Lung Health: Emphysema 101

Emphysema is a debilitating lung disease which is a part of Chronic Obstructive Pulmonary Disease or COPD. It is characterized by persistent respiratory symptoms and limitation in airflow or obstruction that is not fully reversible.

Estimated to affect 32 million people in the United States, COPD is the third leading cause of death in the US. In Hawaii, 4.2% of the local population is affected by the condition. It’s more common in men than in women and majority of cases are found in ages 40 years old and up.

At its very core, COPD is an inflammatory condition in the lungs. Smoking and other irritants cause inflammation that leads to damage, scarring, loss of elasticity and ability of the lung airways to recoil.

In emphysema, loss of the elasticity and recoil happens in the small air sacs at the tips of the lung branches. These small air sacs are where the exchange of oxygen and carbon dioxide happens.

The damaged air sacs abnormally enlarge because of the loss of elasticity and inability to recoil, and airflow is obstructed, and the person has trouble exhaling fully. The trapped air causes hyperinflation and abnormal gas exchange making the person short of breath. It’s like an old balloon that is full of air.

The old balloon has lost its elasticity and becomes stiffer so when you let the air out it does not deflate as instantaneous as a new balloon would and some of the air is trapped and leads to hyperinflation without effective gas exchange.

Smoking is the most significant risk factor in developing COPD.

First-hand and second-hand smoking both increase a person’s risk. Occasionally, long term exposure to irritants like pollution, occupational and household inhaled chemicals and dust also increases risk. There is a subset of patients that have a strong genetic disposition due to an enzyme deficiency, so a family history of COPD is considered a risk factor.

Symptoms typically include chronic cough with phlegm that is worse in the morning, shortness of breath, wheezing and/or frequent respiratory infections. Many people may attribute the cough to allergies, or the shortness of breath to aging and compensate by adjusting their day to day activities by doing less.

Diagnosis is confirmed by spirometry, a test in which the person inhales then blows long and hard into a tube and a machine measures their lung capacity and force of exhalation.

Quitting smoking is the key to prevent disease occurrence and deter progression.

Treatment to prevent exacerbations or flare ups include strict adherence to maintenance inhalers and staying up to date with pneumococcal and influenza vaccinations. Treatment during flare ups may include corticosteroids, rescue inhalers, nebulizer treatments and antibiotics. Non-pharmacologic measures especially for end stage COPD include supplemental oxygen therapy, pulmonary rehabilitation, lung volume reduction therapy and lung transplant.

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