Sunday, September 21, 2003
Emphysema is a lung disease that literally leaves people gasping for air. Lung damage builds up over a number of years, at first without symptoms but later causing wheezing and shortness of breath.
In addition to about 2 million Americans diagnosed with emphysema, many more have lung damage that has yet to become apparent.
"Emphysema -- also called chronic obstructive pulmonary disease and end-stage lung disease -- is very preventable," Steamboat Springs internal medicine physician Lambert Orton, M.D., said.
"There are some hereditary causes, and occupational exposure to air-borne particulate matter can increase the risk. But most cases of emphysema are caused by many years of smoking."
When air is breathed into healthy lungs, the alveoli -- tiny air sacs in the lungs responsible for oxygen exchange -- expand to take in oxygen from the new air. They then contract to squeeze out carbon dioxide that is exhaled. Emphysema causes lung tissue to lose its elasticity so it can no longer expel bad air. The trapped air makes lungs flabby and oversized.
Unfortunately, there is no cure. The only way to stop progression is to quit smoking. For some people, it may take a diagnosis of emphysema to finally decide to quit. Those who continue to smoke face a far more rapid deterioration.
"In most cases, some reversibility is possible if people quit smoking," Orton said. "If they don't, it becomes irreversible. And emphysema also makes people more susceptible to bronchitis and pneumonia."
Orton recommends that every smoker get a spirometry test to use as a baseline. It's a relatively simple test, administered in a physician's office, that measures air flow and air volume when the lungs are fully inflated. Taking into account a person's age and sex, lower readings can indicate early emphysema.
Although medications can't cure emphysema or alter the course of the disease, they can help patients breathe more easily and improve quality of life. Bronchodilators are often used to ease airway constriction. Drugs such as albuterol and theophylline are frequently used as medications that go directly to the lungs.
Corticosteroids, which are not approved for the treatment of emphysema by the FDA, are often prescribed off-label. Although inhaled steroids can be beneficial for short-term use, experts warn against long-term use of oral corticosteroids such as prednisone, which can cause osteoporosis, diabetes and hypertension.
Exercise therapy is an important part of treatment to help patients maintain muscle strength and stay independent. Oxygen therapy can literally extend the lifespan of patients with low blood oxygen levels by improving heart and brain function. Many people remain comfortable and relatively active with portable oxygen.
Lung volume reduction surgery may provide short-term improvement for some patients. Surgery removes diseased portions of the lungs, allowing better expansion of the remaining air sacs and allowing the smaller lung to fit better in the chest cavity.
Orton is hopeful that public awareness of chronic lung damage may influence some smokers to quit. "The most important thing for people to know is that most cases are preventable if they would just stop smoking," he said.
Quitting is hard, but not as difficult as the struggle waged by those who fight for every breath they take.
Christine McKelvie is public relations director
of Yampa Valley Medical Center.