This overview is a sample of the type of information available to you at Griffin Hospital's Community Health Resource Center. It is not intended to replace your physician's instructions in the management of your health problems, but to better inform you about a particular illness and alert you to the availability of other materials. If you have a question about any piece of information presented in theses fact sheets, please call your physician, or stop by the Community Health Resource Center at your convenience.

EMPHYSEMA

Emphysema is one of a group of lung problems that is also referred to as COPD (chronic obstructive pulmonary disease). In emphysema, the tiny air sacs in the lungs, called alveoli, have lost their elasticity, or the ability to return to their original size and shape after being inflated with air. (Emphysema comes form the Greek word meaning "inflate"). Stale air stays in the alveoli, leaving no room for oxygen-rich air to enter. Sometimes the air sacs become so over inflated that their walls rupture, which decreases their ability to function normally.

As the disease progresses, it becomes more difficult for the lungs to supply the body with oxygen. People with emphysema begin to feel "air hungry" or short of breath, and they breathe faster to make up for the decreased amount of oxygen they are taking in. As breathing becomes more difficult, people may begin to use muscles in their neck, shoulders, chest, and abdomen to help them breathe. Using these extra muscles to breathe may make them very tired.

WHAT CAUSES EMPHYSEMA?

Cigarette smoking is the leading cause of emphysema, especially if it has continued over many years. Air pollution and exposure to irritating chemicals, fumes, or dust can also cause emphysema. Some people may be especially susceptible to emphysema due to an inherited lack of a blood protein called alpha antitrypsin which normally protects the lung's elasticity.

WHO GETS EMPHYSEMA?

People who smoke are the most likely to get emphysema. This risk increases if they live in a heavily polluted area, or work in a job that regularly exposes them to irritating fumes or dust. Men are more likely to develop emphysema than women, although this may reflect the fact that more men are smokers. It is also more likely to occur in people over 50 years of age since it usually develops gradually over many years.

WHAT ARE THE SYMPTOMS?

The major symptom of emphysema is shortness of breath. This may be most noticeable during periods of exercise, or immediately upon waking up in the morning until accumulated secretions are coughed up. Many people with emphysema also suffer from a chronic cough due to increased secretions in their lungs. They may also complain of a poor appetite and feeling tired all the time since much of their energy is spent in the effort of breathing.

Over the years, these symptoms may become worse. If the body is not getting enough oxygen, the individual may complain of feeling depressed and irritable, and may notice a decrease in memory. In severe cases, there may also be swelling in the ankles and lower legs, and tenderness in the area of the lungs as the heart muscle becomes damaged due to increased pressure in the lungs.

DIAGNOSING EMPHYSEMA

During a physical examination, you will be asked questions about your medical history, especially concerning your cough, the amount and color of your sputum and which activities cause you to be short of breath. Your doctor will also listen to your lungs with a stethoscope, and tap on your chest in order to locate areas of hollow-sounding, overfilled air sacs. You may also have a chest x-ray, and possibly an electrocardiogram (EKG), to check for possible damage to your heart.

You will most likely be given some breathing tests call pulmonary function tests

(PFTs). These will measure how much air you can inhale and exhale, how fast you can exhale, and how much resistance is in the air passages.

Your doctor may also order blood tests to determine whether you are making too many red blood cells to make up for the decrease in oxygen in your bloodstream. A blood test can also determine whether there is an increase in white blood cells which may indicate a possible lung infection. Laboratory examination of your sputum may also show if there is an infection in your lungs.

A lack of alpha antitrypsin can be determined by an inexpensive blood test. Although this condition is rare (1 in 50,000), you may be tested for it. You may be also asked to have a blood test called an arterial blood gas (ABG) that determines how much oxygen is in your blood.

TREATMENT

Although there is no way to cure emphysema or regain damaged lung tissues, it is possible to relieve many of the symptoms and prevent the disease from getting worse. The primary form of treatment is oxygen, which is given to relieve breathlessness and to allow increased activity. Your doctor may prescribe bronchodilators, either in the form of pills or aerosol inhalers, which can open up blocked air passages. You may also be asked to take steroid hormones, such as cortisone, which decrease swelling and inflammation. Antibiotics may be prescribed if there is a respiratory infection that could further interfere with breathing.

You may also need postural drainage, which uses gravity to help drain secretions, and chest percussion, when someone claps on your back to help loosen secretions in your lungs. Your doctor may also recommend that you be vaccinated against the flu each year to prevent additional infections.

WHAT CAN YOU DO?

One of the most important things you can do is to stop smoking. Even if you already have emphysema, by no longer smoking you can relieve some of the symptoms and avoid damaging more areas in your lungs. It will also help to avoid places where the air is polluted or filled with smoke, dust, or fumes. If you live in an area where air pollution can be severe, avoid going outdoors or doing strenuous physical activities outside when pollution is at its worst. Wood or coal burning stoves or fireplaces can increase indoor air pollution. Some people find that a kitchen exhaust fan helps by removing irritating cooking fumes

Breathing exercises may help you to breathe more effectively. Gradually increasing the amount of exercise you get can help strengthen muscles and prevent you from becoming so easily fatigued. Drinking plenty of fluids, unless your doctor says otherwise, can help keep secretions thin so that they can be more easily coughed up.

Good nutrition is also important to promote your body's natural resistance to infection and to maintain your ideal weight. Being overweight increases your need for oxygen. Being too thin can weaken your body. If eating is difficult for you, try to avoid big meals by eating several small snacks instead.

COPING

Learning to live with a chronic illness can sometimes be difficult for patients as well as for their families. Tasks that were once easy may become more difficult. This can lead to depression, anxiety, and guilt. Having a family member, friend, or professional to talk to about these feeling can help. Many communities have support groups for people who have chronic breathing problems and their families. These groups can help reassure you that you are not alone, and can provide information about how others have learned to live with emphysema.

A good attitude is very important for maintaining your health and well-being. With a positive outlook, many people find that they do not have to give up activities that they enjoy, such as a full social life, recreation and hobbies, or sexual activities. With a good understanding of their illness, and with proper treatment, many people with emphysema can live active, enjoyable lives.

Please note that this information is intended to give you a general overview of the topic. It is not intended to replace advice or instruction of a health professional. We recommend that you consult your physician, nurse, or qualified health professional regarding the information in this publication. © 1994 Planetree, Inc. Reproduction of this material in any form is limited to license agreement.

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