Emphysema: Breathing Problems - Treatments

by Food and Drug Administration (FDA)

We begin life with a breath, and the process continues automatically without a thought. It's only when we can't take a deep breath or, as in Shirley Gooden's case, can't catch our breath at all without effort, that we become aware of how precious easy breathing really is.

Gooden, whose breathing is now supplemented with the help of an oxygen tank, was diagnosed with emphysema 14 years ago. Since then, the 68-year-old Bethesda, Md., resident has gradually felt the effects that the debilitating disease has had on her life as well as her lungs.

"I'm held back from interacting with my grandchildren, " Gooden says, and like the healthy lungs she used to have, "that's something I can never get back."

While it is true that the damage done to Gooden's lungs is not reversible, the disease is manageable, says John S. Saia, M.D., a pulmonary specialist with the Rockville Internal Medicine Group in Maryland, and Gooden's doctor. Saia adds that state-of-the-art medical advances can offer relief from many of the troubling symptoms of emphysema, and help patients breathe easier.

What Is Emphysema?

Emphysema is a degenerative disease that usually develops after many years of assault on lung tissues from cigarette smoke or other toxins that pollute the air. These toxins destroy the small air sacs in the lungs, called alveoli, that stretch as they transport oxygen from the air to the blood and then shrink as they force out carbon dioxide. As a result, the lungs lose their elasticity, and exhaling becomes difficult as the damaged lungs trap air and cannot effectively exchange it with fresh air. As the damage progresses, the effort needed to breathe increases and, ultimately, each breath becomes labored. (Illustration provided by the American Medical Association.)

Emphysema is one of a group of lung diseases referred to as chronic obstructive pulmonary disease (COPD) that can interfere with normal breathing. Other diseases that come under COPD include asthma and chronic bronchitis. According to the American Lung Association (ALA), nearly 16 million Americans are estimated to suffer from some form of COPD, and COPD is the fourth-ranking cause of death just behind heart ailments, cancers, and stroke.

Causes of Emphysema

ALA estimates that 2 million Americans had emphysema in 1998, and cigarette smoking was the primary cause. Exposure to air pollution and irritating fumes and dusts on the job are also thought to be contributing factors of emphysema.

Symptoms and Signs of Emphysema

The predominant symptom of emphysema is shortness of breath or the feeling of not being able to get enough air. A person may initially visit the doctor because he or she has begun to feel short of breath during activity, but as the disease progresses, this symptom may be present all the time, as in Gooden's case, even while sitting quietly. Coughing, wheezing, and chronic mucus production are other common symptoms.

A diagnosis, however, cannot be based on these symptoms alone, Saia says. A careful history, he explains, focusing on the number and duration of these symptoms, as well as smoking and occupational histories, is basic to diagnosing the disease.

The physician will thoroughly examine the chest, observe breathing patterns, and monitor how hard the person is working to breathe. A thorough exam will also include noting the degree of over-inflation of the lungs, listening to the chest with a stethoscope to hear the airflow in and out of the lungs, and listening to heart sounds to determine its rate and rhythm and any signs of heart strain that may accompany advanced stages of emphysema. (See "The Mechanics of Breathing.")

In addition, routine lung function tests can determine several characteristics and capabilities of the lungs. The following tests can identify various stages of emphysema:

Spirometry: Through a tube connected to a machine that records airflow and capacity, the patient takes a deep breath and blows it out as quickly as possible. Measuring the amount of air that can be forced out in one second and the total amount of air that can be exhaled is the best way to determine the amount of airways obstruction.

Arterial Blood Gas (ABG): An ABG is done by analyzing blood from an artery for amounts of carbon dioxide and oxygen. This test is often used to assess more advanced stages of emphysema and to determine whether or not a person needs extra oxygen.

Pulse Oximetry: A special light, clipped onto the finger or earlobe, can indirectly measure the amount of oxygen in the blood.

X-rays: X-rays are not often helpful in early-stage diagnosis of emphysema, but in moderate to severe cases, a reasonably accurate diagnosis can be made with the plain chest x-ray and computerized axial tomography (CAT) scanning. Some of the more common appearances on the chest x-ray include flattened diaphragms, loss of blood vessel markings, and the appearance of a reduced size of the heart.

These and other test results are then compared to values considered healthy for various age groups, heights, weights, genders, and races.

About the Author

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