Emphysema is a chronic lung condition in which the alveoli (the air sacs in the lungs) are damaged, causing decreased respiratory function and shortness of breath (a condition known as dyspnea).
The alveoli may have been damaged for a number of reasons, including:
The damage to the alveoli is permanent because it is not repairable. Once they form, the holes in the walls of the lower lung tissue remain there forever.
Causes of pulmonary emphysema
Emphysema is caused by long-term exposure to irritants that damage the lungs and airways. The main risk factors for emphysema are:
Smoke. 75% of people with pulmonary emphysema are active smokers or former smokers.
Prolonged exposure to other lung irritants. Environmental pollution, air, chemical dusts from the environment or that are inhaled in the workplace can cause emphysema. Also second-hand smoke, inhaled by people who do not smoke but live with smokers.
It is less common, but some people with alpha-1 antitrypsin protein deficiency, which is a genetic condition, are at higher risk of developing pulmonary emphysema.
Symptoms of pulmonary emphysema usually occur in people in their 40s.
Incidence of emphysema
Emphysema is a form of chronic obstructive pulmonary disease (COPD). This is a group of lung diseases with a high incidence worldwide.
In the world. The World Health Organization (WHO) Global Burden of Disease Study reports a prevalence of 251 million cases of COPD in 2016. About 91% of the world’s population lives in places where air quality levels exceed the healthy WHO limits.
While ambient air pollution affects both developed and developing countries, low- and middle-income countries experience the greatest burden, with the highest number of casualties in the Western Pacific and South-East Asia regions.
Worldwide, it is estimated that this group of chronic lung diseases kills about 3 million patients each year, and that by 2030 it will be the third most important cause of mortality, according to WHO data.
In Latin America. Seven out of ten cases of COPD (71%) in people over 30 years of age in the Americas are caused by tobacco smoke. A 2019 study indicates that the incidence of pulmonary emphysema in the region (based on seven countries analyzed) was 6.2 to 19.6%, with a high degree of underdiagnosis.
In the U.S. Approximately 3.8 million Americans have been diagnosed with emphysema, according to the Centers for Disease Control and Prevention (CDC). More than 90% of the cases involve people over 45 years of age. In 2016, 1.6 million women and 1.8 million men had emphysema.
The disease disproportionately affects low-income Latino communities, where there is still a high incidence of smokers, and who live in industrial areas with high levels of environmental pollution.
Symptoms of emphysema
Pulmonary emphysema usually has no symptoms at first. Over time, symptoms appear and tend to get worse. Are:
- Frequent cough
- Wheezing (whistling when breathing)
- Shortness of breath (especially when doing physical activity)
- Feeling of pressure in the chest
If it is a severe case, the person may be more prone to respiratory infections such as colds or the flu.
You may also experience unexplained weight loss, lower muscle weakness, and swollen ankles, feet, and legs.
Diagnosis of emphysema
In addition to the physical exam, the doctor may order the following tests to confirm the diagnosis of pulmonary emphysema:
Pulmonary function test (spirometry or spirogram). This test measures the air flow and the volume of air circulating into the lungs. There are several types of these tests, but basically the person must exhale several times into a tube.
High resolution computed tomography. This imaging test allows the pulmonologist to have clear images of the lungs and to see the extent of the injuries.
Chest X-ray. This test can confirm the diagnosis of pulmonary emphysema while ruling out other lung conditions.
Blood gas analysis of the arteries. This blood test can determine if the lungs are transferring oxygen well to the bloodstream and if they are removing carbon dioxide well.
Sputum exam. This test can help identify some lung problems.
Treatment of emphysema
Pulmonary emphysema is a chronic condition. There is no cure but there are treatments and actions that help control the disease, prevent it from progressing rapidly. Caring also allows the person to be active.
- If you smoke, quitting immediately is the first big step.
- Avoid secondhand smoke and be in areas where the air may be polluted.
- Maintain proper nutrition. A nutritionist can help you establish a diet that strengthens your breathing capacity.
- Work out. The doctor can order the appropriate exercises to strengthen the muscles that help you breathe better.
Bronchodilators. They help relax the muscles of the airways, making them open and breathe easier. They also release mucus into the ducts, which relieves shortness of breath. Its action usually lasts 3 to 6 hours.
Its most popular formulation is in the form of inhalers, but they can also be consumed as nebulizers, tablets, inhalation powder, and in liquid form.
Bronchodilators can cause side effects such as dizziness, headache, nausea, vomiting, and palpitations. Inform your doctor about these side effects.
Corticosteroids. In some cases, inhalers may contain corticosteroids, which reduce lung inflammation and help relieve shortness of breath.
Antibiotics If the person has a lung infection, they should be given antibiotics.
Therapies for emphysema
Pulmonary rehabilitation. These programs teach the person breathing exercises and techniques to reduce shortness of breath and to be able to exercise without rapid loss of breath.
Nutritional therapy. At the beginning of the development of emphysema, the person in general must lose weight, while when the pulmonary emphysema is advanced, they must gain weight. A nutritional plan helps with both stages of the condition.
Oxygen. The oxygen supplement provides oxygen in cases of severe emphysema. It can be used at specific times, for example when you are exercising, or 24 hours a day, using an oxygen backpack.
Surgical therapies for emphysema
Lung volume reduction. This procedure removes damaged tissue from the lung, allowing the remaining healthy tissue to expand and help improve lung function.
Transplant. If you have a severe form of emphysema and other therapies have failed, a lung transplant may be recommended.
Can emphysema be prevented?
The best prevention that a person can control one hundred percent is to never smoke or be around smokers, so as not to inhale secondhand smoke.
There are other forms of prevention that the person cannot always control, health determinants, for example not living in neighborhoods near highways or industrial zones, where air pollution levels may be higher, which increases the risk of suffering. pulmonary emphysema.
Sources: Johns Hopkins Medicine, Mayo Clinic, Cleveland Clinic, Cedars-Sinai, University of Rochester, MedlinePlus, UCSF Health, Emphysema Foundation, WHO, PAHO.