Emphysema Causes and Treatments

What is emphysema and what does it mean if you or a loved one have been given this diagnosis? What are the symptoms, what are the causes (in addition to smoking), and how is it treated?

Emphysema is a chronic lung disease caused by damage to the alveoli, the tiny air sacs in the lung where the exchange of oxygen and carbon dioxide takes place. With emphysema, damage to the alveoli results in air becoming trapped, causing them to expand and rupture. Damage to alveoli, and the resultant compromise in air exchange results in a decreased level of oxygen in the blood (hypoxemia) combined with an increased level of carbon dioxide in the blood (hypercapnia).

Emphysema is one type of chronic obstructive pulmonary disease (COPD), a category of lung diseases that also includes chronic bronchitis and bronchiectasis. COPD is now considered to be the fourth leading cause of death in the United States.

Symptoms of emphysema may include:

• Shortness of breath: The most common symptom of emphysema is shortness of breath. It often comes on gradually, occurring at first only with activity. As the disease progresses, shortness of breath (dyspnea) also occurs at rest.
• Cough: A persistent cough is very common and is sometimes difficult to distinguish from a smoker's cough.
• Production of sputum or phlegm
• Wheezing. Emphysema, at least in the early stages, can be somewhat difficult to distinguish from asthma. The difference is that with asthma the airway obstruction is reversible whereas with emphysema it is not.
• Frequent respiratory infections such as bronchitis or pneumonia
• Chest pain
• Cyanosis: Blueness of the fingers and lips
• Exercise intolerance: Some people do not notice shortness of breath directly, but instead note that they are unable to as physically active as they once were, for example, it becomes difficult to walk as far or to climb as many flights of steps.
• Muscle atrophy: The combination of decreased exercise along with other effects of the disease can result in muscle wasting and atrophy. This muscle wasting, especially in core muscles, can, in turn, lead to further shortness of breath due to a decreased respiratory effort.

Smoking is the most common cause of emphysema, thought to be responsible for 85 percent to 90 percent of the cases. But there are many other causes which can act alone, or in conjunction with smoking, to cause emphysema. We aren't certain exactly what causes COPD, but several risk factors have been identified including:

• Secondhand smoke
• Occupational exposures to fumes, dust, and vapors, such as ciliates, cadmium, coal dust, and grain and flour dust
• Air pollution
• Alpha-1-antitrypsin deficiency: This inherited disorder may cause emphysema which appears in patients who are much younger in general. This condition should be suspected when several family members have developed emphysema, especially those who have never smoked.
• Asthma: Asthma refers to reversible lung diseases whereas emphysema is irreversible, but in some cases, asthma may lead to emphysema.

Emphysema is irreversible and progressive over time, so the goals of emphysema treatments are slowing the progression of the disease and improving symptoms. Some treatments include:

• Medications: There are no drug treatments that have proven successful in slowing the rate of decline of lung function with emphysema. Instead, the medications are used to help increase exercise tolerance, reduce COPD exacerbations, and improve overall health status. Medications used for stable COPD include bronchodilators, glucocorticoids, and antibiotics for infections.
• Oxygen therapy: This can be given continuously, during activity, or for the relief of sudden episodes of shortness of breath. Long-term oxygen therapy of over 15 hours per day is given when a patient has low oxygen saturation levels during Stage IV COPD. In advanced COPD, oxygen therapy may improve survival.
• Quitting smoking: This is very important for individuals living with this condition and can help to slow the progression of the disease.
• Pulmonary rehabilitation: There are many benefits of pulmonary rehabilitation, which is physical therapy for the lungs. It is an interdisciplinary program that should last at least six weeks. Pulmonary therapy can make a big difference for some people living with emphysema in improving exercise tolerance, reducing symptoms, and decreasing hospitalizations and lengths of stay.

Emphysema is characterized by what is known as COPD exacerbations—periods in which the symptoms become worse, often requiring hospital admission. These exacerbations are often precipitated by infections but may be set off by other conditions such as exposure to air pollution, wood smoke, or even perfumes in a mall.

Increased Risk of Lung Cancer

People with emphysema are also at increased risk of developing lung cancer. Lung cancer screening is available for those who are between the ages of 55 and 80 and have smoked for at least 30 pack-years. That said, emphysema is an independent risk factor for lung cancer and some people may wish to be screened even if they have not smoked, or have smoked less than 30 pack years. It's also important to be aware of the symptoms of lung cancer if you have emphysema, as some of the symptoms between the two conditions can look very similar. If your COPD symptoms are worsening, even if they are normal symptoms for you, talk to your doctor about the possibility of lung cancer. Lung cancer is much more curable when it is diagnosed in the early stages of the disease.

Emphysema can be a frustrating disease all the way around. Not only do you have to cope with symptoms and treatments, but those symptoms and treatments can affect nearly every other area of your life. Many people with COPD receive inadequate support. 

The Future of the Disease

At the current time, emphysema remains an irreversible disease and treatment is aimed at slowing the progression and complications related to the disease. Using recent advances in the understanding of stem and progenitor cells in the lung, laboratory studies have offered hope that lung regeneration therapy may be a way to reverse this progression in the future. Clinical trials, however, have failed to show any benefit of this approach to date.