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Emphysema 

Emphysema is a long-term, progressive disease of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli (air sacs in the lung). In people with emphysema the lung tissues involved in exchange of gases (oxygen and carbon dioxide) is impaired or destroyed. It is included in a group of diseases called chronic obstructive pulmonary disease or COPD. Emphysema is called an obstructive lung disease because the destruction of lung tissue around smaller airways (bronchioles), makes these airways unable to hold their shape properly when exhale. This makes them inefficient at transferring oxygen into the blood, and in taking carbon dioxide out of the blood. 

Causes 

The main cause of emphysema is long- term exposure to airborne irritants, including: 

• Tobacco smoke 

• Marijuana smoke 

• Air pollution 

• Chemical fumes and dust 

Cigarette smoking is by far the most dangerous behaviour that causes people to develop emphysema, and it is also the most preventable cause. Other risk factors include a deficiency of an enzyme called α-1- antitrypsin, air pollution, airway reactivity, heredity, male sex and age. 

Symptoms 

Two of the key symptoms of emphysema are shortness of breath and a chronic cough appears in the early stages. A person with shortness of breath, or dyspnea, feels being unable to catch a breath may start only during physical exertion, but as the disease progresses, it can start to happen during rest, too. Emphysema and COPD develop over a number of years. In the later stages, the person may have: 

• Frequent lung infections, 

• Excess production of mucus, 

• Wheezing, 

• Reduced appetite and weight loss, 

• Fatigue, 

• Blue-tinged lips or fingernail beds, or cyanosis, due to a lack of oxygen, 

• Anxiety and depression, 

• Sleep problems, 

• Morning headaches due to a lack of oxygen, when breathing at night is difficult.

• Risk Factors 

Factors that increase risk of developing emphysema include: 

• Smoking: Emphysema is most likely to develop in cigarette smokers, but cigar and pipe smokers also are susceptible.The risk for all types of smokers increases with the number of years and amount of tobacco smoked. 

• Age: The lung damage that occurs in emphysema develops gradually; most people with tobacco-related emphysema begin to experience symptoms of the disease between the ages of 40 and 60. 

• Exposure to second-hand smoke: Second-hand smoke, also known as passive or environmental tobacco smoke, is smoke that you inadvertently inhale from someone else’s cigarette, pipe or cigar. Being around second- hand smoke increases your risk of emphysema. 
• Occupational exposure to fumes or dust: Breathe fumes from certain chemicals or dust from grain, cotton, wood or mining products, are more likely to develop emphysema. This risk is even greater in cigarette smokers. 

^{Complications} 

People who have emphysema are also more likely to develop: 

• Collapsed lung (pneumothorax): A collapsed lung can be life-threatening in people who have severe emphysema, because the function of their lungs is already so compromised. This is uncommon but serious when it occurs. 

• Heart problems: Emphysema can increase the pressure in the arteries that connect the heart and lungs. This can cause a condition called corpulmonale, in which a section of the heart expands and weakens. 

• Large holes in the lungs: Some people with emphysema develop empty spaces in the lungs called bullae. They can be as large as half the lung. In addition to reducing the amount of space available for the lung to expand, giant bullae can increase your risk of pneumothorax. 

Treatment 

Medications used for treatment of emphysema are: 

Bronchodilator: Salmeterol, Albuterol, Metaproterenol, and Formoterol 

Anticholinergic: Ipratropium bromide and Tiotropium 

Steroids: Prednisone, Dexamethasone PDE4 inhibitors: Roflumilast 

Stop smoking: This recommendation for people with emphysema, quitting smoking may halt the progression of the disease and improve the function of the  lungs to some extent. Lung function deteriorates with age. In those susceptible to developing COPD, smoking can result in a five-fold deterioration of lung function. Smoking cessation may return lung function from this rapid deterioration to its normal rate after smoking is stopped. 

Antibiotics: These medications are often prescribed for people with emphysema who have increased shortness of breath. Even when the chest X-ray does not show pneumonia or evidence of infection, people treated with antibiotics tend to have shorter episodes of shortness of breath. It is suspected that infection may play a role in an acute bout of emphysema, even before the infection worsens into a pneumonia or acute bronchitis. 

Oxygen Therapy: As a patients’ disease progresses, they may find it increasingly difficult to breathe on their own and may require supplemental oxygen.