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Wednesday, July 11, 2012

What is emphysema?

Emphysema causes alveoli to become overdistended
 Your question:  What is emphysema?

My humble answer:  According to the Mayo Clinic, Emphysema is a condition where your lung tissue is slowly destroyed, and this results in you becoming more short of breath over time.

In your lungs you have air passages that branch off into smaller and smaller passages like the branches of a tree.  The larger passages are called bronchi, and the smallest are called bronchioles.  At the end of the smallest passages there are several tiny balloon like structures called alveoli.

Air travels down this bronchiole tree to the alveoli, and this is where oxygen you inhale can get into the blood, and carbon dioxide in the blood can move into the lungs to be exhaled.  This process is called respiration.

The Mayo Clinic writes that emphysema causes the elastic tissue that keeps the air passages open to break apart.  When this happens the alveoli beyond region collapse.  This causes air that makes its way into these alveoli to become trapped in the lungs.

Likewise, according to the Mayo Clinic, this condition also breaks the tissue lining the alveoli, and results in them becoming "large, irregular pockets with gaping holes in their inner walls. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream."

As this disease progresses, and more and more of the lungs breaks down like this, more air gets trapped into the lungs.  It may feel like you can't get air in, yet the truth is you can't get air out. 

Your question:  What causes emphysema?

My humble answer:  Lung tissue destruction caused by emphysema is mainly the result of chemicals you inhale.  The most commin source of such chemicals is cigarette smoke from both first and second hand smoking.  Other things you inhale that can cause it are air pollution, coal, silica, grain, wood, and fumes.  Another common cause is a genetic malformation called alpha 1 antytripson deficiency.  It's also a normal process that results from aging.  In a sense, inhaling certain chemicals speeds up this natural aging process.

Your question:  What is a barrel chest?  What causes it? 

My humble answer:  This is caused due to air trapped in your chest due to chronic tissue damage.  It's called "barrel chest" because your chest becomes rounded, like a barrel.  This is a common feature of emphysema in the later stages as many alveoli are chronically overinflated with air.  The rib cage is expanded as though the person was taking in a deep breath all the time.  The shoulders are generally high.  On an x-ray the lungs are generaly pressed against a flat diaphragm.  Dr. Edward C. Rosenow at the Mayo Clinic provides a more thorough explaination here

Your question:  Is emphysema and asthma the same thing?

My humble answer:  Asthma can also cause air trapping and a barrel chest, yet asthma causes air trapping due to an obstruction of the air passages that is completely reversible with time or medicine.  An asthmatic barrel chest is only temporary, while an emphysemic barrel chest is permanant. 

Your question:  What is a bleb?

My humble answer:  This is when an entire section of the lung becomes an air filled space.  Air exchange in this area is not possible due to destruction of lung tissue.  These blebs can pop and cause a collapsed lung.  This is why it is especially important to use low pressures on these patients when using mechanical ventilation. 

Your question:  Is there a cure for emphysema?

My humble answer:  No.  Once you have lung damage it's usually permanant.  However, there are some things you can do to

Your question:  Is there treatment for emphysema?

My humble answer:  The following will help treat emphysema:
  • Smoking cessation is essential:  This will prevent further destruction.  Remove youself from whatever is causing your lung tissue destruction and this will prevent further progression of the disease.  This disease is often associated with airway constriction due to the muscles lining your air passages spasming (like what occurs in asthma). 
  •  Bronchodilators:   like Albuterol and Xopenex may help open up these air passages making breathing a little easier. 
  • Oxygen therapy:  Oxygen will help with any oxygenation issues.  Often these patients require 2-3 lpm of oxygen either round the clock or while sleeping. 
  • Corticosteroids:  May help reduce inflammed air passages and help improve lung function. 
  • Antibiotics:  These will prevent and treat lung infections mainly due to sputum being trapped in the lungs (due to chronic bronchitis, see below). 
  • Pulmonary rehabilitation:  Exercise can help strenthen your heart and lungs making you more tolerant to dyspnea
  • Proper nutrition:  You should eat small meals to prevent your stomach from pressing against your lungs.  Pop and Beer can cause blotation that can make breathing harder.  Pop and Beer can also increase CO2 in your blood making breathing more difficult.  Proper nutrition is essential.
  • Weight loss: Losing weight can help the lungs and heart by making it so they don't have to work as hard.  It also helps prevent dyspnea associated with exertion.
  • Surgery:  Lung volume reduction is sometimes beneficial to remove blebs to allow other lung tissue room to expand.  This results in better respirations and better air exchange.
Your question:  What are the symptoms of emphysema?

My humble answer:  Common symptoms are:
  • Gradually worsening shortness of breath
  • Diminished lung sounds (due to air tapping)
  • Crackles in bases (due to alveoli reopening with inspiration)
Your question:  What are signs of a worsening or end stage emphysema?
  • Blue lips and finger tips (acrocyanosis) due to poor oxygenation
  • Increased heart rate due to your bodies natural response to push more blood through your system to collect more oxygen molecules.
  • Increased RBCs (polycythemia):  Your body naturally creates more RBCs in an attempt to collect more oxygen molecules. 
  • Enlarged right heart: Cause because your right heart has to work extra hard to push blood through destroyed lung tissue. 
  • Changing heart rhythm:  The most common is atrial fibrilation due to enlarged worn out heart. 
Your question:  Are there other diseases associated with emphysema?

My humble answer:  Yes.  It's usually associated with chronic bronchitis.  This is a condiion where the mechanisms that help you bring up secretions from your lungs are destroyed, mainly due to chemicals you inhale (such as cigarette smoke).  This causes the person to have a chronic cough.  Emphysema and Chronic bronchitis are generally referred to as Chronic Obstructive Pulmonary Disease.

Your question:  What is a pink puffer?

My humble answer:  Quite often a pink puffer is used to describe an emphysema patient.  Usually these patients oxygenate fine but are short of braeth.  They tend to be thin, have barrel chests, are short of breath, and have pink skin.  This is incontrast to your blue bloater, which refers to chonic bronchitis patients who tend to have oxygenation problems and often have blue lips and fingertips.