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Chronic Obstructive Pulmonary Diseases, COPD
Emphysema

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Chronic Obstructive Pulmonary Diseases (COPD) is a term used collectively for chronic bronchitis and emphysema. These diseases are characterized by progressive damage to your lungs.

Definition

Emphysema is a disease condition that develops gradually due to a long-term, irreversible damage to the tiny air sacs (alveoli) in the lungs.

When you inhale, air travels to your lungs through two large airways. Inside the lungs, these large airways subdivide into a million smaller airways, which finally end in clusters of fragile, tiny air sacs called alveoli. The walls of the alveoli contain elastic fibres and tiny blood vessels. Exchange of oxygen and carbon dioxide takes place in the walls of these alveoli. In emphysema, these fragile walls of the air sacs are destroyed and ruptured. Many small air spaces merge to form one large air space, causing loss of elasticity and reducing the surface area for gaseous exchange. As a result, the larges air spaces are not capable to force the air out completely when you exhale. Thus it becomes difficult to get enough oxygen and completely eliminate carbon dioxide.

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Causes

  • Damage to the fibers and other supporting structures in your air sacs and small airways resulting from inflammation caused by:
    • Tobacco smoke
    • Air-borne irritants and pollutants.
    • Exposure to secondhand smoke.
    • Occupational exposure to toxic fumes e.g. chemicals at work or dust from grain, cotton, wood or mining products

  • A hereditary disorder called alpha-1-antitrypsin (AAT) deficiency. This protein normally protects the elastic fibers in the walls of your air sacs.

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Symptoms

  • Chronic cough with or without sputum
  • Difficulty breathing
  • Wheezing
  • Weakness and tiredness
  • Loss of appetite
  • Weight loss
  • Swelling on dependent weight bearing parts of the body like ankles, feet and legs.

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Implications

Recurrent respiratory tract infections commonly accompany emphysema. Emphysema can eventually result in pulmonary hypertension (long term high blood pressure in the pulmonary artery). The right ventricle of the heart has to work harder to pump blood against such high pressure. The right ventricle fails (right ventricular failure) to pump blood adequately and causes a condition called cor pulmonale. In this condition there is persistent low blood oxygen and enlargement of the right ventricle.

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What You Can Do

  • Specific Measures

    • Medications
      • Antibiotics - such as ampicillin, tetracycline, erythromycin and cephalosporin may be prescribed by your physician to fight recurrent respiratory tract infections that accompany emphysema.
      • Bronchodilators - are medications that help open up constricted airways which may present if there is asthma accompanying emphysema.
      • Inhaled steroids - in the form of aerosol sprays may relieve symptoms of emphysema associated with asthma and bronchitis.
      • Protein Treatment - If there is inherited deficiency of alpha-1-antitrypsin, weekly intravenous infusions of this protein may offer some protection and slow down the damage of lung tissue.

    • Oxygen
      • Using oxygen during activities that require exertion and at night may provide some relief and improve the quality of life to some extent.

    • Surgery
      • Lung Volume Reduction Surgery - In this procedure, the surgeon removes small wedges of 20-30 percent of damaged lung tissue from both the lungs. Removing damaged lung tissue reduces the size of your lungs, thus returning the diaphragm to its normal position. As a result, the diaphragm contracts and relaxes more effectively and efficiently. Exchange of oxygen and carbon dioxide improves to great degree following this procedure.
      • Lung Transplant - Usually a single lung transplant is performed as the survival rate due to transplant rejection are better versus double-lung transplant.

    • Rehabilitation Program - This rehabilitation program comprises of a combination of education, breathing exercises, light physical exercises and advice on lifestyle and behavioral changes to restore maximum possible level of independent and good quality life.
  • General Measures
    • Quit smoking

    • Avoid secondhand smoke.

    • Perform regular low impact exercise such as walking or cycling.

    • Practice breathing techniques

    • Avoid respiratory irritants like fumes from paint, motor vehicle exhaust, strong perfumes, dust and cold air.

    • Keep the humidity level in your home to a moderate level (about 40-50 percent). Change furnace and air conditioner filters regularly to limit pollutants in your home. If you enjoy hobbies such as woodworking or ceramics, use a dust mask for protection.

    • Wear a mask to protect your airways if you perform tasks that expose you to toxic chemical fumes and dust

    • Drink plenty of non-alcoholic fluids to easily bring up the mucus secretions and clear them from the airways

    • Breath through your nose and cover you nose and mouth with a scarf or cold air mask to warm the air that you breath as cold air may cause bronchospasm.

    • Avoid direct contact with people who have a cold or the flu.

    • Eat a well balanced and nutritious diet that is easy to digest.

    • Try to maintain an optimum body weight.

    • Influenza (flu) and pneumococcal (pneumonia) vaccine may help protect you against these infections. Influenza (flu) vaccine can be taken annually and pneumonia vaccine every 5 to 7 years.

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Emphysema