Emphysema

GENERAL INFORMATION:

What is emphysema?

• Emphysema (em-fi-SEE-mah) is a long-term disease of the lungs. Emphysema is one of a group of lung diseases called COPD, or chronic obstructive pulmonary disease. Emphysema causes damage to the alveoli (al-VEE-oh-lie) that cannot be reversed (cured). The alveoli are the tiny air sacs of the lungs where oxygen is put into the bloodstream. With emphysema, your lungs become less able to take in oxygen (good air) and get rid of carbon dioxide (deye-OKS-eyed). Carbon dioxide is an invisible gas that your body gives off as a waste product.
  
  
• Another common form of COPD is chronic bronchitis (brong-KEYE-tis). With chronic bronchitis, the airways become inflamed (swollen) and make too much mucus, which also traps air in the lungs. People with emphysema often have chronic bronchitis also.

What causes emphysema?

• Smoking or being around smokers: Cigarette smoking causes most cases of COPD, including emphysema. Other types of smoke, such as pipe and cigar smoke, can also cause COPD. The more you smoke, the more damage you do to your lungs. Children of heavy smokers also have an increased risk of having COPD later in life. People who do not smoke but who live or work around the smoke of others may get emphysema.
  
  
• Exposure to things that irritate your lungs: Working around some dusts and fumes (gases) can damage your lungs over time. Living in an area that has heavy air pollution also increases your risk of lung problems. Living or working around dusts, fumes, or pollution when you have emphysema can make your illness worse. Lung irritants that may cause lung problems over time include:
  
  
  • Working around smoke from burning structures or grasses on a regular basis.
    
    
  • Fumes from chemicals, such as ammonia or chlorine.
    
    
  • Dusts, such as coal dust, grain dust, or dust from metals.
    
    
  • Frequent or severe (very bad) lung infections that can damage your lungs over time.
  
  
• Family history of COPD: You may be more likely to get a lung disease if someone else in your family had one.
  
  
• AAT deficiency: Alpha-1 antitrypsin (al-fah one an-ti-TRIP-sin), or AAT, is a protein found in blood that helps protect your lungs from damage. A deficiency (lack) of AAT can greatly increase your risk of lung problems, including COPD. AAT deficiency is a rare genetic (inherited) problem that can be treated. If someone in your family had lung problems at an early age, tell your caregiver.

What are the signs and symptoms of emphysema?

• Early signs and symptoms: The signs and symptoms of emphysema may happen very slowly. Shortness of breath, especially during activity, is one of the earliest symptoms. You may have a morning cough that is dry, or that brings up mucus from the lungs. Smokers may mistake this cough for a "normal smoker's cough". (A smoker's cough is never "normal" and may mean that your lungs are already damaged by smoking.) As time passes, the cough may start to last longer during the day. You may have colds and other lung infections more often than you used to.
  
  
• Later signs and symptoms: As emphysema worsens over time, you may have more symptoms. Your skin, nail beds, or lips may turn dusky or blue. You may become more short of breath and get tired more easily. You may not be able to walk as far as you used to. At times, you may make a high-pitched noise when you breathe, which is called wheezing. You may notice your breathing is faster and more shallow than it used to be. You may lose too much weight. You may need to lean forward to breathe when sitting down. You may become anxious or depressed because of your breathing problems.
  
  
• Signs and symptoms of heart problems: Advanced (very bad) emphysema may lead to heart problems. This happens when the heart has to work harder because of the damage to your lungs. You may get swelling in your ankles, legs, or abdomen (belly). You may have blood pressure problems or chest pain. Keep all appointments with your caregiver so that any new problems with your heart or lungs can be found and treated early.

What is an exacerbation of emphysema?

• When a person has COPD, they may have times where their symptoms get worse very quickly. These are called exacerbations (eg-zas-er-BAY-shuns). Exacerbations of emphysema can be triggered (started) by infections (in-FECK-shuns) such as colds or the flu. Being around lung irritants such as air pollution, dusts, fumes, or smoke can also trigger an exacerbation. Other medical conditions, such as heart problems or infection elsewhere in the body, can make your breathing problems worse. Exacerbations of emphysema can be serious, even life threatening.
  
  
• The main symptom of an emphysema exacerbation is increasing shortness of breath. You may cough up more mucus than usual, or mucus that is a different color than usual. Exacerbations of emphysema need to be treated as soon as possible. If you have increasing trouble breathing, signs of an infection, new trouble thinking, or new chest pain or pressure, see a caregiver right away.

How is emphysema diagnosed? Your caregiver may ask you many questions about your work, lifestyle, and the signs and symptoms you have. Your caregiver will examine you and listen to your heart and lungs through a stethoscope (STETH-oh-skohp). You may need tests such as blood tests or a chest x-ray. You may need an EKG test to check your heart. Pulmonary (PUL-moh-ner-ee) function tests may also be needed. Pulmonary function tests are also called lung function tests. These tests measure how well your lungs can take in, hold, and use air.

How is emphysema treated? Emphysema cannot be cured. The goal of treatment is to help you feel better and to keep your lungs as healthy as possible. The most important thing you can do to help your emphysema is to stop smoking. You may need to see a special lung doctor called a pulmonologist (pul-moh-NAHL-oh-jist). You may need special caregivers to help you learn about such things as a healthy diet, exercise, and activity planning. Other things that may decrease your symptoms or prevent problems include the following.

• You may need medicines to help you breathe easier. These may include inhalers, oxygen, and steroids (STER-oids). Always follow the directions given to you by your caregiver when using oxygen and taking medicines. You may need to sleep with your upper body elevated (raised) to help you breathe more easily. You may need to learn special breathing exercises, such as pursed-lip breathing.
  
  
• Always call your caregiver at the first sign of illness, such as a cold or the flu. You may need special treatment to prevent a serious lung infection, such as pneumonia (noo-MOH-nyah). During exacerbations, you may need to go into the hospital for tests or treatments. Rarely, surgery (such as a lung transplant or lung reduction) is done for people with severe (very bad) COPD.

Risks: The risks of emphysema depend on how bad your lungs are and your general health. As emphysema gets worse over time, you may have pain, trouble sleeping, or anxiety. You may need to use oxygen to help you breathe. You may lose too much weight. Having COPD may increase your risk of having lung cancer. Smoking also increases this risk, and increases the risk of your emphysema getting worse. Lung infections in people with emphysema may be life threatening. You may die from having emphysema.

For more information:

• Emphysema is a life-changing disease for you and your family. Accepting that you have emphysema is hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Let them help you. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to support a person with emphysema.
  
  
• You may also want to join a support group. This is a group of people who also have emphysema or other kinds of COPD. Ask your caregiver for the names and numbers of support groups near you. You may also contact the following for more information:
  • American Lung Association
    61 Broadway, 6th floor
    New York City, NY 10006
    Phone: 1-800-586-4872
    Web Address: http://www.lungusa.org
    
  • Centers for Disease Control and Prevention
    1600 Clifton Road
    Atlanta, GA 30333
    Phone: 1-404-6393311
    Phone: 1-800-3113435
    Web Address: http://www.cdc.gov
    

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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