDI), and pills. MDIs are a convenient way to take inhaled medication. However, most users of the drugs do not experience their full benefits because they do not use the inhaler properly. Here are some tips on how to make sure you’re getting the most out of your medication.

First, carefully read the instructions that came with the metered-dose inhaler. Check the label to make sure the drug is the correct one and that the expiration date has not passed.

Then carefully follow these steps for using an inhaler:

  1. Remove the cap, hold the inhaler upright, and shake the inhaler.
  2. Tilt your head back slightly and breathe out all your air without forcing it.
  3. Place the MDI in your mouth and close your lips tightly around the mouthpiece.
  4. Press down once on the inhaler to release the medicine. At the same time, start to breathe in slowly (some instructions may refer to this as a “puff”).
  5. Continue to breathe in slowly for three to five seconds. The long, slow inhalation allows more medicine to go into your lungs.
  6. Hold your breath for 10 seconds to allow the medicine to settle onto your airways.
  7. Repeat puffs as directed by your doctor. Wait one minute between puffs to allow the next puff to get into your lungs better.
  8. If you use a spacer, wash it and the MDI mouthpiece once a week.

If you use inhaled dry powder capsules, close your mouth tightly around the mouthpiece of the inhaler and breathe in quickly. Most of these devices have a counter for the number of inhalations used.

Supplemental Oxygen

Supplemental oxygen can help a person who cannot get enough oxygen while breathing normally. Depending on the degree of lung damage, the doctor may suggest either continuous (24 hours a day) or activity related (non-continuous) oxygen therapy.

There are three types of oxygen administration devices: compressed oxygen in tanks, liquid oxygen, and oxygen concentrators. With supplemental oxygen, you’ll have one of these oxygen delivery devices right in your home. Compressed and liquid oxygen can be portable and, therefore, are desirable for trips outside the home. Concentrators are powered by normal home electricity; most electric companies will adjust their charges for patients using concentrators. A long, thin tube connects to the oxygen delivery device. At the other end is either a two-pronged device that delivers oxygen to your nostrils, or a mask that is worn over your nose and mouth.

The tube should be long enough to allow you to move about your home. If you need to go out, portable oxygen tanks with either compressed or liquid oxygen are available. An oxygen supply company will deliver the oxygen to you and replenish your supply when necessary.

Your doctor must write a prescription for oxygen therapy. The prescription will spell out the flow rate, how much oxygen you need per minute – referred to as liters per minute (LPM or L/M) – and when you need to use oxygen.

Some people use oxygen therapy only while exercising, others only while sleeping, and some need oxygen continuously. Your physician will either order an arterial blood or a non-invasive pulse oximeter test that will indicate what your oxygen level is and help determine what your needs are.

Continuous, long-term oxygen use is the only therapy that has been shown to lengthen the life of people who have low blood oxygen levels, or hypoxemia. Alertness, motor speed, and hand strength also improve with adequate oxygen therapy.

Need To Know:

Oxygen in tanks is a fire hazard. You should never smoke or burn a candle near someone who is on oxygen. Keep the oxygen far away from fireplaces or wood-burning stoves. Oxygen is not explosive but it makes fires burn faster and hotter.

Oxygen, particularly when used continuously, is expensive. Therefore, insurance companies usually follow Medicare guidelines which require that oxygen be below certain levels before authorizing payment.

 

Surgical Treatments

Surgical treatments for emphysema remain experimental and are not covered by insurance. Most people with emphysema are not candidates for surgery.

Two types of surgery for people with emphysema are:

Lung Reduction

A surgical procedure called lung reduction may improve symptoms for people with certain types of emphysema. During the procedure, part of the lung is cut out, giving healthy lung tissue more room to expand.

Lung reduction may eliminate the need for supplemental oxygen and make it much easier for the person to breathe. Early studies show that it reduces the volume of the over-inflated lungs. This improves the ability of the lung and chest wall to spring back during exhalation. This more-elastic lung appears to be the biggest reason that emphysema sufferers experience relief.

Need To Know:

The National Emphysema Treatment Trial (NETT) is a large study supported by the National Heart, Lung, and Blood Institute and other federal organizations. The purpose is to study the effectiveness of lung reduction surgery in the treatment of emphysema.

The study was expected to include about 2,500 patients. It began in 1997 and was scheduled to conclude in late 2002. The goal is to provide definitive answers to questions such as:

  • What are the benefits and risks of lung reduction surgery, as compared with good medical therapy alone?
  • How long do any benefits last?
  • Does the surgery benefit some people more than others?

Lung Transplantation

Lung transplant surgery is another treatment that may help a small number of emphysema sufferers. A lung transplant is a complex procedure that carries substantial risk of complications. This type of surgery is performed only at major hospitals and medical centers.

Living With Emphysema

Although many questions about emphysema remain unanswered, one thing is clear – quitting smoking can prevent the occurrence of emphysema and slow the disease. Other changes to your environment, such as avoiding smog, may also help prevent the development of emphysema or keep it from getting worse. Researchers continue to investigate the causes of and treatments for this disease.

Things to consider include:

How-To Information:

Slowing the disease progression

People who have been diagnosed with emphysema can help to slow the progress of the disease by following these general health guidelines:

  • Build your resistance to infections. Ask your doctor if you’re a candidate for the influenza (flu) and pneumococcal pneumonia vaccines. Though not proven to specifically help those with emphysema, the general advice to all patients should be followed: Eat a diet high in vitamins, fiber, and other nutrients, and get enough sleep.
  • Engage in a regular exercise program, which can help to build resistance to infections and improve your overall health. In general, if you can recover to normal within 5-10 minutes following exercise, you are not creating a strain on your body. Consult your doctor before starting any exercise program.
  • Try to avoid exposure to other airborne irritants, such as smoke from fireplaces or wood-burning stoves.
  • Contact your doctor if you feel a cold or respiratory infection coming on.
  • Remember that air pollution may make emphysema symptoms worse. Weather reports on radio and television, and in local newspapers, provide information about air quality. It’s usually safest to be active during early morning or late evening, when air pollution levels are lowest. If pollution levels climb, it’s best to stay indoors and limit activity.

How-To Information:

Adjusting your daily routine

Emphysema is a chronic condition that forces most sufferers to limit their activities. Experts make these suggestions for adjusting to life with emphysema:

  • Plan ahead and figure out the least strenuous way to get things done. Rearrange your home for maximum efficiency.
  • Prioritize. Decide what must get done, then delay or ignore the rest.
  • Schedule rest periods throughout the day.
  • Consider using a small utility cart for doing chores and a remote control for the TV. Do as much as possible while seated.

Nice To Know:

What are some things I should think about before traveling?

Consult with your doctor if you plan to travel. If you’ll be traveling outside of the U.S., consult a physician who specializes in travel medicine. He or she will be able to identify treatment concerns and provide information about levels of pollution in the areas you are visiting, weather conditions, and other pertinent factors.

  • The International Society of Travel Medicine http://www.istm.org publishes a Clinic Directory designed to help health care providers, the travel industry, and the public find health-care professionals with an expertise in travel medicine. More than 500 travel medicine clinics representing more than 40 countries are included in this directory.
  • AMTRAK http://www.amtrak.com provides train travelers with space for oxygen tanks. However, travelers dependent on supplemental oxygen must provide a battery-backup power source. Tell the reservation sales agent that you will be bringing an oxygen tank with you on your trip, so that appropriate arrangements can be made. As an additional safety precaution, you must advise the conductor that you are carrying oxygen when you board the train.
  • Airplane travel requires a few more steps. Airlines require a prescription from a physician indicating diagnosis, liter flow, and the number of oxygen tanks the carrier needs to provide during the trip. Travelers must contact carriers at each destination to have their oxygen delivered to their home or to the plane. For a list of local carriers, ask your home care company or consult the Yellow Pages. Information also is available from the American Society for Respiratory Care.

Airline charges for in-flight oxygen can vary widely, so it pays to shop around if you plan to fly. A recent survey of 33 international and domestic carriers found that charges for in-flight oxygen ranged from $64 to $1500. Airlines that provide in-flight oxygen usually require 48 to 72 hours notice, and liter flow options vary. You should pack any personal supplies you’ll need, including extension tubing.

Unexpected layovers create problems for travelers dependent on supplemental oxygen. If you find yourself stranded without supplemental oxygen, contact the airport first-aid station or the airport fire station. Call 911 only if you are experiencing severe difficulty breathing, because ambulance crews are required to transport people they assist to a hospital.

How-To Information:

What impact can nutrition and diet have on emphysema?

Plenty. First of all, food is fuel. Emphysema sufferers use extra energy in the simple act of breathing, so their caloric requirements can be higher than those of healthy people. Food also provides vital vitamins and nutrients. Good nutritional support helps to maintain lung function, while improper nutrition can cause the diaphragm and other breathing muscles to weaken.

Here are eating tips for people with emphysema:

  • Limit salt intake. Too much sodium can cause fluid retention that may interfere with breathing.
  • Limit intake of caffeinated drinks, which may interfere with some medications and may also make some people feel nervous.
  • Avoid foods that produce gas or make you feel bloated. The best process to use in eliminating foods from the diet is through trial and error.
  • Choose foods that are easy to prepare so you don’t waste energy in preparing a meal. Try to rest before and after eating.
  • Avoid foods that have little or no nutritional value.
  • Eat six small meals a day instead of three large ones. A stomach that is too full can cause shortness of breath.
  • If you use supplemental oxygen, be sure to keep it on while eating, and after meals, too. Eating and digestion require energy, and causes the body to use more oxygen.

 

Can Emphysema Be Prevented?

The best way to prevent emphysema is never to smoke cigarettes. If you do smoke, quit now. There are many excellent smoking cessation methods available today.

If you have emphysema but stop smoking before too much of your lungs has been damaged, the disease may progress more slowly.

Research continues to try to find answers to many questions about emphysema, including the best ways to prevent it.

For more information about how to stop smoking, go to Smoking: How To Stop.

Emphysema: Frequently Asked Questions

Here are some frequently asked questions related to emphysema.

Q: Why do people with emphysema sometimes have problems with fluid retention and ankle swelling?

A: Swelling, or edema, of the ankles, legs, and abdomen often accompanies emphysema. This is because damage to the lungs can also lead to heart damage.

  • In addition to the gradual removal of lung tissue (which includes blood vessels) by progression of emphysema, as the amount of oxygen in the blood decreases, it causes blood vessels in the lungs to constrict.
  • The blood pressure in the lungs rises, making it harder for the right side of the heart to pump blood to the lungs.
  • This may result in an enlargement of the right side of the heart, called cor pulmonale, and edema.
  • When the heart cannot pump blood efficiently, the movement of blood through the body slows, and the flow of blood to other organs decreases.
  • Therefore, the liver and kidneys can no longer function normally. This leads to protein and salt imbalances, which cause fluid – mostly water – to “leak” into the spaces between the blood vessels and into the surrounding tissues and cells.
  • Most of the fluid goes to areas that are not within the circulatory system or the cells, which normally act as “overflow containers.” Since the fluid is not contained, it responds to the pull of gravity, often moving to the hands and feet.

Some medications, especially steroids, which are often prescribed for people with emphysema, can make edema worse.

Q: What is the treatment for edema?

A: Medications called diuretics, also called “water pills,” are commonly used to treat edema. These medications increase urination, making your body shift fluid and salts from the blood. Other treatments are aimed at increasing the heart’s ability to pump.

Q: What impact can nutrition and diet have on emphysema?

A: Plenty. First of all, food is fuel. Emphysema sufferers use extra energy in the simple act of breathing, so their caloric requirements can higher than those of healthy people. Food also provides vital vitamins and nutrients. Good nutritional support helps to maintain lung function, while improper nutrition can cause the diaphragm and other breathing muscles to weaken.

Q: Where can I find moral support to help me deal with a diagnosis of emphysema?

A: Contact the American Lung Association http://www.lungusa.org via the Internet or by telephone (toll-free, 1-800-LUNGUSA) to find a support group near you. Your local hospital also may sponsor a support group.

Q: It’s hard to know if my breathing problems are being caused by asthma or emphysema. How can we tell?

A: Sometimes the first obvious symptom of emphysema is wheezing, which also can be a symptom of asthma. Asthma and emphysema sometimes are confused with each other and often coexist. In general, wheezing while inhaling is due to asthma while wheezing during exhalation but not during inspiration is due to emphysema and/or bronchitis. Another way to tell the difference is to try asthma medications and see if they make a difference. People with emphysema usually do not respond to asthma medications.

Emphysema – Putting It All Together

Here is a summary of the important facts and information related to emphysema.

  • Emphysema is a chronic lung disease that reduces the lungs’ ability to expand and contract.
  • When the air sacs in the lungs cannot expand and contract normally, less oxygen passes through the lungs to the body.
  • Cigarette smoking is the major cause of emphysema.
  • Diagnosis of emphysema is based on a review of symptoms, lung function tests, breathing patterns and, sometimes, x-rays or CT scans.
  • A substance called alpha-1 antitrypsin (AAT) is thought to protect against some of the damage caused by cigarette smoke or other irritants. People with alpha-1 antitrypsin deficiency (AAT deficiency) are at a higher risk for severe disease.
  • A blood test can establish the diagnosis of AAT deficiency.
  • There is currently no cure for emphysema, but the symptoms can be lessened with medication, supplemental oxygen, and proper nutrition
  • Lung reduction surgery and lung transplants are newer treatments for emphysema that are gaining acceptance but are still in the investigative phase.
  • For people with emphysema due to AAT deficiency, weekly infusions of alpha 1-proteinase inhibitor may slow lung tissue destruction.

Emphysema: Glossary

Here are definitions of medical terms related to emphysema.

Alpha-1 antitrypsin (AAT): A protein produced in the liver that blocks the destructive effects of certain enzymes.

Alpha-1 antitrypsin deficiency (AAT deficiency): A deficiency of a protein produced in the liver that blocks the destructive effects of certain enzymes. This inherited condition is associated with emphysema and liver disease.

Alpha-1 proteinase inhibitor: A drug that acts by inhibiting the destructive effects of certain enzymes in the lungs.

Alveoli: Tiny sac-like airspaces in the lungs, resembling a bunch of grapes, where carbon dioxide from the body is exchanged for oxygen from outside the body.

Anti-cholinergic: An agent that opposes or blocks the action of acetylcholine, a protein that is active in the transmission of nerve impulses. In emphysema, anti-cholinergic drugs act to relax the bronchi.

Arterial blood gas (ABG): A test in which blood taken from an artery is analyzed for amounts of carbon dioxide and oxygen.

Beta2 agonists: Drugs that act to relax the muscles surrounding the bronchi, thus opening the airways.

Bronchial tubes, bronchi : Larger air passages in the lung, usually closer to the throat.

Bronchioles: The smallest tubular airways in the lungs. They branch off the larger bronchi and are joined to the alveoli (tiny sac-like airspaces in the lungs where cardon dioxide from the body is exchanged for oxygen from outside the body).

Bronchodilator: A drug that relaxes bronchial muscles, allowing the bronchial air passages to expand.

Chronic bronchitis: A disease of the lungs characterized by changes in structure of the airways of the lungs, inflammation, and enlargement of the mucous glands. Coughing and sputum (phlegm) production are common symptoms. Chronic bronchitis often develops simultaneously with emphysema.

Chronic obstructive pulmonary disease: Any of a group of irreversible conditions (which variably include bronchitis, emphysema, and bronchospasm) that cause air to become trapped in the lung and limit the ability to exhale.

Collagen: An insoluble, fibrous protein that is the main component of connective tissues in the body.

Computed tomography (CT) scan: A computerized view of the body that creates images of soft tissue.

Congenital: Existing at birth.

Contraction of the heart: The shortening or thickening of the fibers in heart muscle causing the pumping action of the heart.

Cor pulmonale (right-sided heart failure): A disease of the heart characterized by enlargement of the right ventricle.

Corticosteroid: An adrenal-cortex steroid used to control inflammation. These include cortisone, fluticasone, beclomethasone, mometasone, and prednisone. Steroids are the body’s chemical messengers.

Cyanosis: The bluish color of the skin, nail beds, and mucous membranes associated with too little oxygen in the body.

Diaphragm: The muscle that separates the chest and abdominal cavity. It is the primary muscle used in breathing.

Diuretic: A substance that increases urine output.

Dyspnea: Shortness of breath or hard, labored breathing.

Edema: The swelling that results from excess accumulation of fluid in connective tissue or membrane-lined cavities of the body.

Elastin: A protein similar to collagen that is the main component of elastic fibers in the body. Collagen is a protein that is the main component of the body’s connective tissues.

Hypoxemia: Low levels of oxygen in the blood.

Lung reduction: A surgical procedure in which dead or damaged lung tissue is cut away, leaving room for healthy lung tissue to expand.

Macrophage: A “white blood cell” or phagocytic cell that helps to protect the body against infections and harmful substances.

Metered-dose inhaler(MDI): A device that contains pre-measured doses of medication that is inhaled directly into the lungs.

Mucus: Sticky phlegm or liquid in the respiratory tract.

Nasal flaring: An enlargement of the nostrils during breathing. Nasal flaring can indicate that increased work is required for breathing.

Osteoporosis: A condition marked by decreased bone mass, causing the bones to become porous and fragile. Osteoporosis is most commonly seen in older (postmenopausal) women and may be increased by use of corticosteroids.

Sputum: A secretion that is produced in the lungs and the bronchi (tubes that carry the air to the lung). Sputum is the substance that is expelled with deep coughing.

Spirometry: A test performed by breathing into an instrument called a spirometer, which records the amount and rate of air that is inhaled and exhaled. Some of the test measurements are obtained by normal breathing, and other tests require forced inhalation and/or exhalation.

Wheezing: Whistling sound heard when someone breathes out or in.

Emphysema Additional Sources Of Information

Here are some reliable sources that can provide more information on emphysema.

Emphysema Foundation for Our Right to Survive (EFFORTS) 
http://www.emphysema.net/

EFFORTS is a non-profit organization, formed, funded and operated by patients with the disease. Their mission is to promote deeper research for more effective treatment and, hopefully, a cure for emphysema and related lung diseases. The group offers a wealth of information on their website, an active mailing and support list, and links to ongoing studies.

National Emphysema Foundation 
http://emphysemafoundation.org/

NEF is a non-profit organization that focuses on research, education and patient care. Its website includes articles on pulmonary disease and new treatments. A section of the site is devoted to keeping the lungs healthy.

Lung Association 
Phone: (800) 586-4872
http://www.lungusa.org

These are the offices and website for American Lung Association. They offer information on emphysema and many other lung-related diseases.

Heart, Lung & Blood Institute Information Center 
Phone: (301) 251-1222
http://www.nhlbi.nih.gov/index.htm

This division of the U.S. government’s National Institutes of Health deals with lung diseases. In addition to offering many pamphlets and books on bronchitis, this organization is a good resource for new treatments and medications under review.

The American Academy of Family Physicians 
http://familydoctor.org/

The professional association for the family practice doctors in the U.S. The AAFP offers a good selection of consumer brochures on lung diseases, many of which are available on their website.

American Association for Respiratory Care 
Phone: (972) 243-2272,
http://www.aarc.org/

The American Association for Respiratory Care is the national professional association for respiratory therapists and others interested in lung disease. The purpose of the AARC is to provide education to its members on clinical and professional topics and to advance the art and science of respiratory care. It offers many consumer resources including a series of “Check Your IQ” tests.

National Jewish Medical and Research Center 
Phone: 303/388-4461
Phone: 800/222-LUNG (5864)
http://www.njc.org

This is one of the major hospitals and research centers in the U.S. that concentrates mainly on lung and similar diseases. Brochures and other information are available on the website and through the phone hotline.

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