Definition

     Emphysema is a lung disease that involves damage to the air sacs (alveoli) in the lungs. The air sacs are unable to completely deflate, and are therefore unable to fill with fresh air to ensure adequate oxygen supply to the body.

Causes

• Cigarette smoking

• Alpha-1 antiproteinase deficiency

Symptoms 

• Shortness of breath

• Chronic cough with or without sputum production

• Wheezing

• Decreased ability to exercise

     Additional symptoms that may be associated with this disease include the following:

• Anxiety

• Unintentional weight loss

• Ankle, feet, and leg swelling

• Fatigue

Screening and Diagnostics

• Blood count may show polycythemia

• Arterial blood gas shows decreased oxygenation and respiratory acidosis -- usually present in advanced disease only

• Spirometry shows obstruction (decreased flow volume, i.e. FEV1 and FEV1/FVC ratio)

• Chest X-Ray may show hyperinflation or lung blebs

Treatment

• Quit Smoking

• Medications

• Oxygen given by nasal prongs may be needed

• Special exercise programs

• CPAP machines -- provide continuous airway pressures. Usually used during sleep.

• Alpha-1 antiproteinase inhibitor for those with the rare syndrome listed above

• Lung transplantation may be a consideration

• Removal of lung bulla (blebs) should be considered, and now can be done with laser surgery.

Prognosis

     The outcome is better for patients with less damage to the lung. Prognosis is largely determined by initial shortness of breath, exercise tolerance, and results from lung function tests (spirometry). Death may occur from respiratory failure, pneumonia, or other complications.

Complications 

• Recurrent respiratory infections

• Pulmonary hypertension

• Cor pulmonale (enlargement and strain on the right side of the heart)

• Erythrocytosis (increased red blood cell count)

• Death

Prevention

     Avoiding smoking -- or quitting if you do smoke -- can greatly decrease risk for this disease.