Emphysema

What is Emphysema?

Emphysema is a long-term, progressive disease of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli (air sacs in the lung). In people with emphysema, the lung tissue involved in exchange of gases (oxygen and carbon dioxide) is impaired or destroyed. Emphysema is included in a group of diseases called chronic obstructive pulmonary disease or COPD (pulmonary refers to the lungs).

Emphysema is called an obstructive lung disease because airflow on exhalation is slowed or stopped because over-inflated alveoli do not exchange gases when a person breaths due to little or no movement of gases out of the alveoli, leaving no room for fresh, oxygen-rich air to enter.

Emphysema changes the anatomy of the lung in several important ways. This is due to in part to the destruction of lung tissue around smaller airways. This tissue normally holds these small airways, called bronchioles, open, allowing air to leave the lungs on exhalation. When this tissue is damaged, these airways collapse, making it difficult for the lungs to empty and the air (gases) becomes trapped in the alveoli.

This effect impairs normal ciliary function and smooth muscle contraction, necessary for effective lung secretion clearance. As the emphysema causes inflammation which triggers additional mucus production in the lungs, there is often an excessive retention of mucus. This unfortunately provides ideal conditions for further infections to take hold.

What causes Emphysema?

Once the natural defences of the respiratory system have been bypassed by some form of invading infection a normal inflammatory immune response usually occurs. The cell walls of the airways would become swollen, additional protective mucus is produced and white blood cells converge on the area to attack the invading pathogens.

In individuals with emphysema there are approximately 5 to 10 times higher number of macrophage white blood cells present in the lung tissues and fluids. There is also an increased number of neutrophil white blood cells that release excess amounts of proteases. These break down the protein based elastic structure of the airways cell walls. It is the loss of the cell wall elasticity that leads to the permanent dilation of the airways.

The permanent dilation of the airways, combined with the damage to the cells walls, is a cumulative process. The result is greater mucus production and retention, loss of functional lung surface and a greater risk of repeat infections.

• Cigarette Smoking is the most dangerous behavior that causes people to develop emphysema, and it is also the most preventable cause.

Cigarette smoke contributes to this disease process in two ways. It destroys lung tissue, which results in the obstruction of air flow, and it causes inflammation and irritation of airways that can add to air flow obstruction.

• Air pollution and chemical fumes and dust acts in a similar manner to cigarette smoke. The pollutants cause inflammation in the airways, leading to lung tissue destruction.
• Close relatives of people with emphysema are more likely to develop the disease themselves. This is probably because the tissue sensitivity or response to smoke and other irritants may be inherited. The role of genetics in the development of emphysema, however, remains unclear.
• Abnormal airway reactivity, such as bronchial asthma, has been shown to be a risk factor for the development of emphysema.
• Men are more likely to develop emphysema than women. The exact reason for this is unknown, but differences between male and female hormones are suspected.
• Older age is a risk factor for emphysema. Lung function normally declines with age. Therefore, it stands to reason that the older the person, the more likely they will have enough lung tissue destruction to produce emphysema.

What are the symptoms of Emphysema?

You can have emphysema for many years without noticing any signs or symptoms.

The following symptoms may begin gradually:

• Shortness of Breath
• Cough, sometimes caused by the production of mucuc
• Wheezing
• Decreased exercise tolerance
• May use pursed-lipbreathing to help maintain positive lung pressure and empty the trapped air
• Visible use of upper body, accessory breathing muscles
• Persistent hyperinflation of lungs creates ‘barrel chest’ appearance (distance from the chest and back becomes more pronounced)
• Not mentally alert
• Advanced cases of emphysema can leave the individual with wasted limb muscles, visibly elevated jugulars, signs of cyanosis and peripheral oedema.

How is Emphysema Diagnosed?

To determine if you have emphysema, your doctor will ask about your medical history and do a physical exam.

• Chest X-Ray. A chest X-ray can help support a diagnosis of advanced emphysema and rule out other causes of shortness of breath. But the chest X-ray can also show normal findings if you have emphysema.
• CT scan. CT scans can be useful for detecting and diagnosing emphysema. You may also have a CT scan if you’re a candidate for lung surgery.
• Lung Function Tests. These noninvasive tests measure how much air your lungs can hold and how well the air flows in and out of your lungs. They can also measure how well your lungs deliver oxygen to your bloodstream. One of the most common tests uses a simple instrument called a spirometer, which you blow into.

Managing Emphysema 

Emphysema and COPD can’t be cured, but treatments can help relieve symptoms and slow the progression of the disease.

Smoking Cessation

Although not strictly a treatment, most doctors make this recommendation for people with emphysema (and everyone). Quitting smoking may halt the progression of the disease and should improve the function of the lungs to some extent.

Medication

Doctors use several kinds of medications to treat the symptoms and complications of emphysema. You may take some medications on a regular basis and others as needed.

Therapy

Here at Respiratory Physiotherapy Ireland, we can apply a range of therapy techniques and advice to manage your symptoms and maintain the best possible level of lung function and comfort. We can also advise on activity modification to make daily living easier. Along with advice for you and your family on appropriate self-management techniques to maximise your functional ability between therapy sessions.

What would physiotherapy treatment for Emphysema involve?

At Respiratory Physiotherapy Ireland, Our physiotherapists will ensure you receive specialised treatment for your emphysema. Giving up smoking has one of the biggest global health benefits to the improvement of this condition. Depending on the severity and duration of your condition, your treatment may involve:

• Secretion clearance:
  • Active Cycle of Breathing
  • Autogenic Drainage
  • Positive Expiratory Pressure (PEP)
  • Oscillating positive expiratory pressure
  • Effective / productive coughing techniques.
  • Postural drainage in sitting and lying.
  • Manual techniques, including percussion and vibrations
• Breathing techniques:
  • Controlling respiratory rate
  • Diaphragmatic breathing
  • Relaxation breathing exercises
• Education and Advice:
  • Illness cause and progression.
  • Effects of environmental and allergen factors, including smoking.
  • Medication management
• Exercise Assessment and Prescription
  • Those experiencing dyspnoea on exertion (even mild dyspnoea) may benefit from a formal exercise program. A formal exercise program generally includes aerobic and resistance training. Exercise training includes intensity, frequency, duration, type, mode and progression based on the severity and type of emphysema.

Summary

Although there is no ‘cure’ for emphysema it is usually possible to improve your health and quality of life with the support of health professionals. Respiratory physiotherapists are an essential part of the team that can help you.

For more information on how physiotherapy can help treat emphysema or to book yourself an assessment, please contact us here at Respiratory Physiotherapy Ireland.