What is emphysema?

Emphysema is a chronic (long-lasting) disease that gradually destroys the lungs. This destruction means that you become unable to breathe in enough oxygen. You also have trouble breathing out carbon dioxide.

How does it occur?

Emphysema is almost always caused by cigarette smoking. However, rare genetic diseases can cause similar changes in the lungs and, when combined with cigarette smoking, more rapid destruction of the lungs.

Cigarette smoke can damage the cells in your lungs. This damage changes the structure of the tiny air sacs in your lungs called alveoli. The surface area of the air sacs for the exchange of oxygen and carbon dioxide becomes smaller, and the air sacs become less elastic. These changes affect your ability to breathe out carbon dioxide after breathing in. As the carbon dioxide accumulates in your lungs, there is less and less room available for oxygen to be breathed in.

Once this damage has occurred, it is not reversible. Researchers are looking for ways to predict who is more likely to develop emphysema if they smoke. At this time, however, they have found no tests for this risk.

What are the symptoms?

The most common symptom of emphysema is a feeling of shortness of breath. At first this occurs with mild exercise or normal daily activities. Eventually the shortness of breath is constant.

Another symptom that often accompanies the shortness of breath is frequent coughing, usually with very thick mucus.

Sometimes the first obvious symptom of emphysema is wheezing, which can also be a symptom of asthma. These two disorders can be confused with each other.

How is it diagnosed?

Your health care provider will ask about your medical history, including your smoking history and family medical history.

Your health care provider will examine your heart and lungs. Then he or she will examine your hands and feet to look for signs that your body is not getting enough oxygen.

Spirometry, a breathing test, is the most helpful test for emphysema. People who have emphysema lose the ability to breathe out forcefully and quickly. Often asthma medication is given after the first spirometry test and then the test is repeated. If you have asthma, the test results clearly improve after you take the medicine. If you have emphysema, the results improve just slightly or not at all.

Early in the disease, you may not have any physical symptoms and lab tests of your blood and x-rays of your chest may be normal. However, once you begin to have some symptoms, blood tests may show that you have more red blood cells than normal. (Red blood cells are the cells that carry oxygen in your blood.) Other blood tests may show that too much carbon dioxide is staying in your body. As damage to your lungs gets worse, chest x-rays will probably show changes that suggest emphysema.

An electrocardiogram (a record of the activity of the heart) may also be done. However, the test may be normal until later stages of the disease.

If you are young or a nonsmoker, your health care provider will do tests to see if alpha-1-antitrypsin deficiency, a genetic disorder, is causing the emphysema. New treatments are being developed for this type of emphysema.

How is emphysema treated?

Emphysema is incurable but treatment can help control the disease. The treatment goals for emphysema are:

• to keep you as active as possible, based on your ability and lifestyle

• to avoid the things that make emphysema or its symptoms worse, such as smoking and lung infections.

The most important part of treatment is to stop smoking. Talk to your health care provider about ways to stop smoking. You might find it helpful to join a quit-smoking program or to use nicotine patches or gum.

The first medications usually used to improve breathing ability are asthma inhalers. Many people with emphysema are helped by these drugs, some more than others. Oral asthma medicines, such as theophylline, may be used as well.

Prednisone or steroids often help to relieve the symptoms of emphysema, either for a brief period during an infection (when symptoms may become worse) or on a daily basis. These drugs can be taken in tablet or inhaled form.

Your health care provider may prescribe a program of regular exercise, usually walking, if you are able to exercise. This will help keep your heart and other muscles healthy. However, if you have symptoms of emphysema, do not start an exercise program without your health care provider's approval.

You need prompt treatment for any possible lung infections. Symptoms of emphysema often worsen during an infection. To help avoid lung infections, you need two important immunizations. One is pneumovax, a one-time injection to protect against a common type of pneumonia. In addition, you need to get a flu shot every October to protect against yearly winter flu epidemics.

If you plan to travel, discuss your plans with your health care provider beforehand to make sure there will be no problems with altitude, humidity, temperature, or pressurized airplane cabins.

At some point it is likely that you will need oxygen therapy. At first you may need oxygen only during air travel, but later you may need continuous oxygen at home.

How long will the effects last?

There is no cure for emphysema. It gradually worsens over many years until the lungs can no longer function.

How can I prevent emphysema?

The most effective way to prevent emphysema is never to smoke cigarettes. If you already smoke, quit now. The fewer years you smoke, the less likely it is that you will develop emphysema.

If you already have emphysema, but you stop smoking before much of your lungs have been damaged, the disease may progress more slowly. Also, if you stop smoking you are less likely to have problems with frequent bronchial infections.