Emphysema
Description
Pulmonary emphysema is a chronic lung disease. In all forms of emphysema there is a disturbance of the enzyme balance in the lung. In a healthy state, this enzyme balance builds on an equilibrium between lung tissue degrading (protease) and protective (anti-protease) proteins. If this equilibrium is disturbed, it can lead to a progressive loss of lung tissue. The gas exchange is thereby reduced and the oxygen content in the blood decreases. This leads to the phenomenon of a hyperinflated lung. In principle emphysema is divided into three forms: centrilobular emphysema (primarily affects the upper part of the lung), panlobular emphysema (affects the lower lung, lack of anti-protease alpha-1-antitrypsin), cicatricial emphysema/vesicular emphysema/ageing-lung emphysema (a natural old age phenomenon).
Symptoms
Patients typically suffer from shortness of breath, initially with heavy exertion, later even with light strain. Persistent cough and sputum are other common symptoms. As the alveoli are gradually destroyed and the normal gas exchange no longer functions as well, organs and tissues are no longer adequately supplied with oxygen. This may trigger other symptoms: exhaustion, reduced performance, rapid fatigue and deterioration of the general condition.
Causes and Risks
In emphysema, the gas exchange in the alveoli is significantly disrupted by invading pollutants. When smoking for example, toxic substances move directly into the respiratory tract, permanently damaging the alveoli system. Other factors that may be involved in the development of pulmonary emphysema include frequent respiratory infections, high levels of overall pollution (e.g. at work), or a genetic predisposition. Emphysema usually occurs as a result of excessive cigarette smoking in the course of chronic obstructive bronchitis, and is associated with the pathology of chronic obstructive pulmonary disease (COPD).
Examination and Diagnosis
A general physical examination and recording of the medical history are standard practise. If emphysema is suspected then lung function tests and other analyses are required. The main lung function tests are spirometry and whole-body plethysmography (in which the amount of non-exhalable air in the lungs can be determined). Emphysema can only be confirmed via a diffusion capacity measurement. In this test, it is necessary to hold the breath for 10 seconds. During this time, test gases provide information about the lung surface. In addition, computed tomography (CT), X-ray examination of the chest or magnetic resonance imaging (MRI) will provide further clues. Blood tests of general blood levels are used to check for signs of inflammation. A blood test can also reveal whether an alpha 1-antitrypsin deficiency may be the possible cause of emphysema. In an arterial blood gas analysis, the doctor measures the oxygen content, carbon dioxide content and pH value in the blood as indicators of the extent of the breathing disorder.
Treatment
The target of treatment is to achieve a cessation of emphysema and alleviate discomfort. Treatment of pulmonary emphysema consists of various building blocks, which depend on the severity and individual expression of the disease. The first step in successful treatment is indisputably to give up smoking. Further stresses to the lungs such as fine dust, gases, etc. should be avoided if possible. Medicines called bronchodilators can also be prescribed which allow a widening of the airways and improved supply of oxygen, or also cortisone preparations which are anti-inflammatory. Physiotherapy with a balanced blend of strength and endurance training helps patients to improve lung function and quality of life. With advanced emphysema, long-term oxygen therapy is recommended, or else surgical intervention to reduce lung volume or in extreme cases a lung transplant.
Course and Prognosis
Emphysema is not reversible. However, the course of the disease can be favorably influenced. If treatment begins early, that can help avoid a worse and more rapid course.
Miscellaneous/Other Comments
Alongside the treatment of emphysema, common comorbidities such as chronic bronchitis, diabetes and heart weakness must also be treated. Comprehensive emphysema therapy will include further preventive measures to avoid respiratory infections. These include annual vaccination against flu viruses and pneumococci.