When getting air is not as easy as breathing

Tue, Apr 14, 2009

MEN’S HEALTH MATTERS: Emphysema can be a debilitating condition, writes THOMAS LYNCH .

Q You wrote recently about emphysema and cigarette smoking. I found it very informative and have given up cigarettes as a result. I am worried that I might have the disease.

Can you tell me what are the common symptoms and how would my doctor diagnose emphysema? What tests are usually performed? Is there any treatment available for my emphysema and can it reverse the damage done to my lungs?

A Emphysema is a lung condition which involves permanent and irreversible damage to the air sacs (alveoli) in the lungs which leads to difficulties with efficient exchange of gases in the lungs. As a result, your body does not get the oxygen it needs. Emphysema occurs almost exclusively in the lungs of smokers.

Breathlessness is the most common symptom of emphysema. Emphysema is often associated with chronic bronchitis (chronic obstructive airways disease COPD) which tends to cause a cough productive of mucus, especially in the mornings.

Wheeze is another common symptom. If you have not already developed some of these symptoms, the likelihood of developing them depends on how long you have been smoking (and whether you continue to smoke) and the severity of the emphysema.

Patients with emphysema and COPD are prone to develop chest infections. These infections can be viral or bacterial and tend to lead to a worsening of breathlessness, cough and wheeze. Some patients present for the first time with an infection having perhaps not previously been aware of any background symptoms due perhaps to a very sedentary lifestyle, or having come to tolerate a certain level of breathlessness as ‘normal’ for them.

Some patients with emphysema and COPD develop frequent infections, known as “exacerbations” and some patients require hospitalisation for intravenous steroids, antibiotics, nebulised bronchodilators and possibly oxygen.

Any patient who smokes or has a significant smoking history and presents with shortness of breath, cough or wheeze will raise suspicion for emphysema or COPD. The doctor concerned will proceed with physical examination, chest X-ray and breathing tests (known as PFTs – pulmonary function tests).

The chest X-ray may be normal in these conditions or can indicate overinflated lungs due to trapping of air. The chest X-ray is useful to exclude pneumonia, fluid congestion due to heart failure, or lung cancer as a cause of symptoms. In some cases your doctor may proceed to a CT scan of the lungs for a more accurate visualisation of the extent and severity of emphysema.

The PFTs will usually indicate obstruction of varying severity to airflow in the airways and can also measure the efficiency of gas exchange in the lungs. These tests in particular are a sensitive and reliable indicator of lung function.

In patients with significant symptoms and evidence of more severe disease, a measure of the blood oxygen and carbon dioxide levels may be undertaken.

Likewise, in the more severely affected patients a six-minute walk test may be performed with measurement of blood oxygen saturations at rest and with exertion, through use of a special finger probe.

I am glad to see that you have quit smoking as this is the only measure which has been proven to slow the accelerated decline in lung function, which happens with COPD. If people wish to quit smoking, they will often be referred to, or advised on, a cessation programme.

There are a number of treatments available for emphysema and COPD. Unfortunately, no medical treatment has been shown to reverse structural damage already done to the lungs but they do relieve symptoms, improve quality of life, reduce frequency of exacerbations and need for hospitalisation.

The treatments available include inhaled therapies that help to relieve airflow obstruction by opening up the airways. Home oxygen can be organised for appropriate patients with more severe disease.

What treatment you will require will depend on the severity of your emphysema as objectively measured by the PFTs. If your symptoms are mild and your PFTs demonstrate mild reduction in pulmonary function, you may require only occasional use of a bronchodilating (drug to open up the airways) inhaler. Other medications are added in a stepwise fashion as symptoms progress.

Occasionally, surgical treatment options may be considered. The surgical options, however, are complex and not without risk, and only ever applicable to a very small number of patients.

This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James’s Hospital, Dublin with a contribution from Dr Deirdre O’Riordain, consultant physician, St James’s Hospital, Dublin