emphysema

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Emphysema



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Overview

Emphysema is a type of chronic obstructive pulmonary disease (COPD) involving damage to the air sacs (alveoli) in

the lungs. As a result, your body does not get the oxygen it needs. Emphysema

makes it hard to catch your breath. You may also have a chronic cough and have




Overview

trouble breathing during exercise.

The most common cause is cigarette smoking.

If you smoke, quitting can

help prevent you from getting the disease. If you already have emphysema, not smoking




Overview

might keep it from getting worse. Treatment is based on whether your symptoms

are mild, moderate or severe. Treatments include inhalers, oxygen, medications

and sometimes surgery to relieve symptoms and prevent complications.




Symptoms

At first, COPD may cause no symptoms or only mild symptoms. As the

disease gets worse, symptoms usually become more severe. Common signs

and symptoms of COPD include:




Symptoms

-- An ongoing cough or a cough that produces a lot of mucus (often called "smoker's cough")

-- Shortness of breath, especially with physical activity

-- Wheezing (a whistling or squeaky sound when you breathe)

-- Chest tightness




Symptoms

If you have COPD, you also may have colds or the flu (influenza) often.

Not

everyone who has the symptoms above has COPD. Likewise, not everyone

who has COPD has these symptoms. Some of the symptoms of COPD are




Symptoms

similar to the symptoms of other diseases and conditions. Your doctor

can find out whether you have COPD.

If your symptoms are mild, you

may not notice them, or you may adjust your lifestyle to make breathing




Symptoms

easier. For example, you may take the elevator instead of the stairs.

Over time, symptoms may become severe enough to see a doctor. For example, you may get short of breath during physical exertion.

The

severity of your symptoms will depend on how much lung damage you have.




Symptoms

If you keep smoking, the damage will occur faster than if you stop

smoking.

Severe COPD can cause other symptoms, such as swelling in your ankles, feet, or legs; weight loss; and lower muscle endurance.

Some




Symptoms

severe symptoms may require treatment in a hospital. You—with the help

of family members or friends, if you're unable—should seek emergency

care if:

-- You're having a hard time catching your breath or talking.




Symptoms

-- Your lips or fingernails turn blue or gray. (This is a sign of a low oxygen level in your blood.)

-- You're not mentally alert.

-- Your heartbeat is very fast.

-- The recommended treatment for symptoms that are getting worse isn't working.




Diagnosis

Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results.

Your

doctor may ask whether you smoke or have had contact with lung




Diagnosis

irritants, such as secondhand smoke, air pollution, chemical fumes, or

dust.

If you have an ongoing cough,

let your doctor know how long you've had it, how much you cough, and




Diagnosis

how much mucus comes up when you cough. Also, let your doctor know

whether you have a family history of COPD.

Your doctor will

examine you and use a stethoscope to listen for wheezing or other




Diagnosis

abnormal chest sounds. He or she also may recommend one or more tests to

diagnose COPD.

Lung Function TestsLung function tests

measure how much air you can breathe in and out, how fast you can




Diagnosis

breathe air out, and how well your lungs deliver oxygen to your blood.

The

main test for COPD is spirometry (spi-ROM-eh-tre). Other lung function

tests, such as a lung diffusion capacity test, also might be used. (For




Diagnosis

more information, go to the Health Topics Lung Function Tests article.)

SpirometryDuring

this painless test, a technician will ask you to take a deep breath in.

Then, you'll blow as hard as you can into a tube connected to a small




Diagnosis

machine. The machine is called a spirometer.

The machine measures how much air you breathe out. It also measures how fast you can blow air out.

Other TestsYour doctor may recommend other tests, such as:

-- A chest x ray or chest CT scan.




Diagnosis

These tests create pictures of the structures inside your chest, such

as your heart, lungs, and blood vessels. The pictures can show signs of

COPD. They also may show whether another condition, such as heart

failure, is causing your symptoms.




Diagnosis

-- An arterial blood gas test.

This blood test measures the oxygen level in your blood using a sample

of blood taken from an artery. The results from this test can show how

severe your COPD is and whether you need oxygen therapy.




Treatment

COPD has no cure yet. However, lifestyle changes and treatments can

help you feel better, stay more active, and slow the progress of the

disease.

The goals of COPD treatment include:




Treatment

-- Relieving your symptoms

-- Slowing the progress of the disease

-- Improving your exercise tolerance (your ability to stay active)

-- Preventing and treating complications




Treatment

-- Improving your overall health

To

assist with your treatment, your family doctor may advise you to see a

pulmonologist. This is a doctor who specializes in treating lung

disorders.




Treatment

Lifestyle ChangesQuit Smoking and Avoid Lung IrritantsQuitting

smoking is the most important step you can take to treat COPD. Talk

with your doctor about programs and products that can help you quit.

If




Treatment

you have trouble quitting smoking on your own, consider joining a

support group. Many hospitals, workplaces, and community groups offer

classes to help people quit smoking. Ask your family members and friends

to support you in your efforts to quit.




Treatment

Also, try to avoid secondhand smoke and places with dust, fumes, or other toxic substances that you may inhale.

For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's "Your Guide to a Healthy Heart." Although these resources focus on heart health, they include basic information about how to quit smoking.




Treatment

Other Lifestyle ChangesIf

you have COPD, you may have trouble eating enough because of your

symptoms, such as shortness of breath and fatigue. (This issue is more

common with severe disease.)




Treatment

As a result, you may not get all of

the calories and nutrients you need, which can worsen your symptoms and

raise your risk for infections.

Talk with your doctor about




Treatment

following an eating plan that will meet your nutritional needs. Your

doctor may suggest eating smaller, more frequent meals; resting before

eating; and taking vitamins or nutritional supplements.

Also, talk




Treatment

with your doctor about what types of activity are safe for you. You may

find it hard to be active with your symptoms. However, physical

activity can strengthen the muscles that help you breathe and improve

your overall wellness.




Treatment

MedicinesBronchodilatorsBronchodilators relax the muscles around your airways. This helps open your airways and makes breathing easier.

Depending

on the severity of your COPD, your doctor may prescribe short-acting or




Treatment

long-acting bronchodilators. Short-acting bronchodilators last about

4–6 hours and should be used only when needed. Long-acting

bronchodilators last about 12 hours or more and are used every day.

Most




Treatment

bronchodilators are taken using a device called an inhaler. This device

allows the medicine to go straight to your lungs. Not all inhalers are

used the same way. Ask your health care team to show you the correct way

to use your inhaler.




Treatment

If your COPD is mild, your doctor may only

prescribe a short-acting inhaled bronchodilator. In this case, you may

use the medicine only when symptoms occur.




Treatment

If your COPD is moderate or severe, your doctor may prescribe regular treatment with short- and long-acting bronchodilators.

Inhaled Glucocorticosteroids (Steroids)Doctors

use inhaled steroids to treat people whose COPD symptoms flare up or




Treatment

worsen. These medicines help reduce airway inflammation.

Your

doctor may ask you to try inhaled steroids for a trial period of 6 weeks

to 3 months to see whether the medicine helps relieve your breathing




Treatment

problems.

VaccinesFlu ShotsThe flu (influenza)

can cause serious problems for people who have COPD. Flu shots can

reduce your risk of getting the flu. Talk with your doctor about getting




Treatment

a yearly flu shot.

Pneumococcal VaccineThis vaccine lowers your risk for pneumococcal pneumonia

(NU-mo-KOK-al nu-MO-ne-ah) and its complications. People who have COPD

are at higher risk for pneumonia than people who don't have COPD. Talk




Treatment

with your doctor about whether you should get this vaccine.

Pulmonary RehabilitationPulmonary rehabilitation (rehab) is a broad program that helps improve the well-being of people who have chronic (ongoing) breathing problems.

Rehab




Treatment

may include an exercise program, disease management training, and

nutritional and psychological counseling. The program's goal is to help

you stay active and carry out your daily activities.

Your rehab




Treatment

team may include doctors, nurses, physical therapists, respiratory

therapists, exercise specialists, and dietitians. These health

professionals will create a program that meets your needs.




Treatment

Oxygen TherapyIf you have severe COPD and low levels of oxygen in your blood, oxygen therapy can help you breathe better. For this treatment, you're given oxygen through nasal prongs or a mask.

You

may need extra oxygen all the time or only at certain times. For some




Treatment

people who have severe COPD, using extra oxygen for most of the day can

help them:

-- Do tasks or activities, while having fewer symptoms

-- Protect their hearts and other organs from damage




Treatment

-- Sleep more during the night and improve alertness during the day

-- Live longer

SurgerySurgery

may benefit some people who have COPD. Surgery usually is a last resort




Treatment

for people who have severe symptoms that have not improved from taking

medicines.

Surgeries for people who have COPD that's mainly related to emphysema include bullectomy (bul-EK-toe-me) and lung volume reduction surgery (LVRS). A lung transplant might be an option for people who have very severe COPD.




Treatment

BullectomyWhen

the walls of the air sacs are destroyed, larger air spaces called

bullae (BUL-e) form. These air spaces can become so large that they

interfere with breathing. In a bullectomy, doctors remove one or more




Treatment

very large bullae from the lungs.

Lung Volume Reduction SurgeryIn

LVRS, surgeons remove damaged tissue from the lungs. This helps the

lungs work better. In carefully selected patients, LVRS can improve




Treatment

breathing and quality of life.

Lung TransplantDuring a lung transplant, your damaged lung is removed and replaced with a healthy lung from a deceased donor.

A

lung transplant can improve your lung function and quality of life.




Treatment

However, lung transplants have many risks, such as infections. The

surgery can cause death if the body rejects the transplanted lung.

If

you have very severe COPD, talk with your doctor about whether a lung




Treatment

transplant is an option. Ask your doctor about the benefits and risks of

this type of surgery.




Causes

Long-term exposure to lung irritants that damage the lungs and the airways usually is the cause of COPD.

In

the United States, the most common irritant that causes COPD is




Causes

cigarette smoke. Pipe, cigar, and other types of tobacco smoke also can

cause COPD, especially if the smoke is inhaled.

Breathing in

secondhand smoke, air pollution, or chemical fumes or dust from the




Causes

environment or workplace also can contribute to COPD. (Secondhand smoke

is smoke in the air from other people smoking.)

Rarely, a genetic condition called alpha-1 antitrypsin deficiency

may play a role in causing COPD. People who have this condition have




Causes

low levels of alpha-1 antitrypsin (AAT)—a protein made in the liver.

Having

a low level of the AAT protein can lead to lung damage and COPD if

you're exposed to smoke or other lung irritants. If you have this




Causes

condition and smoke, COPD can worsen very quickly.

Although uncommon, some people who have asthma

can develop COPD. Asthma is a chronic (long-term) lung disease that

inflames and narrows the airways. Treatment usually can reverse the




Causes

inflammation and narrowing. However, if not, COPD can develop.




Prevention

You can take steps to prevent COPD before it starts. If you already

have COPD, you can take steps to prevent complications and slow the

progress of the disease.

Prevent COPD Before It StartsThe




Prevention

best way to prevent COPD is to not start smoking or to quit smoking.

Smoking is the leading cause of COPD. If you smoke, talk with your

doctor about programs and products that can help you quit.

If you




Prevention

have trouble quitting smoking on your own, consider joining a support

group. Many hospitals, workplaces, and community groups offer classes to

help people quit smoking. Ask your family members and friends to

support you in your efforts to quit.




Prevention

Also, try to avoid lung

irritants that can contribute to COPD. Examples include secondhand

smoke, air pollution, chemical fumes, and dust. (Secondhand smoke is

smoke in the air from other people smoking.)




Prevention

For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's "Your Guide to a Healthy Heart." Although these resources focus on heart health, they include basic information about how to quit smoking.

Prevent Complications and Slow the Progress of COPDIf




Prevention

you have COPD, the most important step you can take is to quit smoking.

Quitting can help prevent complications and slow the progress of the

disease. You also should avoid exposure to the lung irritants mentioned

above.




Prevention

Follow your treatments for COPD exactly as your doctor

prescribes. They can help you breathe easier, stay more active, and

avoid or manage severe symptoms.

Talk with your doctor about whether and when you should get flu (influenza) and




Prevention

vaccines. These vaccines can lower your chances of getting these

illnesses, which are major health risks for people who have COPD.



emphysema

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