Explaining Emphysema - Part 1: Risk Factors & Symptoms

There are many people in the United States, and around the world, living with COPD. Emphysema is one lung condition that falls under the umbrella of COPD. If you've ever wondered about the basics of it, read on!

What is emphysema?

Emphysema is a lung condition that causes shortness of breath. It involves the loss of lung elasticity, and enlargement of the alveoli (or air sacs) in the lung. For people with emphysema, the alveoli in the lungs at the end of the bronchioles, become damaged. This is the actual air/tissue interface available for gas exchange. Gas exchange, as we all know, is where the oxygen diffuses into the blood stream during inhalation, and the carbon dioxide diffuses out of the blood stream and is removed during exhalation. Over a period of time, the inner walls of this physical structure of the air sacs weaken and rupture. This creates larger air spaces instead of many small ones. This then reduces the surface area of the lungs and, in turn, inhibits the amount of oxygen that can reach the bloodstream and the amount of carbon dioxide that can be removed with each breath.

How does emphysema affect the body?

The damage occurring during emphysema is permanent and irreversible. The ability to breathe normally cannot be fully recovered. The condition, however, is treatable.

Emphysema, is an obstructive pulmonary disease. The 'obstructive' refers to the inability to exhale a sufficient amount of air with each breath. The condition is such, that when you exhale, the damaged alveoli don't work properly. The old air becomes trapped, leaving no room for fresh, oxygen-rich air to enter the air spaces for good gas exchange.

Emphysema and COPD

An emphysema related condition is chronic obstructive pulmonary disease (COPD), an acronym for a group of diseases which cause progressive damage to the lungs. These diseases include chronic bronchitis, asthma and emphysema. Of the approximate 20-million plus Americans with COPD it is estimated more than 3-million have symptomatic emphysema and millions more are in the early stages of the chronic lung disease before easily recognized signs and lung disease symptoms become obvious.

Many people with emphysema also have chronic bronchitis. Chronic bronchitis is inflammation of the tubes that carry air to your lungs (bronchial tubes), which leads to a persistent cough.
Emphysema and chronic bronchitis are two conditions that make up chronic obstructive pulmonary disease (COPD). Smoking is the leading cause of COPD. Treatment may slow the progression of COPD, but it can't reverse the damage.

Causes and risk factors

Most cases of COPD, and therefore emphysema, are caused by cigarette smoking (but not all!). This has been estimated to be between 85% and 90% of those with the disease. However, not all smokers will develop it, but rather those who are genetically susceptible to the disease.
Most cases of COPD and consequently emphysema are caused by different kinds of “exposures,” which are usually some form of toxic irritants in the air to which a person is exposed.

These risk factors can include:

• Smoking - Emphysema is most likely to develop in cigarette smokers, but cigar and pipe smokers also are susceptible. The risk for all types of smokers increases with the number of years and amount of tobacco smoked.
• Age - Although the lung damage that occurs in emphysema develops gradually over time, most people with tobacco-related emphysema begin to experience symptoms of the disease between the ages of 40 and 60.
• Exposure to secondhand smoke - Secondhand smoke, also known as passive or environmental tobacco smoke, is smoke that you inadvertently inhale from someone else's cigarette, pipe or cigar. Being around secondhand smoke increases your risk of emphysema. This can begin at a young age when the exposure occurs.
• Occupational exposure to fumes or dust - If you breathe fumes from certain chemicals or dust from grain, cotton, wood or mining products, you're more likely to develop emphysema. This risk is even greater if you smoke.
• Exposure to indoor and outdoor pollution - Breathing indoor pollutants, such as fumes from heating fuel, as well as outdoor pollutants — car exhaust, for example — increases your risk of emphysema.
• Genetics - Some people have a deficiency of a protein known as alpha1-antitrypsin. This is a genetic factor that can lead to a rare form of emphysema. Alpha1-antitrypsin protects the lungs against the destruction of alveolar tissue by neutrophil elastase. This deficiency is congenital, as some are born with it. These people can develop emphysema at a relatively early age, without ever smoking. Smoking does, however, accelerate emphysema in people who are genetically susceptible.

Symptoms

Two of the key symptoms associated with emphysema are shortness of breath and a chronic cough. These appear in the early stages.

A person with shortness of breath, or dyspnea, feels as though they are unable to catch their breath. This may start only during physical exertion, but as the disease progresses, it can start to happen during rest, too.

Emphysema progression

Emphysema and COPD have an insidious progression in that they develop gradually over a number of years. For many people this slow progression is barely noticeable from day to day. After years, it seems as though the symptoms have suddenly appeared and gotten immediately worse. On COPD.net, Derek Cummings, one of our contributors, refers to this as "The COPD Bump."

In the later stages of emphysema a person may experience any of the following:

• frequent lung infections
• increased amounts of mucus and secretions
• wheezing
• reduced appetite and weight loss
• fatigue
• blue-tinged lips or fingernail beds, (cyanosis), due to a lack of oxygen
• anxiety and depression
• sleep problems
• morning headaches (due to a lack of oxygen), when breathing at night is difficult

Other conditions share many of the symptoms of emphysema and COPD, so it is important to seek medical advice for a definitive diagnosis.

Testing and diagnosis

In order to diagnose emphysema initially, the doctor will obtain a complete medical history and perform a comprehensive physical exam. The physician may recommend a variety of tests.

Imaging tests: A chest X-ray can help support a diagnosis of advanced emphysema and rule out other causes of shortness of breath. But the chest X-ray can also show normal findings if you have emphysema.

Computerized tomography (CT) scans combine X-ray images taken from many different angles to create cross-sectional views of internal organs. CT scans can be useful for detecting and diagnosing emphysema. You may also have a CT scan if you're a candidate for lung surgery.
Lab tests: An arterial blood gas (ABG) sample from an artery in your wrist can be tested to determine how well your lungs transfer oxygen into, and remove carbon dioxide from, your bloodstream.

Lung function tests: These noninvasive tests measure how much air your lungs can hold and how well the air flows in and out of your lungs. They can also measure how well your lungs deliver oxygen to your bloodstream. One of the most common tests uses a simple instrument called a spirometer, which you blow into.

Keep an eye out for the second part of this series for information on treatment and more!