Emphysema is one of those diseases that cannot be cured and its damage cannot be reversed. It slowly suffocates its victims and is an awful process to go through for both patients and loved ones. As a youngster, I watched my grandfather waste away from it. He was a heavy smoker until the day he died. As sad as that was, it is even sadder to think that this scene does not have to be repeated. In the vast majority of cases, emphysema can be prevented. Like so many other diseases that ravage our national health, emphysema is primarily a result of unhealthy lifestyle choices. Let’s look at some of the particulars of this condition and see if we can learn how to turn the corner in fighting this formidable enemy.
What is Emphysema?
Emphysema is a chronic, progressive lung disease that affects over two million people in the United States alone. Emphysema is often bundled together with chronic bronchitis and called Chronic Obstructive Pulmonary Disease (COPD). COPD is the fourth leading cause of death in America, after coronary disease, cancer, and stroke. Until recently, COPD was found more frequently in men than in women. However, as the number of women smokers has increased, their incidence of COPD has increased as well. In fact, in 2003, more females died from COPD than males. Cigarette smoking is by far the leading cause of emphysema. Smoking and other environmental issues are responsible for over 95% of cases. Less than 5% are genetic in nature.
Normally, the lungs are elastic in nature. They are designed to expand when air is inhaled, and contract when air is exhaled. In healthy lungs, air is able to pass freely through the airways called bronchus and into the air sacs called alveoli. In the alveoli, oxygen is transferred into the blood, and carbon dioxide and other waste products are filtered out.
When the lungs are repeatedly exposed to cigarette smoke or other environmental pollutants, the immune system kicks in and the body seeks to intervene by producing substances that protect the lungs. These substances often attack the cells of the lungs as well. Normally the body would secrete other substances to prevent this, but in smokers and in those with certain inherited defects, this does not occur, and the lung tissues are damaged. The lungs lose their elasticity, and the system breaks down. The bronchus collapse and air is trapped inside the alveoli. Air cannot efficiently be moved in and out of the alveoli any longer, and eventually they stretch and burst. Small sections of destroyed alveoli are called blebs, and larger ones are called bullae. One of the major problems that patients have to deal with is calledresidual volume. This occurs because the lungs can no longer exhale properly, and air is trapped inside the lungs. Patients feel as though they can never get enough breath because the old de-oxygenated air is not exchanged properly with fresh incoming air. Another effect of residual volume is that the chest becomes permanently expanded and barrel shaped. As emphysema worsens, the lungs cannot supply enough oxygen to the blood, and thus all the body’s organs are eventually affected.
What Causes Emphysema?
As stated above, the primary cause for the vast majority of emphysema is cigarette smoke and other pollutants. Smoking is responsible for over 80% of all COPD. Many other irritants are occupational hazards. Most of us have heard of “Black Lung.” This is just another name for emphysema that is common in coal miners who have breathed in coal dust during their working years. Any environment that exposes one to fine dust or fibers is not good for the lungs. Some lines of work that increase the risk of developing emphysema are:
- Sand blasters
- Metal grinders
- Wood workers
- House painters
- Cotton workers
- Talc, coffee, or cereal grains handlers
- Fiberglass workers
- Asbestos removers
- Iron workers (iron filings)
- Silica workers
- Agricultural workers (dust and pesticides)
- Anyone who uses their lungs extensively, such as glass blowers, and horn players
While not as destructive as cigarette smoking, other types of tobacco use can cause emphysema too, such as pipe and cigar smoking. Marijuana smoke is particularly dangerous, as it is inhaled deeply and held in the lungs by the smoker. Some studies have shown that marijuana smoke is chemically more toxic than tobacco smoke.
A minority of emphysema cases are triggered by an inherited genetic condition that afflicts approximately 50,000-100,000 Americans. These folks have insufficient amounts of a protein called alpha 1-antitrypsin (AAT). This condition does not always cause emphysema, but it increases risk.
What Are the Symptoms of Emphysema?
Most patients complain of shortness of breath. They feel that they just can’t get enough air, and it is no wonder. Emphysema starves the body of oxygen and it is commonly described by sufferers in terms of inability to “catch my breath.” Initially, this may occur only after exertion. But as the disease progresses, it may happen at any time. In addition to shortness of breath, common symptoms are as follows:
- A mild cough that never seems to go away
- Coughing up clear sputum
- Weight loss is found in many, but not all, patients
- A “barrel chest” due to residual volume
- Complications may develop over time as the lungs deteriorate. These include: pneumonia, chronic respiratory failure, and pulmonary hypertension
How is Emphysema Diagnosed?
If your health provider suspects emphysema, the first step is a thorough physical exam. One clue they look for is a hollow sound in the chest when tapping on it and listening with a stethoscope. This can indicate rupture of alveoli in the lungs.
Pulmonary function tests may also be helpful in discerning emphysema.
- Total Lung Capacity measures the volume of air in the lungs. A higher than normal reading can indicate emphysema.
- Vital Capacity measures the amount of air that is inhaled and exhaled in one deep breath. A lower reading points to emphysema.
- Spirometry evaluates respiratory gases and pulmonary function.
A chest x-ray can be useful too. Physicians look for abnormally enlarged or stretched lungs, blisters in the lung tissue, bulging of muscles associated with the respiratory system, and even abnormalities of the heart (such as an unusually small or vertical heart).
In advanced cases, sometimes an EKG is ordered and heart abnormalities due to lack of oxygen in the blood can be identified.
What Treatment Options are Available?
Emphysema cannot be cured, nor can damage be reversed. The two main objectives of treatment for emphysema are first to slow the progression of the illness, and secondly to help minimize the risk of serious life-threatening complications.
First let me say a word of warning about a couple of common mainstream medical treatments. Be very careful about using inhalators that may be suggested. A recent study from 2006 has indicated that a certain type of very commonly prescribed inhaler (beta-agonist) may actually double the risk of respiratory death in some COPD patients! The cure is truly worse than the cause in this case.
Secondly, there is a type of surgery that is sometimes suggested that is very risky and I would stay away from it. It is called volume reduction surgery, and it involves removal of part of the lung(s) to decrease the total volume and thereby increase lung efficiency. Up to 18% of patients may die as result of this surgery. The more advanced the emphysema is, the greater the chance of fatality. I would definitely get a second, third, etc. opinion before considering this option.
Now that I’ve had my say, I’ll get off the soapbox and we can continue looking at some excellent treatment options that may actually help a patient and not kill them.
The first is a no-brainer: if you are still smoking, stop.
Secondly, if you are in a risky occupation, take every precaution necessary to minimize your risk. Always use appropriate protection devices such as ventilators.
Supplemental oxygen is often ordered for COPD patients. Emphysema robs the body of oxygen, so supplying oxygen can help not only with breathing, but also to support the heart. More than any organ of the body, the heart cannot function properly with out sufficient oxygen. Studies have shown that the survival rate of advanced COPD patients is in direct proportion to the amount of time spent on oxygen.
Learning to breathe properly can be a great help to emphysema sufferers. In fact, it is something all of us could benefit from. Taking deep breaths and exhaling fully is the best way to ensure that enough oxygen is delivered throughout the body. It also helps to rid the body of free radicals and other harmful microbes, as well as ridding the body of waste products. A lack of oxygen puts the body in a diseased state, and makes it impossible for us to properly absorb and use the nutrients in our food. Proper exhaling is especially critical for the emphysema patient in order to rid the lungs of stale air and make room for oxygen-rich fresh air being inhaled. Patients may be taught to learn how to use specific muscles that help the body to breathe.
Gentle exercise is highly recommended too. Rebounding on a mini-trampoline is especially good. Some subjects who have advanced COPD have used a helper that actually does the work to make the trampoline to bounce while they sit on it and reap the benefits.
A diet loaded with whole foods and heavy on organic, locally grown fruits and veggies is beneficial as well. Combine that with avoiding processed foods, high fat foods, red meat, preservatives, and the like will boost the immune system and help to reach the goal of keeping the patient’s body form deteriorating further. This type of diet will also help to prevent emphysema, and a ton of other conditions, in the first place, and after all, isn’t that the point?
Are There Any Herbal Remedies That Can Help?
Yes there are. The following herbs have shown some promise:
- Echinacea: immune system booster, strengthens the body
- Thyme: drinking a tea of thyme helps with shortness of breath
- Sage: antiviral and antibacterial
- Lungwort: healing properties for the lungs
- Black cohosh: helps with coughing
- Garlic: antiviral and fights lung congestion