Health
Problems
Emphysema
What is
Emphysema?
Emphysema and chronic bronchitis are both termed "chronic
obstructive pulmonary disease" (COPD). In the U.K. it accounts for over 20,000 deaths
each year. The vast majority of cases are the direct result of cigarette smoke which is
known to contain hundreds of chemicals which damage lung tissue. However, environmental
pollutants, poor posture, poor nutrition and nervous tension are considered to be
contributory factors. For instance, one study revealed that road workers in California USA
are 250 times more likely to develop Emphysema than the general population(1). Researchers
have also found that a herbicide called 'Paraquat' can cause emphysema(2).
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Known Causes
Among men between the ages of 45 and 64 it is the second most
frequent cause for admissions to hospital and among women it ranks fourth. Unlike asthma,
the respiratory damage of COPD is considered to be irreversible, yet ironically, it is a
quite preventable disease.
Emphysema often follows chronic bronchitis. If lung tissue
is progressively damaged through cigarette smoke or environmental pollutants, the lung
loses its natural tendency to deflate or spring shut. The bronchial tubes, as a result,
become swollen and inflamed, and their diameter may then become considerably reduced.
Excessive amounts of mucous are characteristic of bronchitis, and this may further impair
breathing.
In emphysema, the air sacs (alveoli) are destroyed and
replaced by scar tissue. The lungs become like large floppy balloons, unable to squeeze
out each breath of air properly. In some cases, oxygen is not fully transmitted and in
severe cases, the carbon dioxide produced in the body by everyday metabolism can no longer
be exhaled adequately, and accumulates in the blood.
Some individuals are more sensitive to nicotine and to
cigarette smoke than others. Very occasionally a nonsmoker may develop emphysema either
through occupational and environmental pollutants or congenital chemical imbalances. In
most cases, the patient will have accumulated a long and heavy smoking history before
noticing symptoms. The disease may have been present for years but the lungs' reserve
capacity will have compensated until over 50% of the airways are damaged.
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Symptoms
The first symptom of emphysema is usually shortness of breath
on exertion. Chronic bronchitis usually has a longstanding cough as its first warning.
Most patients have a mixture of the two. As the disease progresses, shortness of breath
increases and in the end, even speaking more than a few words at a time can become too
much. The accompanying cough may become incapacitating and, in many cases, literally cups
of yellow or green sputum may be coughed up each day.
Emphysema can become terminal and in such cases, the
patient begins to lose weight as eating becomes difficult, and all the energy that can be
mustered is spent trying to breathe through the damaged lungs. The slightest cold or
respiratory burden, and even the use of mild sedatives is enough to cause respiratory
failure. In some cases, a mechanical ventilator becomes necessary.
The heart is burdened in many cases by trying to maintain
circulation through a scarred and narrowed pulmonary circulation and very often heart
failure results. Patients with Emphysema are also more susceptible to Pneumonia and many
contract lung cancer from their smoking habits.
When patients stop smoking, the disease can be slowed down
and, naturally, continuation always speeds up the disease. Amazingly, many patients have
been known to keep smoking even as they are recovering from a bout on the ventilator!
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Diagnosis
The symptoms mentioned above are, in a heavy smoker, highly
suggestive of the disease. A physical examination may reveal characteristic sounds in the
lungs and, in some patients, a peculiar rounding of the finger nails is observed. Chest
x-rays sometimes (but not always) reveal hyperinflation or scarring of the lungs. The most
reliable test is pulmonary function breathing measurement (spirometry) where the rate of
airflow is measured. Unlike asthma, the reduced flow is not reversed to near normal after
bronchodilator drugs are given. Blood samples are measured for oxygen and carbon dioxide
content from an arterial sample taken usually at the wrist.
The symptoms of emphysema are very similar to congestive
heart failure, sarcoidosis, tuberculosis and other lung diseases and care must be taken by
the examining doctor to identify the correct disease.
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Conventional Treatment
No medical treatment can arrest or reverse Emphysema, although
a variety of aggravating factors can be treated. In some patients, overgrowth of bacteria
in the bronchi cause flare-ups, and antibiotics such as tetracycline,
amoxicillin, and TMP-sulfa can help. Still others have an asthma-like reaction as part of their disease,
and treatment as outlined for asthma provides benefit. A fraction of patients respond to
cortisone or prednisone, but long term use can have serious side effects.
Training of the patient in respiratory exercises and other
techniques can help the symptoms. Emotional counseling is important for some patients.
Prompt treatment of any worsenings is important. Obviously, avoidance of smoking is always
advised and it is vital for severely ill patients to avoid sedating drugs, as these may
induce respiratory failure.
The results of experimental treatments such as x-ray
therapy and surgery have been disappointing. It seems that once the diagnosis is made, the
best course is to stop smoking, find a skilled and caring physician, call her/him as soon
as any flare-ups begin, and follow a comprehensive program of judicious medications,
training, and careful lifestyle adjustment. It is sad to reflect the fact that whilst up
to 20,000 people die annually in the U.K. of Emphysema and COPD (the highest incidence
anywhere in the world) , and many thousands more become severely disabled, the incidence
of smoking and Emphysema continue to rise.
Emphysema is a disease involving damaged lung tissue which
is said to be irreversible. However, a great deal can be done to halt the progress of the
disease and to alleviate the symptoms, making breathing easier and improving the quality
of life. The body can be taught to compensate, adjust and adapt to make good use of the
remaining lung capacity.
(1) Mortality among California highway workers. Maizlish N;
Beaumont J; Singleton J Occupational and Environmental Health Unit, University of
California, Davis. Am J Ind Med 1988, 13 (3) p363-79
(2) Paraquat poisoning: findings on chest radiography and CT in 42 patients. Im
JG; Lee
KS; Han MC; Kim SJ; Kim IO Department of Diagnostic Radiology, Seoul National University
Hospital, Korea. AJR Am J Roentgenol Oct 1991, 157 (4) p697-701
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