American Medical Association Family Medical Guide - American Medical Association [404]
Other factors that can cause the airways of the lungs to narrow and contribute to the development of emphysema include pollution, recurring respiratory tract infections, and allergies that affect the respiratory tract. In rare cases, emphysema also may develop in people who have an inherited disorder called alpha1-antitrypsin deficiency and lack the protective enzyme.
Healthy lungs are elastic, and contract and expand fully. When the alveoli of the lungs are stretched out, as occurs in emphysema, the alveoli rupture and merge to make fewer and larger air spaces. The increased pressure caused by labored breathing and spasms of coughing weakens the walls of the alveoli even more. Emphysema can make you more susceptible to chest infections such as pneumonia (see page 660) and can lead to respiratory failure (see page 645) or congestive heart failure (see page 570).
Symptoms
The main symptom of emphysema is shortness of breath. At first, the shortness of breath occurs only during exercise or strenuous activity. But over time, the shortness of breath worsens and occurs during everyday activities. The person’s chest may become barrel-shaped because, as the lungs lose their elasticity, air becomes trapped in the lungs. If you also have chronic bronchitis (see page 655), as most people with emphysema do, you may cough up phlegm.
Diagnosis
To confirm a diagnosis of emphysema, your doctor probably will tap your chest with his or her fingers and listen to and interpret the sounds produced by the tapping. He or she will also listen to your lungs with a stethoscope and will probably recommend diagnostic tests such as a chest X-ray and lung function tests (see page 647).
Treatment
Emphysema cannot be cured, but the symptoms can be treated and the progression of the disease can be slowed if you stop smoking. Treatment can improve the quality and length of your life. Quitting smoking (see page 29) is the single most important step you can take. Avoid places with polluted air and people who have a cold or the flu. Exercise regularly but avoid breathing in cold, humid air. Get a vaccination against pneumococcal pneumonia every 5 to 7 years (see page 145) and a flu shot (see page 650) every year.
To relax the muscles of your bronchial tubes and reduce inflammation (and make your breathing easier), your doctor may prescribe a bronchodilator (see page 641), taken through an aerosol inhaler or in tablets. He or she may also prescribe a corticosteroid to help reduce inflammation and relieve shortness of breath. If you develop a bacterial infection such as pneumonia, your doctor will prescribe an antibiotic.
For some people with emphysema, physical therapy and breathing exercises can be helpful. Your doctor may suggest joining a pulmonary rehabilitation program to improve your physical conditioning, which can help reduce your breathing needs during ordinary activities. If you have severe emphysema, your doctor may prescribe supplemental oxygen. You can have oxygen tanks delivered to your home or use an oxygen concentrator, which extracts oxygen from the air. You breathe the oxygen through one or two plastic tubes called cannulas inserted into your nostrils. The treatment does not interfere with your ability to talk, eat, or drink.
Using a portable oxygen tank
People whose lungs have lost the ability to absorb sufficient amounts of oxygen may need to use supplemental oxygen