Emphysema causes a permanent change in the structure of the lung, impeding the exchange of oxygen and carbon dioxide. Smoking most often causes emphysema, but in rare cases, heredity causes an impaired immune response. Symptoms during end stage emphysema can differ from person to person; however, severe breathlessness is always the foremost debilitating factor. According to the Centers for Disease Control and Prevention, people with chronic emphysema usually experience a steady decline in lung function, eventually leading to death.
Definition
Emphysema, derived from the Greek word "emhysan" meaning to inflate or swell, is a disease characterized by the rupture of the air sacs or alveoli in the lungs. These ruptures occur because of an interaction between environmental chemicals or pollutants and the body's immune system. Normally inflammation caused by these chemicals attracts certain types of white blood cells that contain an enzyme that destroys the alveolar walls. Normally another enzyme called alpha-1 antitrypsin inhibits this process.
Disease Development
The first symptom of emphysema is breathlessness, generally mild and leading most sufferers to dismiss the symptom. Breathlessness occurs because of the reduced surface area available for air exchange. According to MayoClinic.com, eventually, the level of oxygen in the person's blood begins to fall, leading to increased and more severe breathlessness as well as pulmonary hypertension or elevated blood pressure. Pulmonary hypertension can lead to the right side of the heart becoming enlarged called cor pulmonale.
Disease Progression
As the disease progresses, the symptoms become more severe causing debilitating shortness of breath, even at rest. Most people suffering from late stage emphysema will use supplemental oxygen, as their lungs are no longer able to absorb and transfer oxygen to the cells, as well as release carbon dioxide. As the damage spreads, it leads to a constriction or collapsing of the smaller airways. Sufferers may develop an expanded chest, called a "barrel chest" due to air trapping. Coughing becomes difficult, and the body can no longer clear inhaled particulates making the sufferer more susceptible to infection. Eventually lung function can no longer sustain the process of respiration, leading to death.
Diagnosis
A physician will examine breathing patterns, chest excursion or the rising and lowering of the chest. She also listens to the lungs to discern if there is fluid or an absence of breath sounds. Emphysema causes breath sounds to be faint and distant. With advanced stages, breath sounds become nearly nonexistent as the smaller airways collapse. A chest X-ray as well as pulmonary function testing called spirometry, which measures the amount of air inhaled and exhaled over time, confirms the diagnosis.
Treatment
No cure exists, but certain measures can improve the quality and length of life. Smokers need to stop smoking. Avoiding exposure to people suffering with a cold or flu becomes crucial, as a serious lung infection can be fatal to someone with end stage emphysema. Bronchodilator drugs will relieve some symptoms, and corticosteroids will help to reduce breathlessness and wheezing. Relaxation techniques and breathing exercises will help with anxiety as breathing becomes more and more difficult.
