Emphysema (Chronic Obstructive Pulmonary Disease, COPD)

Emphysema is a chronic condition in which the alveoli, or air sacs, of the lungs have lost their elasticity and become stretched out and filled with stale air. As a result, the tiny blood vessels in the sacs cannot perform their normal function of picking up a fresh supply of oxygen while getting rid of carbon dioxide and other waste products; thus the breathing process is labored and inefficient.

As the alveoli become more diseased, the body is increasingly starved for oxygen, and the slightest exertion produces shortness of breath and fatigue. A person with emphysema eventually develops a barrel-shaped chest because the lungs are expanded with stale air that cannot be exhaled.

The primary cause of emphysema is smoking, although air pollution, occupational exposure to toxic chemicals and gases, chronic bronchitis and other lung disorders, and an inherited tendency to develop the condition may also be responsible.

Diagnostic Studies and Procedures

Diagnosis begins with gathering background information. A doctor will want to know whether you ever smoked and if you have recurring bronchitis or asthma. This is followed by a physical examination with particular attention to lung function. A definitive diagnosis requires a simple test called spirometry, in which you take a deep breath and then exhale as much air as you can as quickly as possible. This test indicates whether you can empty your lungs normally.

Other diagnostic studies include lung X-rays, lung scans, and blood studies to check for signs of infection and measure levels of oxygen and carbon dioxide reaching the body's tissues.

Medical Treatments

Emphysema has no cure, but medical treatments can relieve its symptoms, slow the progression of the disease, and help to delay disability.

Drug therapy usually includes the use of bronchodilators, medications that relax the airway and facilitate the flow of air in and out of the lungs. These drugs are usually taken at regular intervals several times a day, rather than only when symptoms appear.

Corticosteroid drugs, in either oral or inhaled form, may be prescribed to counter lung inflammation, and antibiotics may be given, not only to treat airway infections but also to prevent them. For example, a doctor may advise a patient to take antibiotics at the first sign of a cold to stave off a secondary infection -- even though the drugs will have no effect against the cold itself. Annual flu shots are a particularly important preventive measure, as is immunization against pneumococcal pneumonia, because these illnesses can be life threatening for any person who has emphysema.

Severe cases may require supplemental oxygen, administered through tubes in the nostrils. This can be given at home, although hospitalization is sometimes necessary.

An experimental operation in which 20 to 30 percent of the damaged lung tissue is removed has brought dramatic improvement to some patients with advanced emphysema. Reducing the size of the distended lungs allows more room for the remaining tissue to inflate when inhaling. The operation does not halt progression of the disease, however; in severe cases, a lung transplant may be considered.

Alternative Therapies

Aromatherapy. Thyme oil, which is extracted from the flowering tops of the plant, is said to have therapeutic qualities useful in alleviating emphysema. Aromatherapists also use the oils from hyssop plants and eucalyptus trees to treat respiratory ailments. These oils may be inhaled by placing a few drops in a bath or a basin of hot water and breathing the vapor, or by putting the drops on a handkerchief and placing it on your pillow at night.

Herbal Medicine. To clear the lungs of phlegm, herbalists recommend adding 1 teaspoon of powdered elecampane root to 1 cup of cold water, letting it stand for 9 to 10 hours, and then heating the water and drinking the solution while it is hot. This remedy should be taken two or three times daily.

Chinese herbalists use the ma-huang combination, which consists of cinnamon, licorice root, apricot seeds, and ma-huang, to treat emphysema and other pulmonary disorders.

T'ai Chi. This gentle exercise is recommended to help emphysema sufferers maintain their muscle tone and fitness without excessive exertion. It also fosters a sense of well-being.

A technique for helping to rid the lungs of stale air is to exhale slowly through lips pursed as if your were going to whistle.

Yoga. Abdominal yoga exercises that emphasize deep diaphragmatic breathing are said to increase oxygen flow.

Self-Treatment

The most important aspect of self-treatment is to quit smoking and to avoid exposure to secondhand smoke and other lung irritants. Because emphysema begins years before symptoms appear, stopping smoking while you are still healthy can halt the progression of lung damage before it becomes disabling. Some of the early changes in lung function from smoking may even be reversed after you give up the habit.

Living with emphysema involves pacing yourself and allowing for rest periods whenever you feel short of breath. If you set priorities for daily activities, you won't become overly tired. Regular exercise such as walking can help prevent disability, but you should avoid overly strenuous activities that stress the heart and lungs.

Learn pursed-lip breathing methods to minimize exhaustion during physical activity: Inhale deeply through your nose, and exhale slowly and steadily through a small opening between pursed lips. Exhale for twice as long as you inhale. This technique slows down your breathing and helps expel stale air from your lungs.

If you are overweight, make every effort to lose the extra pounds. Reduce salt intake, especially if you suffer from fluid retention and swelling of the feet and lower legs, a complication that may result from corpulmonale, a form of heart failure that is associated with advanced emphysema.

Other Causes of Breathing Difficulties

Chronic and progressive breathing difficulties can be the result of any lung infection or inflammation, including AIDS-related pneumonia, tuberculosis, chronic bronchitis, and such occupational lung disorders as black lung disease. Bronchiectasis, a condition in which bronchial tubes become dilated and blocked with thick secretions, also hampers breathing, as does congestive heart failure, a condition in which the lungs become congested with fluid that the heart is unable to pump out.