Pulmonary Emphysema

Pulmonary emphysema is primarily the end-stage of lung diseases such as chronic bronchitis or COPD. Read more about symptoms, causes, and treatment.

Definition

Pulmonary emphysema is a serious, progressive, and incurable disease of the lungs. Medical professionals also refer to it as pulmonary emphysema. The colloquial language is particularly familiar with the disease terms lung flatulence or lung overinflation. With pulmonary emphysema, lung function continues to decrease. This creates progressive shortness of breath. The associated lack of oxygen not only severely restricts physical performance. There are also secondary reactions that place a heavy strain on the heart, among other things. A typical consequence of emphysema is, for example, the cor pulmonale, a common form of right heart failure.

Alpha-1 Antitrypsin Deficiency

In addition to the acquired form of emphysema, there is also a congenital variant. Alpha-1-antitrypsin deficiency is one of the rare diseases with 2.5 new cases per 10,000 inhabitants per year. In this disease, the congenital deficiency of the protein alpha-1-antitrypsin triggers chronic inflammatory processes in the lungs.

Frequency

According to experts, the frequency of emphysema is growing worryingly. Exact figures are not available because emphysema and COPD are not always properly recorded separately. But it is assumed that there are around a million cases in Germany. The vast majority of emphysema occurs in smokers over the age of 50.

Symptoms

A characteristic symptom of emphysema is increasing shortness of breath (dyspnoea). As a rule, the shortness of breath initially only occurs during physical exertion. As the disease progresses, there is difficulty breathing even when the body is at rest.

Advanced emphysema causes chronic oxygen deficiency, which can be recognized by the blue color of the lips and fingers (cyanosis). Another visible symptom of emphysema is a barrel-like enlargement of the upper body, the so-called barrel chest. Doctors speak of the barrel chest. The barrel breast is created because the lung tissue continues to inflate.

Causes

By far the most common cause of emphysema is chronic lung diseases such as chronic bronchitis. If the bronchial passages are permanently inflamed, narrowed, and cause shortness of breath, coughing, and increased sputum, this chronic bronchitis is one of the chronic obstructive pulmonary diseases that are described in more detail under COPD. Chronic bronchitis and COPD are also precursors of lung cancer. The most common cause of all these diseases smoking.

Pulmonary Emphysema

How Do The Symptoms Of Chronic Bronchitis Arise

In healthy people, the air you breathe reaches the alveoli via the bronchi. Gas exchange takes place in these alveoli. During the gas exchange, the elastic alveoli absorb the oxygen from the inhaled air and then release carbon dioxide from the blood with the exhaled air. That requires a certain elasticity. In the case of emphysema, this elasticity is gradually lost as a result of inflammatory processes. The alveoli become increasingly inelastic and are no longer able to completely release the exhaled air. As a result, less fresh inhaled air can be taken in. This causes the alveoli to expand and ultimately lose their function entirely. Sometimes the small alveoli transform into large emphysema bubbles.

The approximately 300 million alveoli of a healthy person have a surface area the size of a football field. With emphysema of the lungs, this area for gas exchange sometimes shrinks to the size of a towel.

Treatment

Pulmonary emphysema cannot be cured. Treatment can only relieve symptoms. The most important thing is to prevent the disease from progressing, or at least to slow it down. To do this, it is imperative to stop smoking.

Drug Therapy For Emphysema

The symptoms of not too advanced pulmonary emphysema can be alleviated by drug therapy. The aim of this therapy is to widen the bronchi (bronchodilation) and to stop the inflammatory processes in the lungs. So-called beta-2 sympathomimetics are often inhaled for this purpose. Active substances in this group are salbutamol, salmeterol, or reproterol. Anticholinergics like ipratropium or inhaled glucocorticoids like budesonide, beclometasone, or fluticasone have even stronger anti-inflammatory properties.

In the case of congenital alpha-1-antitrypsin deficiency, the protein can be given in the form of medication (infusions) and thus prevent the development of pulmonary emphysema. Unfortunately, the therapy is very costly and not as promising as one initially hoped it would be.

In the case of very advanced pulmonary emphysema, selected emphysema patients (younger than 60 years, high therapeutic motivation, no additional complications) only have a lung transplant as the last chance. The possibilities of artificial ventilation are very limited due to the characteristics of the disease.