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Emphysema:
Symptoms, Causes, Risk Factors, Diagnosis & Treatment

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1.What is Emphysema?

Emphysema is a lung-related condition which gradually deteriorates the lining and structure of the Alveoli in the lungs. Alveoli are pockets that are used to store air in the lungs. A person affected by Emphysema will face difficulty in breathing as the lining between the air pockets gets deteriorated and this reduces the surface area and the ability of the lungs to absorb more oxygen-rich air. Patients experiencing Emphysema also tend to hold a lot of toxic air for longer than required intervals as the Alveoli finds it difficult to release toxic air due to prolonged, yet gradual deterioration.

Emphysema is a major form of COPD that contributes to millions of deaths worldwide. Though it is very treatable and avoidable, it is still one of the major contributors to the mortality rate caused by COPD. Smoking and consuming second-hand smoke are the primary causes of this condition. People living in Polluted cities and near chemical factories are also susceptible to this condition.

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2.Symptoms of Emphysema

The major symptoms of Emphysema are:

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3.Causes

Smoking cigarettes, marijuana, and consuming second-hand smoke of second-hand products are the primary causes of Emphysema. Air pollution is also a major contributor to this condition.

The smoke from tobacco causes the inner lining of the lung and the cilia present in the air passages to get destroyed gradually. Due to constant degradation, the lining disappears and the lack of linear motion from the Celia makes it difficult for the mucus from the lower respiratory tract to be removed from the body. Smoking also increases the secretion of mucus and the body’s inability to remove the mucus due to the lack of Celia makes it difficult for the person with emphysema to breathe properly. Adding to that, the stored mucus acts as a breeding ground and as a source for nutrition to bacteria and other disease-causing germs.
Emphysema causes inflammation in the lungs and the body’s response to fighting constant inflammations makes it runs of certain proteins which are responsible for maintaining the elasticity of the lungs. Smoking also causes the walls of the alveoli to thin out and eventually disappear, thereby resulting in lasting damage to the respiratory system.

Due to smoking, the body is not able to produce the enzyme Alpha-1, this is a digestive enzyme used for digestion and also as an antibody to fight off infections. In the lungs, this is used to neutralize the destructive effects of Trypsin. Trypsin is an enzyme released by the lung and Alpha-1 neutralizes this to maintain normal function.

When a person suffers from Alpha-1 deficiency, the enzymes that are supposed to be fighting bacteria start attacking the cell tissue as the compound responsible for maintaining this function are unable to function as usual. This is also called the innocent Bystander effect.

Air pollution is also a major cause of Emphysema. The pollutants released in cities with low air quality and from chemical factories also simulate a response that is similar to that of active and passive smoking.

In India biomass fuel exposure is a major cause of emphysema especially in the female population.

Gender is also a major contributor to this condition.from all the reported cases of Emphysema worldwide, the majority of them have been from Men. The underlying cause of this condition is still unknown.

Lungs tend to become less functional as a person ages and deterioration due to age is often observed in patients who are over 60 years of age.

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4.Risk factors

The factors that put people at risk of developing this condition are the same as the ones that cause it. While age and proximity to a chemical plant or an industrial unit play a major role. The habit of smoking or consuming second-hand smoke also contributes to this.

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5.Steps to prevent Emphysema

There are multiple home-based remedies that you can do to prevent yourself from being affected by Emphysema. They are:

Exercising regularly:

Exercising regularly significantly increases your lung capacity and keeps you healthy. The exertion caused due to exercising makes every air pocket grasp more air, thereby ensuring that the lower pockets in the lungs don’t go dormant.

Avoid smoking:

Smoking cigarettes or marijuana or inhaling second-hand smoke is one of the major causes of Emphysema in patients. Staying away from cigarettes makes a person less susceptible to this condition.

Cold Air:

Cold air causes the lungs to spasm and makes it difficult for a person to breathe. Avoiding cold air with a mask or a scarf makes it easier for you to breathe when the air gets colder.

Air pollutants:

Chemical pollutants trigger COPD related symptoms. People living in industrial areas and near chemical refineries are the most susceptible to this. Wearing filtered masks and covering your nose with scarfs can help avoid this.

Vaccinations:

Getting vaccinations for flu-related diseases can help mitigate any virus or bacteria-based infections.

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6.Diagnosis

Patients suffering from Emphysema often show symptoms mimic those of Bronchitis and Asthma. You can rely on imaging studies and physical lung examination to make a diagnosis.

X-rays and CT scans:

X-rays can be used to diagnose advanced stages of Emphysema by studying the internal structure of the lung. In a few cases, the imaging is not and deriving an accurate diagnosis becomes difficult.
Using computerized tomography can help build a cross-section of the respiratory system by taking images from different angles. This helps in diagnosing the severity of the condition and also helps in preparing a candidate for lung surgery.

Physical tests:

There are a lot of non-invasive lung functions tests that help pulmonologists understand how the lung is functioning in terms of holding in air, transferring oxygen into the blood and how it is pumping carbon dioxide out of the body.
Spirometry is the use of a spirometer where the patients blow air into the device and the device is used to calculate the amount of air that goes into the lungs, it helps identify abnormal patterns in breathing. The anomaly could either be in inhaling or exhaling.

Other lab tests can help doctors make the diagnosis for Emphysema. Blood samples extracted from the arteries near the wrists help make a conclusive diagnosis on how much oxygen is dissolved in the blood, thereby assessing the lung’s efficiency.

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7.Stages of Emphysema

The GOLD test is used to identify the stage of the condition to come up with prognosis and devise a treatment plan. The GOLD system considers data on how many times you have been affected by the condition, the results on Forced Exhaled Volumes (FEV) and the physical symptoms a patient exhibits to help make a conclusive diagnosis.
The FEVplays a major role and the scores from the FEV test classifies the severity in the Mild, Moderate, Severe and Very severe brackets.

  • If the FEV1 shows readings at or above 80, the condition is said to be mild.
  • if the FEV1 readings lie between 50 and 80, the severity of Emphysema is said to be moderate.
  • When the FEV1 readings are between 30 and 50, it is considered as a severe condition of Emphysema.
  • Any reading under 30 in the FEV1 test is alarming and considered very severe.

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8.Treatment and management of Emphysema

Emphysema is a disease for which there is no cure yet. Many medical institutions across the world are researching the condition and running clinical trials in patients in various stages to find a cure.
Emphysema is not curable. However, there are ways in which patients can relieve symptoms and help slow down the progress of this condition.
Based on the severity of the condition, the consulting pulmonologist might recommend medication, therapy or surgery.

Medication:

People suffering from Emphysema can rely on Antibiotics, Corticosteroids and Bronchodilators to manage the symptoms and prevent the onset of another attack.

Antibiotics help people prevent any bacterial infection that could occur due to the enzymes released into the lungs due. It also helps manage a few symptoms that could arise from a bacterial infection based Emphysema.
Using corticosteroids in the form of a pill or as an aerosol could help fight the inflammation in the lungs and trachea and make the airways open and prevent the lungs from collapsing.
Bronchodilators help relieve patients from immediate symptoms and conditions like shortness of breath.

Therapy

People suffering from Emphysema can rely on therapy to improve their condition while undergoing medication. Studies have shown that simple exercises like brisk walking have strengthened the lungs and other muscles involved in the process of respiration.
Using Pulmonary rehabilitation, nutrition therapy, and supplemental oxygen have shown progressive results in many patients.
In Pulmonary rehabilitation, the patient undergoes a series of pulmonary exercises that makes dealing with shortness of breath and other forms of respiratory distress manageable.
With Nutrition therapy, the patient focuses on managing their diet and an active effort is made on avoiding food that could cause gas. Patients suffering from Emphysema are often asked to lose weight or gain weight depending on the severity of the condition and Nutritional therapy has seen positive results in achieving these results.
People with severe or very severe forms of Emphysema are advised to rely on external supplements of oxygen while exercising. This is introduced to them directly through thin transparent nasal tubes.

Surgery is only suggested when the patient is not responding to medication and therapy. The most major forms of surgery are Lung transplants and lung volume reduction surgery.
In the lung volume reduction surgery, the air pockets that have sustained a lot of damage are surgically removed, thereby making space for the healthy ones to expand and absorb large volumes of air.
In lung replacement, the lungs of the patient are replaced by healthy lungs from a donor.

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9.Road to Recovery and Aftercare

The road to recovery for people suffering from emphysema involves care which have them rely on exercise, medication, and healthy living practices. They are:

Exercise:

Exercising regularly helps people regulate and improve lung capacity. It also ensures that air reaches the Alveoli that are in the lower parts of the lung.

Medication:

Depending on the severity of the condition, a medication regime is prescribed for managing the symptoms. This helps patients prevent the onset of any viral or bacterial infections.

Practice pursed breathing:

Pursed breathing has helped people suffering from breathlessness manage that condition in 10 seconds or less. In pursed breathing, you breathe in through your nostrils and hold in your lungs and count to 2, once that’s done, you breathe out of your mouth. While you are breathing out, purse your mouth by contracting your upper lips and lower lips together. You should hear a faint whistling sound while breathing out whilst pursing your lips.

Vaccination:

Consulting your doctor about getting vaccinated on any flu based diseases that could cause any respiratory distress either as a primary or secondary symptom.
Vaccination against Pneumonia and Influenza is advised.

Monitor your sleeping positions:

Notice the way you sleep and find a position that best helps you breathe with ease and the least amount of inconvenience. Sleeping in a recliner or elevating your head while sleeping can ensure that your lungs function at its best.

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10.Emphysema FAQs: All your concerns addressed

Q.  Is Emphysema curable?

  1. Emphysema as a condition is not curable. But, advancements in medicine across the world has now made treating and managing the symptoms of this condition. People can rely on medication, exercise, and therapy to treat and manage Emphysema.

Q.  What are the alternative treatment options for Emphysema?

  1. Nutrition therapy and pulmonary rehabilitation have had positive effects on people suffering from Emphysema. With regular exercise and controlled intake of food, people can treat this condition without having to completely rely on allopathic medication.

Q.  Why am I always out of breath after physical activity and not while I am doing it?

  1. Generally, when exercising, people are very focused on the exercise and how are they are breathing while they are at it. For example, when you are walking up a fleet of stairs, you are thinking of walking and regulating your breath and once you are up those stairs, you subconsciously tend to go back to unregulated breathing.

Q.  What are the probable causes that trigger COPD?

  1. Smoking is known to be the leading key factor in the development and progression of COPD. However, apart from smoking (tobacco use), other factors like asthma, exposure to air pollutants in the home/workplace, genetic factors, and respiratory infections play a vital role in the development of COPD.
    In the rarest of scenarios, COPD can also be caused by Alpha-1 antitrypsin deficiency. Alpha-1 antitrypsin deficiency is an inherited disorder that leads to the development of lung disease in adults alongside liver disease in adults and children.

Q.  How easy it is to diagnose COPD?

  1. To diagnose the signs of COPD, your doctor will perform a physical exam on you. He/she will take a complete overview of your medical history, were you ever indulged in smoking, and if you have a family history of COPD. Once the details are taken, the doctor will measure the level of oxygen in your blood through a simple blood test or by using a pulse oximeter (a painless device that clips to your finger).
    Another trick to identify is through Spirometry. It’s a simple test that measures how much air moves in and out of your lungs, and at what speed. This test is recommended by doctors as it can find problems even before you show any signs of Emphysema (COPD) and also help you to determine its severity level. Additional tests include CT Scan and X-rays,

Q.  What are the symptoms of Emphysema?

  1. In the initial stages, you might not even experience any symptoms at all. However, as the disease gets worse, your symptoms will start surfacing and will become more severe. The symptoms include:
    • Tightness in the chest
    • Bringing up phlegm (if the chronic bronchitis is also present)
    • Frequent wheezing and coughing
    • Shortness of breath (especially after physical activity)
    • Difficulty sleeping (probable signs of Insomnia)
    • Whistling or squeaky sound while breathing
    • Swelling in the ankles, feet or legs
    • Weakness in lower muscle
    • Weight loss

Q.  Will I have to regularly exercise if I am diagnosed with Emphysema?

  1. Yes, exercise plays a major role in regulating the breath. When you exercise, your body undergoes exertion and in this process, your lungs absorb larger volumes and air and involve all the alveoli in the lower portions of the lung, thereby maintaining the elasticity of the lung.

Q.  Is COPD the same as Emphysema?

  1. COPD (Chronic Obstructive Pulmonary Disease) is an umbrella in which Bronchitis and emphysema fall under.

Q.  Is emphysema the same as Bronchitis?

  1. While Emphysema and Bronchitis cause pulmonary obstructions and the symptoms are similar, the major factor that differentiates them is by the effects they have on the lungs.
    Emphysema causes the lining of the alveoli to deteriorate while Bronchitis gradually destroys the cilia.

Q.  I am not a smoker, can I still get affected by Emphysema?

  1. Sometimes inhaling second-hand smoke or inhaling chemical irritants in the air can result in the development of this condition. People living in industrial areas or near chemical factories should take extra care to ensure that they breathe clean air. Using air filters at home and covering your face with masks and scarfs can help prevent the onset of this condition.

Q.  Can I have both Asthma and Emphysema together?

  1. Yes, you can suffer from both asthma and COPD at the same time. Many people who have COPD also suffer from asthma, however, vice-versa that’s not possible. One major difference between the two is that with proper treatment, asthma sufferers can easily get rid of symptoms.
    Additionally, the symptoms of asthma (wheezing, cough, etc.) are usually caused by triggers like cold air, allergens, etc. The signs of asthma are usually seen in the younger generation who’re non-smokers, while COPD symptoms are common to senior citizens, and people who smoke. Airway obstruction with asthma is typically reversible, while people with COPD develop permanent lung damage that progresses over time.

Q.  What all medical treatments are available for curing Emphysema?

  1. Emphysema is a long-term condition that isn’t curable to date. However, there are dedicated medical treatments that can help you ease out the symptoms to a great extent. The treatments include:
    • Quit Smoking
    • Pulmonary Rehabilitation (physical therapy and exercise)
    • Steroids and other medications (as prescribed)
    • Oxygen Therapy
    • Lung surgery or Lung Transplant
    Pulmonary rehabilitation involves exercise and educating the individual about nutritional needs, and psychological counseling. Depending on your symptoms, your doctor can also prescribe inhaler medicines that relax your airways and allow you to breathe easily. If you’re suffering from severe COPD, you might require supplemental oxygen.

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