Emphysema

Emphysema is a long-term, progressive disease of the lung that primarily causes shortness of breath. In people with emphysema, the tissues necessary to support the physical shape and function of the lungs are destroyed. It is included in a group of diseases called chronic obstructive pulmonary disease or COPD (pulmonary refers to the lungs). Emphysema is called an obstructive lung disease because the destruction of lung tissue around smaller airways, called alveoli, makes these airways unable to hold their functional shape upon exhalation.

The term means swelling and comes from the Greek emhysan meaning inflate, itself composed of en meaning in and physa meaning breath, blast.

Emphysema can be classified into primary and secondary color. However, it is more commonly classified by location.

Emphysema can be subdivided into panacinary and centroacinary (or panacinar and centriacinar, or centrilobular and panlobular).

  • Panacinar (or panlobular) emphysema: The entire respiratory acinus, from respiratory bronchiole to alveoli, is expanded. Occurs more commonly in the lower lobes, especially basal segments, and anterior margins of the lungs.
  • Centriacinar (or centrilobular) emphysema: The respiratory bronchiole (proximal and central part of the acinus) is expanded. The distal acinus or alveoli are unchanged. Occurs more commonly in the upper lobes.

Other types include distal acinar and irregular.

A special type is congenital lobar emphysema (CLE). CLE results in overexpansion of a pulmonary lobe and resultant compression of the remaining lobes of the ipsilateral lung, and possibly also the contralateral lung. There is bronchial narrowing because of weakened or absent bronchial cartilage.

There may be congenital extrinsic compression, commonly by an abnormally large pulmonary artery. This causes malformation of bronchial cartilage, making them soft and collapsible.

CLE is potentially reversible, yet possibly life-threatening, causing respiratory distress in the neonate.

Emphysema is a disease of the lung tissue caused by destruction of structures feeding the alveoli, in some cases owing to the action of alpha 1-antitrypsin deficiency. This causes the small airways to collapse during forced exhalation, as alveolar collapsibility has decreased. As a result, airflow is impeded and air becomes trapped in the lungs, in the same way as other obstructive lung diseases. Symptoms include shortness of breath on exertion, and an expanded chest. However, the constriction of air passages isn’t always immediately deadly, and treatment is available. Most of the people who have emphysema are smokers. Damage caused by emphysema is permanent even after the person stops smoking. People with this disease do not get enough oxygen and cannot eradicate the carbon dioxide, so they always have a shortage of breath. Emphysema usually initially presents with dyspnea during physical activity. Eventually the person will notice that the dyspnea is occurring any time they are physically exerted. Finally, the person will be dyspneic all the time even when they are in a relaxed state. People with emphysema can have trouble coughing and lowered amounts of sputum. They can begin to lose weight and have tachypnea when they try to extend their expiration. Breathing is difficult and the patient must use accessory muscles to help them breath. The patient can have an increase of the anteroposterior diameter of their chest which is sometimes referred as “barrel chest.” The patient is often seen leaning forward with arms extended or leaning on something to help them breath. When lung auscultation and chest percussion is done there is a hyperresonant sound that is heard. (Mc Cance) Emphysema patients can have symptoms of cyanosis, lowered oxygen levels and increased carbon dioxide levels.

The primary cause of emphysema is the smoking of cigarettes. In some cases it may be due to alpha 1-antitrypsin deficiency. Severe cases of A1AD may also develop cirrhosis of the liver, where the accumulated A1AT leads to a fibrotic reaction. Some types of emphysema are considered a normal part of aging and are found in the elderly whose lungs have deteriorated due to age. At about 20 years of age, people stop developing new alveoli tissue. In the years following the cessation of the development of new alveoli, lung tissue can start to deteriorate. This is a normal, natural part of aging in healthy people. Alveoli will die, the amount of lung capillaries will decline and the elastin of the lungs will begin to break down causing a loss of pulmonary elasticity. As people age, they will also lose strength and mass in their chest muscles causing these muscles to become weaker. In addition, bones can start to deteriorate and a person’s posture can change. Together, all of these age-related manifestations can cause the development of emphysema. Though not all elderly people will develop emphysema, they are all at risk of having decreased respiratory function. Other causes of emphysema can be anything that causes the body to be unable to inhibit proteolytic enzymes in the lung. This could be exposure to air pollution, second hand smoke or other chemicals and toxins. However, the majority of all emphysema cases are secondary to smoking cigarettes, cigars or other nicotine products. This is why emphysema cases that are caused by these etiologies are referred to as secondary emphysema.

Emphysema is an irreversible degenerative condition. The most important measure to slow its progression is for the patient to stop smoking and avoid all exposure to cigarette smoke and lung irritants. Pulmonary rehabilitation can be very helpful to optimize the patient’s quality of life and teach the patient how to actively manage his or her care. Patients with emphysema and chronic bronchitis can do more for themselves than patients with any other disabling disease.

Emphysema is also treated by supporting the breathing with anticholinergics, bronchodilators, steroid medication (inhaled or oral), effective body positioning (High Fowlers), and supplemental oxygen as required. Treating the patient’s other conditions including gastric reflux and allergies may improve lung function. Supplemental oxygen used as prescribed (usually more than 20 hours per day) is the only non-surgical treatment which has been shown to prolong life in emphysema patients. There are lightweight portable oxygen systems which allow patients increased mobility. Patients can fly, cruise, and work while using supplemental oxygen. Other medications are being researched.

Lung volume reduction surgery (LVRS) can improve the quality of life for certain carefully selected patients. It can be done by different methods, some of which are minimally invasive. In July 2006 a new treatment, placing tiny valves in passages leading to diseased lung areas, was announced to have good results, but 7% of patients suffered partial lung collapse. The only known “cure” for emphysema is lung transplant, but few patients are strong enough physically to survive the surgery. The combination of a patient’s age, oxygen deprivation and the side-effects of the medications used to treat emphysema cause damage to the kidneys, heart and other organs. Surgical transplantation also requires the patient to take an anti-rejection drug regimen which suppresses the immune system, and can lead to microbial infection of the patient. Patients who think they may have contracted the disease are recommended to seek medical attention as soon as possible. A natural solution to live a normal life (without expensive surgery and without needing an oxygen tank) with emphysema is Fucoidan and Agel’s UMI has the best form of bioavailability for fucoidan in its suspended gel.

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