Content

Introduction

Emphysema is a respiratory disease that usually affects both lungs (bilateral emphysema) and over time causes irreversible changes and damage to lung tissue. It affects the bronchioles and pulmonary alveoli, small thin-walled sacs present in clusters around the lungs. "ends of the ramifications of the bronchi.

Around the alveoli there are very thin blood capillaries in which venous blood rich in carbon dioxide and poor in oxygen flows. The capillaries are half immersed in the alveolus which contains the inhaled air to release the carbon dioxide and capture the oxygen present. Over time, the alveoli progressively lose elasticity, atrophy, become irregular, enlarge and begin to malfunction. The word itself emphysema it means huge expansion precisely to indicate the formation of real holes (bubbles), increasingly large, inside the walls of the lungs which cause a decrease in the surface available for gas exchanges.

Due to the progressive reduction of the pulmonary surface useful to allow the capillaries to absorb oxygen, as the emphysema progresses, the blood becomes poor in oxygen and rich in carbon dioxide making the breath "short", with consequent increase of difficulty in breathing (respiratory failure).

Middle-aged adults (between 40 and 60 years of age) and the elderly (senile emphysema) are the categories of people most at risk although, sometimes, the disease is found in relatively young individuals.

The most common cause of emphysema is cigarette smoking. Smokers should therefore stop smoking immediately to slow the progression of the disease.

Emphysema is a form of chronic obstructive pulmonary disease COPD or an important component, often along with chronic bronchitis (long-term and persistent inflammation of the airways), of COPD. Chronic Obstructive Pulmonary Disease, COPD) which causes significant breathing difficulties and which, according to Istat data, affects about 3.5 million people in Italy. Adequate care and regular medical check-ups can certainly help keep the situation under control.

Symptoms

The disorders (symptoms) caused by pulmonary emphysema do not always manifest themselves clearly (especially in the milder or initial forms) and it can take a few years before noticing the signs. Much, therefore, depends on the stage of the disease.

The main disorders (symptoms) are:

  • wheezing and difficulty in breathing (dyspnoea): initially only when an effort is made, later also in the resting phase
  • chronic cough (especially in the morning) with frequent and greater production of rather thick and viscous phlegm that obstructs the bronchioles and pulmonary alveoli
  • increase in the number of heartbeats per minute (tachycardia)
  • shortness of breath and wheezing, with obvious difficulty in speaking
  • purple color of nails and lips (cyanosis), caused by poor oxygenation of the blood and the increased presence of carbon dioxide in it. It occurs when the disease is in a fairly advanced stage and the tissues of the body, due to the respiratory deficiency (pulmonary insufficiency) in progress, require an indispensable administration of oxygen (oxygen therapy)
  • dilated chest, as if it were still in the inspiration phase (barrel chest)
  • noisy or "wheezing" breathing especially while walking and, at times, even only during light and limited efforts in time
  • loss of body weight
  • collapse of the lung (pneumothorax), following the rupture of the "bubbles" present in the lung tissue (bullous emphysema)

Disorders (symptoms) usually tend to increase over time. Therefore, it is advisable to carry out regular medical check-ups and, possibly, in the event that the first signs of breathing difficulties occur, contact your doctor in order to start adequate therapy as soon as possible. It is equally important to check the situation of the other organs (such as brain, heart, etc.) and systems (digestive system, muscle, etc.) which, again due to the low amount of oxygen in the blood, could be in a state of suffering ( e.g. heart failure).

Causes

The main cause of emphysema is exposure to cigarette smoke (both active and passive) due to the presence of irritating and toxic chemicals such as phenols, quinone-hydroquinone, nitrogen compounds, etc. Other risk factors, capable of progressively damage lung tissue and airways causing the disease, are:

  • prolonged exposure in the workplace to fumes, gases, and chemicals such as, for example, wheat and flour dust, silica dust, welding fumes, coal dust which irritate the respiratory tract
  • prolonged exposure to pollution of urban environments (especially determined by motor vehicle exhaust fumes) or domestic environments (caused by heating fumes such as those emitted from fireplaces, stoves, etc.)
  • genetic factors, although quite rare, which concern the hereditary deficiency of alpha-1-antitrypsin, a protein that protects and repairs the elastic fibers of the lung tissue. The amount of this protein varies from person to person
  • presence of family members already sick with emphysema (familiarity with the disease)
  • predisposition to diseases such as bronchitis or asthma (acute emphysema)
  • weak defense system of the organism (immune system)

Emphysema can also be associated with other diseases such as lung cancer.

Diagnosis

The "assessment (diagnosis) of emphysema is carried out through the" execution of some specific tests such as:

  • spirometry, consists in breathing in a machine (spirometer) to analyze the state of health of the lungs and the level of difficulty and respiratory insufficiency present. The spirometer is able to calculate two values: the volume of inhaled and exhaled air and the time required to do so. The values ​​thus obtained are then compared with the reference ones, divided by age groups, in order to evaluate the possible degree of blockage of the respiratory tract
  • radiography (X-ray or X-ray) of the chest in 2 views (front and side image) to help confirm the diagnosis of emphysema and rule out the presence of other respiratory diseases
  • blood analysis to measure the content of oxygen and carbon dioxide present and the possible deficiency of the alpha-1-antitrypsin protein (able to protect the elastic structures of lung tissues)

Sometimes, additional tests may be needed to ascertain the disease:

  • electrocardiogram (ECG) to measure the electrical activity of the heart
  • echocardiogram (ultrasound of the heart)
  • peak expiratory flow test (PEF) to measure how quickly the air in the lungs is expelled (exhaled). Often asked for asthma patients
  • blood gas analysis, to measure the levels of oxygen and carbon dioxide in the blood
  • computed tomography (CT) of the chest to help identify, even at an early stage, any lung problems and damage caused by "emphysema
  • sputum examination (analysis of a small amount of phlegm) to check for a "possible chest infection

Therapy

Today emphysema is not yet a curable disease but the use of adequate treatment (therapy) can certainly be of help in slowing down the progress of the disease and in controlling its disorders (symptoms), first of all the respiratory difficulty which, over time, it could affect the quality of life.It is important to seek treatment as soon as possible, under strict and regular medical supervision, also to avoid possible complications such as, for example, heart disease or collapse of the lungs.

The recommended therapies are: use, always under medical supervision, bronchodilators, aerosols, oxygen cylinders (continuous or only nocturnal home oxygen therapy) and take drugs that can relieve symptoms and disorders to reduce any bacterial infections (antibiotics) and inflammation (anti-inflammatory ) facilitating breathing and relieving cough. For example, the use of bronchodilators relieves cough and dyspnoea (the feeling of lack of air).

We strongly recommend that you:

  • stop smoking (if you are a smoker) to prevent further damage to the respiratory system
  • avoid exposure to sources of pollution and passive smoking
  • perform pulmonary rehabilitation (respiratory physiotherapy) through the "execution of specific physical exercises that will help to breathe in a less" tiring "way
  • carry out the required vaccinations (anti-pneumococic every 5 years and anti-flu every year)

In cases of advanced emphysema it is advisable:

  • to intervene surgically through bullectomy (a surgery performed to remove large areas of air sacs in damaged lungs) or lung transplantation, although this is not always possible, to reduce the volume of the lung by eliminating the diseased parts, or those most damaged by emphysema , in order to improve the quality of life of the patient

Prevention

It is advisable for emphysema sufferers:

  • stop smoking immediately
  • indoors, avoid coming into contact, through inhalation, with irritating and harmful substances for the respiratory tract such as, for example, incense, fumes, chemical sprays for home hygiene, detergents, paints, etc. Even in the open air, avoid breathing pollutants and exhaust gases from vehicles
  • engage in regular physical activity to improve lung capacity
  • follow a healthy and complete diet
  • protect yourself from infections through: vaccinations (pneumococcal and flu), frequent hand washing (also through the use of a disinfectant gel), use of masks on the mouth in particularly closed or crowded places
  • avoid exposing yourself to the cold protecting, if necessary, nose and mouth with a scarf

Complications

Complications of emphysema can be:

  • respiratory failure
  • collapse of the lung (pneumothorax). It occurs in very severe pulmonary emphysema. It is caused by the rupture of a bubble of emphysema (especially in the presence of "giant bubbles" that is empty spaces within the lung tissue) and decreases the ability of the lungs to inhale air correctly

Emphysema, being a chronic respiratory disease, can generate complications affecting the heart:

  • pulmonary heart, occurs as a result of the increase in the arterial pressure of the blood flowing inside the pulmonary artery, generating a worsening in breathing difficulties (dyspnea)

Living with

Suffering from emphysema can, unfortunately, affect many aspects of a person's daily life. To help prevent or limit respiratory problems, however, there are some simple suggestions such as:

  • continue to take the prescribed medications, always under medical supervision (e.g. inhalers) to prevent new inflammations from appearing.In case of need to take other medicines that could interact with basic care (such as painkillers or food supplements) it is good to strictly follow the doctor's instructions, in order to limit unwanted effects (side effects) as much as possible
  • quit smoking as soon as possible
  • engage in regular physical activity. Helps to reduce ailments (symptoms) and improve the quality of life. However, it must be practiced according to your needs, abilities and the advice of the specialist doctor
  • maintain a "healthy" weight. Being overweight can make breathing difficulties (dyspnea) worse
  • follow a proper diet. In the case of emphysema, taking vitamins can help provide some degree of protection for the body. Vitamins A and C, for example, help keep respiratory tissues healthy. Those of the B complex and proteins, play an important role in strengthening lung tissues in the process of deterioration, while vitamin E acts as an antioxidant
  • carry out the required vaccinations, in order to better defend your body from other infections

It is also good to try to avoid:

  • cold spells, too much heat or humidity
  • dusty and poorly ventilated places
  • inhalation of fumes (such as, for example, exhaust gases from vehicles), secondhand cigarette smoke, deodorant sprays, cleaning products with a particularly strong smell, hairspray or perfumes

Bibliography

NHS. Cronic obstructive pulmonary disease (COPD) (English)

Mayo Clinic. Emphysema (English)

Ministry of Health. Emphysema

MedlinePlus. Emphysema (English)

Pahal P, Avula A, Sharma S. Emphysema. StatPearls [Internet]. 2021; July 26 (English)

healthdirect. Emphysema (English)

In-depth link

Tuscany region. Chronic Obstructive Pulmonary Disease (COPD) Guidelines. 2015 (SNLG Regions 16)

Niguarda Hospital. Treating pulmonary emphysema

University of Rome La Sapienza. Tobacconist's Unit (UNITAB). Pulmonary emphysema

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