Emphysema – Prognosis, Life Expectancy, Stages, Causes, Pathophysiology
Emphysema is a condition characterized by gradual destruction of the pulmonary air sacs, resulting in progressive breathlessness. Emphysema belongs to a family of diseases called COPD or chronic obstructive pulmonary disease. Emphysema is mainly caused by smoking.
Worsening of emphysema causes the ‘bunch of grapes’-like air sacs to become irregular large pockets with big holes lining their inner walls. This decreases the overall surface area of the lungs and eventually reduces the total oxygen supply to the bloodstream.
It may also be noted that the small airways that lead into the air sacs are held open by elastic fibers. They slowly get destroyed by emphysema. This permits collapse of the airways during exhalation, thereby trapping the air in the lungs. The progression of emphysema can be slowed with treatment. However, the damage cannot be reversed.
Symptoms of emphysema
- It is possible to have emphysema without experiencing the associated symptoms for many years. The primary symptom is breathlessness which typically starts slowly.
- Patients start avoiding activities to avoid shortness of breath. This can affect the daily routine.
- Eventually, patients may experience breathlessness even when resting.
Individuals affected by emphysema are at greater risk to developing the below listed health complications:
- Cardiac abnormalities, wherein the arteries that connect the lungs and heart experience increased pressure. This can cause a part of the heart to expand and weaken.
- Collapsed lung or pneumothorax, a life-threatening condition.
- Large holes in the lungs or giant bullae, which can be as big as half a lung. It reduces the total available space for the lungs to expand and increases the risk to pneumothorax. They can also get infected.
Stages of emphysema
The staging of emphysema helps ascertain the percentage of lung damage and its severity level. The Global Initiative for Chronic Obstructive Lung Disease, or GOLD, makes use of the FEV1 measurements to help determine the extent of lung damage.
(Refer to the table at the bottom of the article)
Causes of emphysema
- Emphysema is mainly caused due to prolonged contact with airborne irritants such as tobacco smoke, manufacturing fumes, air pollution, marijuana smoke, and silica and coal dust.
- In rare cases, emphysema is caused due to the inherited deficit of a protein which safeguards the elastic pulmonary structures. The condition is known as Alpha-1 antitrypsin deficiency emphysema.
Some risk factors which can increase the vulnerability to developing emphysema are as follows:
- Smoking cigarettes, pipes, and cigars. The risk increases with an increase in the number of years the patient has smoked.
- Exposure to outdoor and indoor pollution, like inhalation of car exhaust and heating fuel fumes.
- Passive smoking
- An increased age. Regular smokers usually start experiencing emphysema symptoms between ages 40 and 60.
- Jobs that include exposure to dust or hazardous fumes.
Treatment of emphysema
There is no known cure for emphysema. Treatment is aimed at slowing down the progression of the disease and managing the symptoms.
- Medications for emphysema
- Bronchodilators relax the blocked airways and thus help alleviate breathlessness, coughing, and breathing problems.
- Smoking cessation medicines like varenicline and bupropion hydrochloride to help quit smoking
- Antibiotics to treat any underlying pulmonary infection.
- Steroid sprays which can be inhaled to find relief from breathlessness.
- Therapy for emphysema
- People with severe emphysema and extremely low levels of blood oxygen may be given supplemental oxygen to be used at home.
- Pulmonary rehabilitation programs aimed at teaching the patients varied breathing techniques and exercises that help decrease breathlessness. Nutritional advice is also provided.
- Surgery for emphysema: Depending on the severity of emphysema, doctors may opt for any of the below listed surgical remedies:
- Surgical removal of the diseased tissues, i.e., reduction of lung volume
- A lung transplant
Emphysema: Prognosis and Life-expectancy
Emphysema is a condition that adversely affects the quality of life and not the lifespan. Prognosis depends on the severity of emphysema, the type of treatment given, and how well further lung damage is prevented.
Currently, there are no studies which have been able to determine the mortality rate of emphysema. However, as per the research work done by the US CDC (Centers for Disease Control and Prevention) and the American Lung Association, 133,000 patients died in the year 2009.In recent times, the National Health Interview Survey conducted in 2011 indicated that emphysema had been diagnosed in 4.7 million individuals and that 24.1 million individuals had been detected with compromised lung functionality.
The prognosis and quality of life can be measured with the help of the BODE score, for future analysis.
- B -Body Mass Index (BMI)
- O -Obstruction. Pulmonary function tests determine lung functionality
- D -Dyspnea or shortness of breath
- E -Capacity for Exercise. The distance covered by an emphysema patient in six minutes by walking.
The life-expectancy or mortality cannot be predicted by either BODE or GOLD scores. They are merely aid-tools that help ascertain emphysema severity levels and how it may affect a patient’s future lifestyle.