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Lung diseases

Emphysema

08/27/1998

Question:

I need to know some specifics about my emphysema condition

Answer:

Emphysema is anatomically defined as the enlargement of air spaces in the lung by destruction of gas exchanging structures. Clinically it presents with breathlessness and is usually diagnosed by physical examination, measures of lung function and X-rays of the chest. The overwhelming cause is cigarette smoking although other factors including genetic predisposition will also play a role. Emphysema is often present with other lung diseases such as chronic bronchitis and asthma as they are also either caused or exacerbated by cigarette smoking. This set of diseases is often grouped together and commonly called chronic obstructive pulmonary disease (COPD).

The American Thoracic Society has proposed a three stage scoring system. This has not been in general usage as it is based solely on Pulmonary Function Tests (PFT) which are already a quantitative measure with prognostic value.

Once lung tissue is destroyed it can not be repaired. Prevention then is the key, and smoking cessation the cornerstone. Patients who can stop smoking may be able to slow further lung deterioration back to the normal rate. In select patients with enzyme deficiency, replacement therapy with alpha1-antitrypsin may be beneficial. Current surgical treatment include resection of giant air collections(bulla) and lung transplantation in select patients. Lung reduction surgery is currently undergoing active investigation as a proposed new method for treating emphysema.

The treatment of emphysema is often directed more towards the other components of COPD than to the emphysema itself. When proper clinical indications are met these measures would include bronchodilator use, anti-inflammatory drugs and antibiotics, immunization against pneumonia and influenza, pulmonary rehabilitation and oxygen supplementation.

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Response by:

Mitchell C Rashkin, MD Mitchell C Rashkin, MD
Professor of Medicine
College of Medicine
University of Cincinnati