Emphysema

*The information on this website is not intended to diagnose, treat, cure or prevent any disease.

What is Emphysema?

Emphysema is a condition in which the lungs start to become remodeled, leading to a breakdown of the small, thin-walled air sacs (called alveoli) which normally exist in healthy lungs and the development of larger sacs (called bullae). These large sacs do not function properly and eventually lead to the trapping of air inside of the lungs while also being inefficient at transporting oxygen into the blood. Emphysema is a type of chronic obstructive pulmonary disease (COPD).

Emphysema tends to progress and worsen after it begins, and can severely curtail normal activities as basic as walking or doing simple tasks around the home. Emphysema affects hundreds of millions of people around the world, with developing nations often the most severely affected. Most deaths from emphysema occur in developing countries, which is likely related to higher rates of smoking and poorer air quality along with reduced access to health care systems.

Common Symptoms

The most common symptoms of emphysema are:

Shortness of breath
Excessive mucous production in the lower airways
Chronic cough
Frequent respiratory infections
Prolonged or increased effort exhaling
Wheezing
“Barrel” chest due to accumulation of air pockets in the lungs
Cyanosis/blue tint to skin and mucous membranes

Diagnosis

The diagnosis of emphysema is largely dependent on physical exam findings and a history which is supportive of emphysema. Shortness of breath, coughing, wheezing, and a history of risk factors associated with emphysema raise suspicion. This may lead to recommendations for the following diagnostics tests:

Spirometry: This test measures the volume of air a patient is able to inhale and exhale. Based on established criteria, a diagnosis can be made using this test.
COPD Questionnaire: Although not used for making a diagnosis, this questionnaire can help determine the severity of this disease.
Chest X-rays: This can be helpful to assess for other types of lung diseases which may be present. They may be particularly useful for people who have risk factors which may also increase risk of cancer as well, and exclude other confounders like pneumonia or congestive heart failure.
Blood Gas Analysis: This test evaluates the saturation of oxygen in the blood, which can help determine how effective oxygen is able to cross the membranes of the lungs into the blood stream.

Treatment Options

There is no established cure for emphysema, however there are various ways to manage the condition and improve quality of life.

Pharmaceuticals and Medical Procedures:

Bronchodilators: This class of medications can help open lower airways and reduce the resistance to exhaling, making it easier to exchange gases with each breath. They are a major medication in improving quality of life in emphysema sufferers. There are short-acting medications which can be used on an “as-needed” basis, as well as longer-acting medications which can provide sustained relief throughout the day. These medications include terbutaline, salbutamol, salmeterol, and indacaterol. These medications are often stimulatory in nature, and may increase heart rates and cause effects similar to those of caffeine.
Corticosteroids: Inhaled or oral steroids can hep reduce the inflammation which occurs in more advanced stages of emphysema, helping to reduce lower airway swelling. Although they can significantly improve quality and potentially length of life, they may also increase risk of pneumonia.
Antibiotics: Due to the reduced ability to clear air and mucous from the lungs, respiratory infections and pneumonia are common. Many people end up on antibiotics chronically.
Mucolytic agents: These drugs reduce the amount of mucous secreted or make it easier to clear by causing it to become thinner.
Routine Vaccinations for Respiratory Pathogens: Influenza, whooping-cough (pertussis) and pneumococcal pneumonia vaccines are essential for those who have emphysema. These infections can easily become life-threatening in those with emphysema.
Oxygen: Prescription oxygen tanks are often helpful for those with emphysema, and can help improve quality and length of life.
Lung Transplantation: This is an option for some people with very severe disease who are good candidates for it. It is often reserved for younger patients.
Lung Volume-reduction Surgery: This is another surgical procedure which involves removing part of the lung which is severely affected. This creates more space in the thoracic cavity which allows the lungs to expand more efficiently.
Positive-Pressure Ventilation: For severely affected or those experiencing an acute crisis, positive pressure ventilation (which can be performed in a non-invasive manner) may help provide relief. Some patients feel this is a not a good quality of life if they become dependent on it.
Zephyr Valve Placement: This is a medical device that is placed in the airways which helps facilitate the escape of trapper air and fluids from the lungs.

Non-pharmaceutical options:

There are many non-pharmaceutical therapies for emphysema which may be beneficial in some people.

Quit Smoking: This is the most important factor (pharmaceutical or otherwise) which improves outcomes and quality of life in patients with emphysema. Smoking is a major risk factor and quitting greatly improves quality and length of life, as well as improving response to most other therapies.
Mind Body Techniques
- Yoga: Yoga seems to make a huge difference for some emphysema patients by improving lung function, strength of core muscles required for breathing, and reducing overall inflammation in the body.
- Acupuncture: A study has shown that COPD sufferers who underwent acupuncture for 10 weeks experienced less effort when breathing during activity and higher quality of life.
- Meditation: Mindfulness meditation involves breathing exercises which may be helpful for improve gas exchange and improving lung function, as well as calming feelings of anxiety which often accompany emphysema.
Breathing Exercises: Various breathing exercises can help maintain lung function and help keep calm.
Exercise: Exercises as simple as walking, but also more intense exercise if able, clearly improves the quality of life in people with emphysema.
Maintain a Healthy Body Weight: Preventing weight gain or encouraging weight loss if overweight will make it easier to breathe in the long term and put less demand on the respiratory muscles and lungs.
Dietary modifications: A well-balanced diet that includes lots of fiber and good sources of high-quality protein are important to maintain the health of muscles involved in breathing. Moderate sodium restriction can help avoid water retention. Drinking lots of water will also naturally help thin mucus secretions. High levels of dietary beta-carotene also seem to be helpful in reducing severity of infections.
Stem Cell Therapy: Stem cells may help by reducing inflammation and promoting remodeling the lungs.
Humidifier: A humidifier can help make it easier to breathe by avoiding drying the airways and thickening mucus secretions.
Chelation Therapy: Chelation therapy has been shown to be helpful in experimentally-induced emphysema in mice and may have translation to humans. There appears to dysregulation of iron storage in the lungs of mice with emphysema.
Supplements:
- Echinacea: This is a traditional herbal remedy for many respiratory infections such as the flu and common cold. It may be especially helpful in those with emphysema who are even at higher risk of these infections.
- Ginger: Ginger contains many antioxidants and may help reduce the severity of infections which occur with emphysema
- Licorice Root: Licorice root may actually help improve the response to some bronchodilator medications in people with emphysema.
- Eucalyptus Oil: Eucalyptus is thought to improve clearance of mucous by making it thinner and making coughs more productive. It is a common ingredient in many over-the-counter cough remedies. It can be taken orally or as a topical supplement.
- N-Acetylcysteine: This supplement is especially helpful and is often prescribed to help thin mucous secreted by the airways. It is an important mucolytic agent which is available over-the-counter.
- Ginseng: There are mixed results on ginseng’s usefulness in emphysema. Some studies show a benefit while others do not. Some patients may find it helpful, but it can interact with some other commonly prescribed medications such as blood thinners, stimulants/bronchodilators, and anti-depressant medications.
- Cordyceps: This is a Chinese medicinal mushroom which has been shown to improve lung capacity in healthy people.
- Lungwort: This anti-inflammatory compound can help protect the lower airways.
- Osha Root: A natural herb which is helpful for congestion
- Oregano: Oregano may act as a natural expectorant
- Antioxidants
  - Vitamin D
  - Vitamin C
  - Vitamin E
  - Coenzyme Q10
  - Omega-3 Fatty Acids

Prevention

The most important and effective way to prevent emphysema is to avoid smoking, which is by far the top risk factor. It is also important to live a healthy lifestyle with regular exercise, balanced diet, and avoiding areas of poor air quality. For those who work in occupations which lead to regular exposure to smoke, fine particles, or other respiratory irritants, respirators and face masks should be used to filter the air when breathing.

Many people live in areas where air quality can become poor due to industrial pollution or fires. In these areas, it is important to be cognizant of air quality reports, and if possible, stay indoors. If you must be outside when the air quality is poor, using a well-fitting face mask which is rated appropriately for fine particles can help reduce the amount of pollution which is inhaled.

At home, using HEPA filters and ensuring that the environment is clean and free of mild and other allergens is also important. Regularly check air filters and replace as needed.

Preventing flare-ups for those who already suffer from emphysema is also paramount. Avoiding exposure to respiratory irritants, washing hands frequently, and getting annual vaccines to avoid infections is important to preventing complications.

Causes

By far the biggest factor in the development of emphysema is a history of smoking, but exposure to air pollution is another major factor. People exposed to second-hand smoke are also at increased risk. There are genetic factors which increase the risk of emphysema, however, even in non-smokers. There is a gene called alpha-1-antitrypsin which is supposed to help protect the elastic fibers in the lungs from becoming damaged. Some people have a mutation of this gene which makes it easier for these fibers to become damaged, eventually leading to breakdown of the alveoli in the lungs and the formation of bullae. People with this mutation are increased risk of emphysema even without smoking, but are at extremely high risk if they do smoke, or if they live in areas of high air pollution.

There are also many occupational hazards which can lead to emphysema. Miners who are exposed to fine amounts of coal dust or other mineral dust are also at an increased risk of developing emphysema later in life. Chemical exposures are also a major factor, and this may affect those who work in factories or even migrant workers who may be exposed to aerosolized pesticides and fertilizers. Textile, rubber, plastic, and construction workers are particular risk of chemical/dust associated emphysema. Mold exposure can also result in emphysema and chronic obstructive pulmonary disease. It is important to maintain a clean home and work environment.

Sometimes, past history of other respiratory problems may eventually lead to emphysema, as well. Those who have had chronic respiratory infections seem to be at increased risk, or a history of asthma. Over time, these conditions result in inflammation which damage the elastic fibers in the lungs, leading to emphysema.