Always Out of Breath? It Might Be Emphysema 

Emphysema is a lung disease that makes it hard to breathe and gets worse over time. It's a type of Chronic Obstructive Pulmonary Disease (COPD) and often goes hand-in-hand with chronic bronchitis, especially in people who smoke. Understanding emphysema can help us manage its effects on our daily lives.

Emphysema primarily affects the tiny air sacs in your lungs, known as alveoli. Picture these sacs as little balloons – when you inhale, they expand to fill with air, and when you exhale, they deflate. In emphysema, the walls between many of these air sacs become damaged and merge into larger, irregularly shaped sacs.

This merging reduces the surface area available for gas exchange, which means your lungs have a harder time transferring oxygen into your bloodstream and removing carbon dioxide from your body. As a result, your lungs must work significantly harder to deliver enough oxygen, leading to a feeling of breathlessness and increased difficulty in breathing. Unfortunately, the damage from emphysema can’t be reversed, and breathing becomes more difficult over time. However, with appropriate care and management, many individuals with emphysema can still maintain active and fulfilling lives.

COPD encompasses two entities-chronic bronchitis and emphysema. Though previously, it was classified as different disorders, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has combined the two and termed the word COPD. GOLD guidelines have classified COPD into four stages/categories based on spirometry. Spirometry is an easy test to describe the progression of COPD. The stages of COPD are as follows:

• Stage 1 (Mild): Patients may notice few symptoms, which often go undetected. Healthcare providers typically recommend lifestyle changes such as quitting smoking and may suggest medications to help open the airways.
• Stage 2 (Moderate): Symptoms become more noticeable, including increased coughing, mucus production, and shortness of breath during physical activity. At this stage, a structured program to improve lung function and additional treatments to reduce inflammation may be recommended.
• Stage 3 (Severe): Patients experience significant limitations in daily activities due to severe symptoms. Frequent worsening of symptoms and increased difficulty breathing become common, often requiring additional support for easier breathing.
• Stage 4 (Very Severe): This stage involves critically low oxygen levels, posing a high risk of respiratory or heart failure. Advanced interventions may be necessary to manage the condition and improve quality of life.

Emphysema is quite common. It is estimated that 7.4% of the adult population in India is affected with chronic obstructive pulmonary disease. Also, it is the third leading cause of death worldwide.

People with emphysema might not notice any symptoms at first, even though their lungs are already damaged. When symptoms do appear, they may include:

• Shortness of breath: Feeling out of breath, especially after physical activity.
• Persistent cough: A deep cough that often brings up mucus and doesn’t go away.
• Wheezing: A whistling or squeaky sound when breathing.
• Chest tightness: A feeling of pressure or tightness in the chest.
• Thick mucus: Mucus that's hard to cough up.
• Breathing difficulty: Trouble breathing, even when sitting or lying down.
• Chest pain: Sharp pain in the chest.
• Shallow breathing: Quick, shallow breaths.
• Swelling: Swollen feet, ankles, or legs.
• Blue or purple lips or fingers: This can happen when oxygen levels are low.

As the disease gets worse, you might also notice:

• Increased number of lung infections: You may get sick more often with colds or lung infections.
• Weight loss: Losing weight without trying, often due to loss of appetite.
• Fatigue: Constant tiredness and lack of energy.
• Sleep problems: Trouble sleeping because of discomfort or breathing issues.
• Anxiety and depression: Struggling with breathing can lead to feelings of worry or sadness.

If you experience any of these symptoms, it’s important to talk to a doctor for advice and treatment.

Emphysema is mainly caused by long-term exposure to irritants that harm your lungs and airways. Smoking is the leading cause of emphysema, with up to 75% of people who have the condition being current or former smokers. Other forms of tobacco, like pipes and cigars, can also lead to emphysema, especially if you inhale them.

In addition to tobacco smoke, several other irritants can contribute to the development of emphysema, including:

• Secondhand smoke: Breathing in smoke from others can damage your lungs.
• Air pollution: Both outdoor and indoor air pollution can harm lung health.
• Chemical fumes and dust: Exposure to harmful substances in your work environment can increase the risk.
• Childhood respiratory infections: A history of respiratory infections during childhood may also play a role in developing emphysema later in life.

A rare genetic condition called alpha-1 antitrypsin (ATT) deficiency can also contribute to emphysema. In this condition, your body does not produce enough ATT, a protein that protects your lungs, making them more susceptible to damage from smoking and pollution. Age is also a factor, as most people with emphysema are over 40 when their symptoms begin.

No, emphysema is not contagious. You can’t catch it from someone else, so you don’t have to worry about getting it from touching or being around someone who has the disease. Emphysema is a long-term lung condition, and the leading causes are smoking and exposure to secondhand smoke or harmful chemicals.

Complications of emphysema include:

• Pneumonia: Individuals with emphysema are at higher risk of pneumonia.
• Collapsed Lung (Pneumothorax): This life-threatening condition can occur in people with emphysema due to already damaged lungs.
• Heart Problems: Emphysema can strain the heart by increasing pressure in the pulmonary arteries (PAH), potentially leading to cor pulmonale, where the right side of the heart weakens and expands.
• Giant Bullae (Holes in the lungs): Large air pockets formed in the lungs can reduce lung capacity and become infected, increasing the risk of a collapsed lung.

If left untreated, emphysema can lead to serious complications affecting overall health.

While there is no cure for emphysema, various treatments can alleviate symptoms and slow its progression. Here are effective management strategies:

Lifestyle Changes

• Quit Smoking: This is the most critical step in managing emphysema. Additionally, avoid secondhand smoke and air pollution.
• Stay Active: Consult your doctor for a healthy diet and exercise plan to strengthen your respiratory muscles.
• Healthy Diet: A balanced diet can bolster your immune system, helping your body resist lung infections.

Medications

• Medications can help open airways for easier breathing. Medications may also be prescribed to treat lung infections when necessary.
• To prevent infections, ensure you are up to date on relevant vaccinations.

Supportive care

• In severe cases of emphysema, breathing assistance may be necessary to ensure an adequate oxygen supply to the body (physiotherapy and pulmonary rehabilitation). A comprehensive approach to managing the condition may involve a structured program focusing on physical activity, nutrition, and overall disease management to improve lung function and enhance quality of life. 
• For the most severe instances, more invasive options may be considered to remove damaged lung tissue or to replace affected lungs entirely, aimed at improving respiratory capacity and overall health.

Dr Athul Francis, a consultant pulmonologist at MAJ Hospital, Edapally, explains that emphysema is not a curable disease but a progressive condition that primarily affects individuals over 40 years of age. "Basically, what happens is your airways get damaged, and it gets remodelled, which means there is destruction of your airways, particularly the peripheral parts," he notes. This damage is irreversible, leading to complications such as respiratory failure or cardiac failure, which can ultimately result in death.

Regarding life expectancy, Dr Francis states, "Life expectancy depends; emphysema is basically smoking-induced. The more you have smoked in your lifetime, the lesser your life expectancy." He emphasises that if a person quits smoking before the age of 40 or 50, their life expectancy can improve significantly. The decline in lung capacity is typically accelerated in smokers, leading to a faster progression to respiratory failure.

Emphysema is a lung disease that makes it tough to breathe and gets worse over time, often due to smoking. Although there's no cure, making healthy lifestyle choices and following your doctor's advice can help you manage the symptoms and feel better. By taking care of your lungs, you can still enjoy an active and fulfilling life!

Life expectancy varies depending on the severity of the disease, lifestyle factors (such as smoking), and overall health. With proper management, some people can live many years after diagnosis, though advanced stages may reduce life expectancy.

No, emphysema cannot be cured. However, medication, appropriate therapy, and lifestyle changes can help manage symptoms and slow disease progression.

The final stage of emphysema, or stage 4, is marked by severe shortness of breath, low oxygen levels, frequent flare-ups, and a high risk of heart and lung failure.

COPD is an umbrella term for lung diseases that obstruct airflow, including emphysema and chronic bronchitis. Emphysema specifically refers to the damage of air sacs in the lungs, while COPD encompasses a broader range of breathing problems.