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• Emphysema
• Stages of emphysema
• What are the symptoms of emphysema?
• What are the causes of emphysema?
• How is emphysema diagnosed?
• How is emphysema treated?
• How to prevent emphysema?

Emphysema

Emphysema belongs to chronic obstructive pulmonary disease with the destruction of alveoli or microscopic air sacs of the lungs, leading to poor gas exchange and airway blockage. We have about 300 million alveoli in each lung. These alveoli expand and fill with air when we inhale. Oxygen diffuses into capillaries around the alveoli, while carbon dioxide leaves the blood entering into the alveoli. When exhaling, alveoli shrink to expel carbon dioxide from the lungs. When emphysema develops, these alveoli coalesce and diminish gases exchange surface of the lung, impairing oxygen uptake and carbon dioxide elimination from the pulmonary capillaries. Shortness of breath is the first sign of emphysema. Lung damages due to emphysema are not reversible and usually aggravate over time. An early diagnosis can provide proper and timely treatments to maintain your quality of life.

Stages of emphysema

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) classifies chronic obstructive pulmonary disease (COPD) into four stages. The stages of COPD describe the severity of emphysema by comparing a patient's lung function with a healthy lung of a person of the same sex, age, and height.

• Stage 1 (Mild): The function of the lungs is 80% or more.
• Stage 2 (Moderate):  The function of the lungs is 50% - 79%.
• Stage 3 (Severe): The function of the lungs is 30 % - 49%.
• Stage 4 (Very severe): The function of the lungs is less than 30%. 

Men between the ages of 50 and 70 are often affected by emphysema.

What are the symptoms of emphysema?

The first signs of emphysema symptoms are fatigue and shortness of breath. However, most people are asymptomatic until 50% or more of their lung tissue is damaged (stage 2). Other symptoms are chronic cough, wheezing, chest tightness, dyspnea, increased mucus production, insomnia, anxiety, depression, and weight loss.

People with emphysema have an increased risk of developing pneumonia, bronchitis, and other lung infections.

When to see your doctor?

Consult your doctor if it becomes difficult for you to breathe or manifest the above symptoms. If you experience severe dyspnea, seek immediate medical attention.

What causes emphysema?

• Years of smoking cigarettes, cigars, e-cigarettes, or marijuana.
• Air pollutants at home or workplace, such as dust and chemical fumes.
• Genetic factors such as alpha-1 antitrypsin deficiency.
• Respiratory infections.

The primary cause of emphysema is cigarette smoke, which damages the lung tissue. Cigarette smoke irritates airways, causing swelling and mucus production, interfering with breathing, and leading to shortness of breath.

How is emphysema diagnosed?

• Physical exam includes listening to breath sounds with a stethoscope. If your lungs are trapping air, there will be a hollow sound or wheezing. Doctors will order tests to confirm if you have emphysema.
• Chest X-ray can detect moderate and severe emphysema.
• A Cheat CT scancan provide more detailed images of your lungs.
• Pulmonary function testing can measure the air volumes you inhale and exhale with a spirometer.
• Arterial blood gas (ABG) analyzes the amount of oxygen and carbon dioxide in the arterial blood and checks if you need extra oxygen.
• An electrocardiogram (EKG) to rule out other causes of shortness of breath, such as heart disease.
• Blood and genetic testing to check if you have alpha-1 antitrypsin deficiency, which is a cause of emphysema.

How is emphysema treated?

The goal of the treatment is to slow down the progression of the disease and maintain the remaining lung tissue and function.

• Quitting smoking is the most effective way to slow down the progression of emphysema in smokers.
• Bronchodilator inhalers are more effective than oral medications in relaxing airway muscles so you can inhale and exhale more air into your lungs.
• Oral corticosteroids for emphysema flare-up.
• Inhaled corticosteroids can improve swollen airways and lower mucus production.
• Antibiotics to treat bacterial infections in the lungs, such as bronchitis and pneumonia.
• Anti-inflammatory medications help relieve airway inflammation.
• Oxygen therapy for people with hypoxemia.
• Lung volume reduction surgery (LVRS) is a procedure to partially remove diseased lung tissues to relieve pressure on the diaphragm and increase lung expandability. Your doctor will consider if you are eligible for the procedure.
• Bronchoscopic lung volume reduction releases the trapped air in the lungs so you can breathe better. Consult your doctor if this procedure is for you.
• A lung transplant is a surgical procedure to replace affected lungs with healthy ones from a donor to extend the life of the patient.

How to prevent emphysema?

• Quit smoking and avoid secondhand smoke.
• Wear a protective mask in areas with air pollution, chemical fumes, or dust.
• Open windows to increase air circulation and vent radon, which can cause lung cancer.
• Use an air purifier with a HEPA filter to improve indoor air quality.

Lifestyle modification and home remedies

• Clean your house to decrease dust accumulation.
• Change air filters in an air conditioner or air purifier regularly.
• Avoid chemical fumes and automobile exhaust, which can irritate your respiratory tract.
• Exercising regularly to increase lung capacity.
• Protect yourself from cold air, which can precipitate bronchial spasms.
• Avoid close contact with people with respiratory illnesses.
• Get a pneumococcal vaccine and flu shot as recommended by your doctor.

COVID-19 and Emphysema

Though rare, COVID-19 can cause giant bullous emphysema, known as vanishing lung syndrome. You may develop giant bullae, a growing air pocket affecting one-third of one or both of your lungs.