HEALTH: EMPHYSEMA (COPD) TREATMENT

HEALTH: EMPHYSEMA (COPD) EMPHYSEMA (LUNGS) SYMPTOMS Lung Cancer>>

What is Emphysema (COPD)?

Emphysema is a long-term, progressive disease of the lungs. Emphysema is a health factor in the progression of chronic obstructive pulmonary disease (COPD), a condition that limits the flow of air when you breathe out. Emphysema occurs when the air sacs at the ends of your smallest air passages (bronchioles) are gradually destroyed. Smoking is the leading cause of emphysema.

In early emphysema, there is associated inflammation of the small airways or bronchioles that limits the amount of air that can flow to the alveoli. In more severe emphysema, there is also loss of elasticity in the alveolar walls that have not been destroyed. As it worsens, emphysema turns the spherical air sacs — clustered like bunches of grapes — into large, irregular pockets with gaping holes in their inner walls. This reduces the number of air sacs and keeps some of the oxygen entering your lungs from reaching your bloodstream. When the patient breathes out, the alveoli and small airways collapse. This makes it hard for air to get out of the lungs and makes it even harder for new air to enter.

As more of the lungs are destroyed and the lungs cannot maintain oxygen concentrations in the bloodstream, the body compensates by gradually increasing the breathing rate. After a while, even hyperventilation (hyper=more + ventilation=breathing) cannot maintain adequate oxygen levels, and the arteries in the lungs begin to constrict or narrow. The heart has to work harder to push blood into these narrower blood vessels, causing the blood pressure in the lung arteries to increase (pulmonary hypertension). Over time, the extra work requirement causes the heart muscle to enlarge (hypertrophy) and can cause heart failure.

Airway obstruction, another feature of COPD, contributes to emphysema. The combination of emphysema and obstructed airways makes breathing increasingly difficult. Treatment often slows, but doesn't reverse, the process. COPD gets worse over time. You can't undo the damage to your lungs. But you can take steps to prevent more damage and feel better.

There are two main forms of COPD:

Chronic bronchitis, which causes long-term swelling and a large amount of mucus in the main airways in the lungs.
Emphysema, a lung disease that destroys the air sacs in the lungs.

Most people with COPD have symptoms of both.

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Also see: Lung Cancer Bronchitis Asthma Allergies Pneumonia Sinuses Common Cold Influenza/Flu Swine Flu

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Health: Causes of Emphysema (COPD)

Emphysema (COPD) is almost always caused by smoking. Over time, breathing tobacco smoke irritates the airways and destroys the stretchy fibers in the lungs.

Other things that may put your health at risk include breathing chemical fumes, dust, or air pollution over a long period of time. Secondhand smoke is also bad.

It usually takes many years for the lung damage to start causing symptoms, so emphysema (COPD) is most common in people who are older than 60.

You may be more likely to get emphysema (COPD) if you had a lot of serious lung infections when you were a child. Approximately 1 to 2 percent of people with emphysema have an inherited deficiency of a protein called alpha-1 antitrypsin, which protects the elastic structures in the lungs. Without this protein, enzymes can cause progressive lung damage, eventually resulting in emphysema. In rare cases, people who get emphysema in their 30s or 40s may have this health disorder that runs in families.

Emphysema (COPD) is also a component of aging. As the lungs get older, the elastic properties decrease, and the tensions that develop can result in small areas of emphysema.

In underdeveloped countries, a common cause of emphysema is indoor air pollution. In these populations, it is very common to have indoor stoves in the kitchen. The smoke from cooking results in the damage to the lungs.

Health: Risk Factors of Emphysema (COPD)

Risk factors for emphysema are:

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

Age - Although 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 secondhand smoke - Secondhand 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 secondhand smoke increases your risk of emphysema.

Occupational exposure to fumes or dust - If you breathe fumes from certain chemicals or dust from grain, cotton, wood or mining products, you're more likely to develop emphysema. This health risk is even greater if you smoke.

Exposure to indoor and outdoor pollution - Breathing indoor pollutants, such as fumes from heating fuel, as well as outdoor pollutants — car exhaust, for instance — increases your risk of emphysema.

HIV infection - Smokers living with HIV are at greater health risk of emphysema than are smokers who don't have HIV infection.

Connective tissue disorders - Some conditions that affect connective tissue — the fibers that provide the framework and support for your body — are associated with emphysema. These health conditions include cutis laxa, a rare disease that causes premature aging, and Marfan syndrome, a disorder that affects many different organs, especially the heart, eyes, skeleton and lungs.

Intravenous drug - use in which some of the non-drug additives like corn starch can be toxic to lung tissue.
Immune deficiencies - in which infections like Pneumocystis carinii can cause inflammatory changes in the lung.
Connective tissue illnesses - (Ehlers-Danlos Syndrome, Marfan Syndrome) in which abnormal elastic tissue in the body can cause alveoli to fail.

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ALTERNATIVE CANCER TREATMENT
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Health: Symptoms of Emphysema (COPD)

Emphysema is a progressive disease that usually manifests itself in patients after 50 years of age.

Symptoms of emphysema (COPD) are mild to begin with but steadily get worse as the disease progresses. The main symptoms of emphysema are:

Shortness of breath (dyspnea) that gets worse with mild activity
Wheezing
Chest tightness
Headaches
Reduced capacity for physical activity
Chronic coughing, that produces mucus - may be streaked with blood, which could also indicate chronic bronchitis
Loss of appetite and weight
Fatigue
Frequent respiratory infections
Swelling of the ankles, feet, or legs, which affects both sides

When you should see a health care provider:

You tire quickly, or you can't easily do the things you used to do
You can't breathe well enough to tolerate even moderate exercise
Your breathing difficulty worsens when you have a cold
Your lips or fingernails are blue or gray, indicating low oxygen in your blood
You frequently cough up yellow or greenish sputum
You note that bending over to tie your shoes makes you short of breath
You are losing weight
as time continues and the disease progresses, the episodes of dyspnea occur more frequently eventually occurring at rest.

At times, your symptoms may suddenly flare up and get much worse. This is called a COPD exacerbation. An exacerbation can range from mild to life-threatening. The longer you have COPD, the more severe these flare-ups will be.

These symptoms don't necessarily mean you have emphysema, but they do indicate that your lungs aren't working properly and should be evaluated by your doctor as soon as possible.

Health: Diagnosis of Emphysema (COPD)

As is the case with most illnesses, the health care provider will take a careful history to learn about the lung and breathing symptoms.

Physical examination will concentrate on the lung findings, but may also include the heart and the circulatory system.

Is there an increased respiratory rate?
Is the patient short of breath just sitting in the examination room?
Is the patient using accessory muscles to breathe, in addition to the rib muscles and the diaphragm?
Is the chest cavity enlarged or barrel-shaped?
Does the chest cavity sound hollower than it should?
Does exhalation take longer than it should?
Is the movement of the diaphragm decreased?
Is the patient cyanotic (having a blue tinge to the skin color signifying lack of oxygen in the blood)?
Listening to the lungs, are there wheezes present, especially if the patient is asked to exhale quickly?

To determine if you have emphysema, your doctor is likely to recommend certain tests:

Pulmonary Function Tests. A variety of lung functions can be measured and may include how much air the lungs can hold and empty with each breath, the degree of airflow obstruction, the available surface for exchange of carbon dioxide and oxygen, the amount of trapped gases, and how elastic the lungs are with inspiration and expiration. By comparing results to a "normal" person of the same age, sex and size, estimations can be made as to the severity of the emphysema or COPD.

During a spirometry, you're usually asked to blow into a simple instrument called a spirometer. PFTs may be done before and after the use of inhaled medications to test your response to them. If you're a smoker or a former smoker, ask your doctor about taking these tests, even if you don't have symptoms of emphysema or COPD.
Arterial blood gase test. These blood tests measure how well your lungs transfer oxygen into, and remove carbon dioxide from, your bloodstream. In some laboratories, the arterial blood gas result will include a carbon monoxide percentage, most often found in the body because of smoking. For each hemoglobin molecule that has carbon monoxide attached, there is one less that can carry oxygen.
A complete blood cell count (CBC) may be performed to check for an increase in the number of red blood cells. In response to lower blood oxygen concentrations, the body manufactures more red blood cells to try to deliver as much oxygen as possible to cells.

Alpha 1-antitrypsin levels may be measured to look for any genetic predisposition to emphysema or COPD.
Oximetry. The oximeter is a device usually placed on the fingertip and detects the pulse of blood. A light is transmitted through the tissue, and the amount of the brighter red color is determined, enabling a measure of oxygen saturation, a measure of hemoglobin oxygen content. To help determine whether you need supplemental oxygen, the test may be performed at rest, during exercise and overnight. This value is usually greater than 90%.
Radiology. A chest X-ray can help confirm a diagnosis of emphysema and rule out other causes of shortness of breath, but an X-ray alone isn't enough to make an accurate diagnosis.
Sputum examination. Analysis of cells in what you cough up (sputum) can help determine the cause of some lung problems.
Computerized tomography (CT) scan. A CT scan can allow your doctor to view your internal organs, where they'll look for the characteristic "holes" or bullae that are caused by emphysema (COPD).

Health: Conventional Treatment for Emphysema (COPD)

Emphysema or COPD is not a curable disease, once lung damage has occurred it cannot be reversed. The goal of treatment is to stop further lung destruction and preserve lung function. The patient needs to know that the focus is on improving health and quality of life and limiting the intrusion of emphysema on daily activities. The most important step in any treatment plan for smokers with emphysema is to stop smoking; it's the only way to stop the damage to your lungs from becoming worse.

There are many things you can do to relieve symptoms and keep the disease from progressing.

The number one treatment goal is to have the patient stop smoking. Education, counseling, support groups and medication may be used to slow the progression of emphysema.

The treatment options are as following:

Bronchodilators. These drugs can help relieve coughing, shortness of breath and trouble breathing by relaxing constricted airways, but they're not as effective in treating emphysema as they are in treating asthma or chronic bronchitis.

Inhaled steroids. Corticosteroid drugs inhaled as aerosol sprays may relieve symptoms of emphysema associated with asthma and bronchitis. Although inhaled steroids have fewer side effects than oral steroids do, prolonged use can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes.

GERD treatment. Symptomatic gastroesophageal reflux disease (GERD) aggravates airway disease in many people, so your doctor may recommend medications as well as life style changes to treat it.

Supplemental oxygen. If you have severe emphysema with low blood oxygen levels, using oxygen regularly at home and when you exercise may provide some relief. Many people use oxygen 24 hours a day. Various forms of oxygen are available, as are different devices to deliver supplemental oxygen to your lungs.

Pulmonary rehabilitation program. A key part of treatment involves a pulmonary rehabilitation program, which combines education, exercise training and behavioral intervention to help you stay active and improve your health and quality of life.
You'll receive help with smoking cessation and your nutritional needs, and you may learn special breathing techniques and ways to conserve energy. Because exercise can help to slow the decline of your lung function, you'll also be given an exercise program.

Antibiotics. If you develop a bacterial infection like bronchitis or pneumonia, antibiotics are appropriate.

Inoculations against influenza and pneumonia. If you have emphysema or other forms of COPD, experts recommend an influenza (flu) shot annually and a pneumonia shot every five years.

Surgery. In an experimental procedure called lung volume reduction surgery (LVRS), surgeons remove small wedges of damaged lung tissue. Removing the diseased tissue helps the lungs work more efficiently and helps improve breathing.
In another surgery, called a bullectomy, doctors remove one or more of the large air spaces (called bullae) that form when the small air sacs are destroyed. This procedure can improve breathing.

Transplant. Lung transplantation is an option if you have severe emphysema and other options have failed.

Health: Personal Self-Care Remedies for Emphysema (COPD)

Things you can do to make it easier for yourself around the home include.

Some simple exercises can improve your breathing if you have emphysema or another chronic lung disorder. They help you control the emptying of your lungs by using your abdominal muscles. Do them two to four times daily.

Diaphragmatic breathing
To perform this type of breathing exercise, take these steps:

Lie on your back with your head and knees supported by pillows. Begin by breathing in and out slowly and smoothly in a rhythmic pattern. Relax.
Place your fingertips on your abdomen, just below the base of your rib cage. As you inhale slowly, you should feel your diaphragm lifting your hand.
Practice pushing your abdomen against your hand as your chest becomes filled with air. Make sure your chest remains motionless. Try this while inhaling through your mouth and counting slowly to three. Then purse your lips and exhale through your mouth while counting slowly to six.

Practice diaphragmatic breathing on your back until you can take 10 to 15 consecutive breaths in one session without tiring. Then practice it while lying on one side and then on the other. Progress to doing the exercise while sitting erect in a chair, standing up, walking and, finally, climbing stairs.

Pursed-lip breathing
Try the diaphragmatic breathing exercises with your lips pursed as you exhale, that is, with your lips puckered - the flow of air should make a soft "sssss" sound. Inhale deeply through your open mouth and exhale. Repeat 10 times at each session. Breathing out against pursed lips increases the air pressure inside the airways, including your very small airways, which minimizes how much they collapse.

Deep-breathing exercise
While sitting or standing, pull your elbows firmly backward as you inhale deeply. Hold your breath in, with your chest arched, for a count to five, and then force the air out by contracting your abdominal muscles and letting your elbows return to their starting position. Repeat the exercise 10 times.

Other steps you can take
If you have emphysema, you can take a number of steps to halt its progression and to protect yourself from complications:

Stop smoking. This is the most important measure you can take for your overall health and the only one that might halt the progression of emphysema. Join a smoking cessation program if you need help giving up smoking. As much as possible, avoid secondhand smoke.
Avoid other respiratory irritants. These include fumes from paint and automobile exhaust, some cooking odors, certain perfumes, even burning candles and incense. Change furnace and air conditioner filters regularly to limit pollutants.
Exercise regularly. Try not to let your breathing problems keep you from getting regular exercise, which can significantly increase your lung capacity.
Clear your airways. If you also have chronic bronchitis, mucus tends to collect in your air passages and can be difficult to clear. To keep secretions thin and easy to bring up, drink plenty of nonalcoholic fluids every day.
Protect yourself from cold air. Cold air can cause spasms of the bronchial passages, making it even more difficult to breathe. During cold weather, wear a soft scarf or a cold-air mask — available from a pharmacy — over your mouth and nose before going outside, to warm the air entering your lungs.
Avoid respiratory infections. Get pneumonia vaccinations as advised by your doctor. Also get an annual influenza immunization. Do your best to avoid direct contact with people who have a cold or the flu. If you have to mingle with large groups of people during cold and flu season, wear a face mask, wash your hands frequently and carry a small bottle of hand sanitizer in your pocket or purse. Try to avoid touching the inside of your nose or rubbing your eyes, which is the way you acquire most viral infections.
Maintain good nutrition. A balanced diet gives your body the nutrients it needs for energy, for building and maintaining cells, and for regulating body processes. Work toward and maintain a desirable body weight. Being overweight causes your body to require more oxygen and can interfere with breathing. If you're underweight, achieving a healthy weight may increase your strength.

When the effort to eat is taxing, you may need to eat smaller meals more frequently. Try eating your largest meal earlier in the day, and avoid lying down after meals. Soft, easy-to-digest foods, such as yogurt, rice, baked potatoes, and poached chicken or fish, may be more agreeable than red meat and heavy dishes.

Health: Prevention of Emphysema (COPD)

Most cases of emphysema or COPD are preventable. To prevent emphysema:

Don't smoke. If you do smoke, seek help to quit as soon as possible.

Make sure no one smokes in your home.

Avoid exposure to secondhand smoke.

Wear a mask to protect your lungs if you work with chemical fumes or dust.

Reduce air pollution by eliminating fireplace smoke and other irritants.

Increase your physical activity or exercise regularly if you've smoked in the past.

Avoiding very cold air.

As emphysema or COPD gets worse, you may have flare-ups when your symptoms suddenly get much worse. It is important to know what to do if this happens. Your doctor can prescribe medicines to help. But if the attack is severe, you may need to go to the emergency room or call 911 .

Knowing you have a disease that gets worse over time can be hard. It’s common to feel sad or hopeless sometimes. If these feelings last, be sure to tell your doctor. Counseling and support groups can help you cope.

Be sure to talk to your doctor about what kinds of treatment you want if your breathing problems become life-threatening. You may want to write a living will. You can also choose a health care agent to make decisions in case you are not able to. It can be comforting to know that you will get the type of care you want.

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Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services

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