Emphysema is a chronic lung condition in which the lungs’ natural airspaces, called alveoli, become larger but decrease in number. The tissue surrounding the alveoli loses elasticity so that the airspaces can no longer expand and shrink as usual. This reduces the amount of oxygen transferred by the lungs to the bloodstream. Air gets trapped in these spaces rather than exhaled, making it more difficult for you to breathe. Emphysema can be part of a lung disease called chronic obstructive pulmonary disease or COPD.
Emphysema usually results from exposure to toxins like cigarettes as well as air pollution, dust, chemical fumes, and irritants. Older adults are more likely to be affected and many people who have emphysema are not aware that they have it. The damage of emphysema cannot be reversed, but treatment may help slow the progression of the disease.
Cigarette smoking is the number one cause of emphysema. Although smoking has decreased in Canada for many years, it’s still a major concern. A huge majority of emphysema sufferers are current smokers or have smoked in the past. Smoking is responsible for 80% to 90% of chronic obstructive pulmonary disease (COPD) cases, including emphysema. Smoking is also responsible for the majority of all lung cancer cases in Canada. A burning cigarette emits over 4,000 different chemicals, many of which are carcinogenic (cancer-causing) or otherwise toxic to living tissue. Being exposed to secondhand smoke also increases your risk of developing emphysema.
Infections of the respiratory tract can also destroy lung tissue and thus contribute to the development or worsening of emphysema. Likewise, having emphysema increases the likelihood of infection.
Heredity is occasionally a factor in emphysema. Carriers of a specific genetic abnormality called homozygous alpha-1-antitrypsin deficiency are at high risk of developing emphysema. However, it is relatively rare and accounts for less than 1% of cases. If you have alpha-1-antitrypsin deficiency, it’s vital not to smoke.
Aging naturally brings changes to the lungs and air sacs even in non-smokers. The loss of elasticity can eventually become severe enough to be classified as emphysema. Air pollution can also irritate the lungs and cause emphysema, although pollution alone is rarely the cause.
There may be few symptoms at the beginning of the disease. As the air sacs become damaged, shortness of breath with physical activity is usually the first symptom. As emphysema progresses, you may experience shortness of breath even when you’re resting. This can make normal activities such as eating difficult, which can lead to a reduced appetite and weight loss. Other symptoms include chest tightness, fatigue, and chronic cough, or your fingernails or lips may turn blue or gray with exertion.
As the air sacs become more stretched, air gets trapped in pockets called bullae that form in the lungs. This can produce a characteristic "barrel chest," which is the shape of the hyper-expanded chest.
Chronic lung damage prevents the heart from circulating blood normally. Lung damage can cause pressure elevations in the part of the heart that moves blood through the lungs. This is called pulmonary hypertension and is suspected when people with emphysema develop leg swelling, abdominal bloating, or prominent pulsations in the veins in the neck. As the heart tries to pump blood into the damaged lungs, it can cause enlargement and strain on the right side of the heart that can lead to heart failure.
Bullae can rupture outside the lung into the pleural space (the space that surrounds the lung). As the air accumulates outside the lung, it may result in a life-threatening condition called pneumothorax – a collapsed lung. The body may also attempt to compensate for the low oxygen level by increasing the number of red blood cells (secondary polycythemia). Sometimes, the increase in red blood cells can be so severe that it causes blood clots.
A doctor who suspects emphysema will likely want to know your history and will also perform lung function tests. The tests may include:
The first treatment for emphysema is to stop smoking. Your lungs won’t repair themselves, but at least further damage can be slowed.
For the vast majority of people with emphysema, the best way to prevent it and slow it down is to not smoke. This outweighs all other considerations.
Following these tips can help protect your lungs if you have emphysema:
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