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Friday, January 23, 2009


WHAT IS EMPHYSEMA? Emphysema is a condition in which the walls between the alveoli or air sacs within the lung lose their ability to stretch and recoil. The air sacs become weakened and break. Elasticity of the lung tissue is lost, causing air to be trapped in the air sacs and impairing the exchange of oxygen and carbon dioxide. Also, the support of the airways is lost, allowing for airflow obstruction.

Early symptoms include shortness of breath and cough.
Symptoms of emphysema include shortness of breath, cough and a limited exercise tolerance. Emphysema and chronic bronchitis frequently co-exist together to comprise chronic obstructive pulmonary disease (COPD). COPD does not include other obstructive lung diseases such as asthma. WHAT CAUSES OF EMPHYSEMA?Cigarette smoking is by far the most common cause of emphysema. Smoking is responsible for approximately 80-90% of deaths due to COPD.1
In addition, it is estimated that 100,000 Americans living today were born with a deficiency of a "lung protector" protein known as alpha 1-antitrypsin (AAT). Another 25 million Americans carry a single deficient gene that could be passed on to their children.2
In the absence of AAT, an inherited form of emphysema called alpha 1-antitrypsin deficiency related emphysema is almost inevitable. Symptoms of AAT deficiency emphysema usually begin between 32 and 41 years of age. Smoking significantly increases the severity of emphysema in AAT-deficient individuals.
HOW SERIOUS IS EMPHYSEMA?Over 3.1 million Americans have been diagnosed with emphysema, of which 91% were 45 years of age or older. Emphysema rarely occurs in those under 45.3 Men tend to have higher rates of emphysema. In 2002 the emphysema prevalence rate was 52% higher in males compared to females.
Together with chronic bronchitis and other chronic lower respiratory diseases, excluding asthma, chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the U.S, claiming the lives of more than 120,000 Americans.4HOW DOES EMPHYSEMA DEVELOP?Emphysema begins with the destruction of air sacs (alveoli) in the lungs where oxygen from the air is exchanged for carbon dioxide in the blood. The walls of the air sacs are thin and fragile. Damage to the air sacs is irreversible and results in permanent "holes" in the tissues of the lower lungs.
As air sacs are destroyed, the lungs are able to transfer less and less oxygen to the bloodstream, causing shortness of breath. The lungs also lose their elasticity, which is important to keep airways open. The patient experiences great difficulty exhaling.
Emphysema doesn't develop suddenly. It comes on very gradually. Years of exposure to the irritation of cigarette smoke usually precede the development of emphysema.
A person may initially visit the doctor because he or she has begun to feel short of breath during activity or exercise. As the disease progresses, a brief walk can be enough to bring on difficulty in breathing. Some people may have had chronic bronchitis before developing emphysema.TREATMENT FOR EMPHYSEMADoctors can help persons with emphysema live more comfortably with their disease. The goal of treatment is to provide relief of symptoms and prevent progression of the disease with a minimum of side effects. The doctor's advice and treatment may include:
Quitting smoking: the single most important factor for maintaining healthy lungs.
Bronchodilator drugs (prescription drugs that relax and open air passages in the lungs): may be prescribed to treat emphysema if there is a tendency toward airway constriction or tightening. These drugs may be inhaled as aerosol sprays or taken orally.
Antibiotics: if you have a bacterial infection, such as pneumococcal pneumonia.
Steroids: these may be used for relapses or "acute exacerbations."
Exercise: including breathing exercises to strengthen the muscles used in breathing as part of a pulmonary* rehabilitation program to condition the rest of the body.
*The term "pulmonary" refers to the lungs.
Alpha 1-Proteinase Inhibitor (A1PI): only if a person has AAT deficiency-related emphysema. A1PI is not recommended for those who develop emphysema as a result of cigarette smoking or other environmental factors.
Lung transplantation: a major procedure, which can be effective.
Lung volume reduction surgery: a surgical procedure in which the most severely diseases portions of the lung are removed to allow the remaining lung and breathing muscles to work better. The short-term results are promising but those with severe forms are at higher risk of death. Recently, the Centers for Medicare and Medicaid Services (CMS) announced that they intend to cover LVRS for people with non-high risk severe emphysema, who meet the criteria stated in the National Emphysema Treatment Trial (NETT). In addition, CMS has decided that LVRS is "reasonable and necessary" only for qualified patients that undergo therapy before and after the surgery. CMS is currently composing accreditation standards for LVRS facilities and will use these standards to determine where the surgery will be covered.5PREVENTION OF EMPHYSEMAContinuing research is being done to find answers for many questions about emphysema, especially about the best ways to prevent the disease.
Researchers know that quitting smoking can prevent the occurrence and decrease the progression of emphysema. Other environmental controls can also help prevent the disease.
If an individual has emphysema, the doctor will work hard to prevent the disease from getting worse by keeping the patient healthy and clear of any infection. The patient can participate in this prevention effort by following these general health guidelines:
Emphysema is a serious disease. It damages your lungs, and it can damage your heart. See your doctor at the first sign of symptoms.
DON'T SMOKE. The majority of those who get emphysema are smokers. Continued smoking makes emphysema worse, especially for those who have AAT deficiency, the inherited form of emphysema.
Maintain overall good health habits, which include proper nutrition, adequate sleep, and regular exercise to build up your stamina and resistance to infections.
Reduce your exposure to air pollution, which may aggravate symptoms of emphysema. Refer to radio or television weather reports or your local newspaper for information about air quality. On days when the ozone (smog) level is unhealthy, restrict your activity to early morning or evening. When pollution levels are dangerous, remain indoors and stay as comfortable as possible.
Consult your doctor at the start of any cold or respiratory infection because infection can make your emphysema symptoms worse. Ask about getting vaccinated against influenza and pneumococcal pneumonia.

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