Emphysema

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One of the lung disorders classified as a chronic obstructive pulmonary disease (COPD), emphysema is caused by damage to the air sacs in the lungs, which reduces the body's ability to pick up oxygen from the air. This results in inefficient breathing because extra effort must be expended to empty the lungs of air. It also becomes necessary to breathe more frequently because of the reduced capacity of the lungs.

The cause of emphysema is almost always smoking, but it may also rarely be caused by a genetic deficiency in the enzyme, alpha-1-antitrypsin (A1A). In smokers, the disease becomes more likely as they get older, but those with A1A deficiency can develop emphysema in their early 30s.

The most common symptom of emphysema is gradually increasing difficulty in breathing that worsens over a period of many years. Eventually, breathing becomes difficult even when the person is at rest. Small amounts of sputum may be seen in coughs, and there can be swelling in the feet and hands. Also prevalent are chronic coughs and frequent respiratory infections.

Because cigarette smoking is responsible for 90 percent of COPD cases in the United States, treatment for emphysema begins with smoking cessation. Also used are medications that open the airways or decrease inflammation. Supplemental oxygen is sometimes recommended, especially when breathing becomes difficult at rest and is the only treatment shown to prolong life.

To manage the disease, pulmonary rehabilitation is effective in moderate to severe cases and involves a program of learning proper breathing techniques, using respiratory equipment and increasing physical exercise to overcome the reduced physical capacity that has developed over the disease's duration. Lung volume reduction surgery is still not widely accepted but may hold promise for selected individuals.

• Don't smoke. Stop smoking if you do.
• Limit exposure to air pollution, including second-hand smoke.
• When working in dust or chemical-filled air, wear a mask that has proper filtration.