Emphysema and Mental Health 

What is emphysema?

Emphysema is a type of chronic obstructive pulmonary disease (COPD), and it occurs when there is damage to the lungs’ air sacs (alveoli). Through time, the alveoli walls become weakened, and this might result in the sacs being collapsed, destroyed, narrowed, over-inflated, or stretched.^1,2 This damage reduces the surface available to make the change in the gases (oxygen and carbon dioxide) in the lungs; therefore, less oxygen reaches the bloodstream. When the alveoli become over-inflated, the air exhaled stays trapped, and there is no room for the air rich in oxygen to come in.^1,3

Treatment can make the progression of the disease slower; however, the damage is not reversible.

Symptoms of emphysema

The main symptoms of emphysema are:

· Shortness of breath – getting breathless on exertion or even at rest.

· Persistent cough – cough that does not resolve with time and gets worse.

· Regular sputum production – clear when non-infective and yellow/green when associated with infection.

· Recurrent lung infection – due to the difficulty in clearing up bacteria and viruses in the airway.

· Wheeze – the narrowing of the airway can cause wheeze.

These symptoms are the main ones and tend to be progressive over time. There are some less common symptoms, which include:

· Weight loss – due to burning a lot of energy in the effort of breathing properly and also reduced appetite caused by changes in the body.

· Reduced exercise tolerance – a limited amount of things that can be done without getting shortness of breath or a limited amount of time doing things without feeling breathless.

· Ankle swelling – due to heart problems caused by the increase in pulmonary pressure.

· Chest pain – caused by different types of damage in the lungs or even as a result of heart problems caused by emphysema.

· Coughing up blood – caused by the rupture of the vessels.⁴

Some symptoms of emphysema and anxiety overlap

Shortness of breath, increased respiratory rate, chest tightness, and increased heart rate are symptoms that can be present in both emphysema and anxiety. It is also important to consider that both can be happening together and trigger each other.

It is easy to see how emphysema is related to anxiety. Breathlessness sends a message to the brain, which understands the signal as a threat, triggering a stress response that is perceived as anxiety. Although this is a normal response of the brain, managing and dealing with the stress caused by it can be challenging, resulting in generalised anxiety and anxiety attacks.

On the other hand, anxiety attacks can cause episodes of shortness of breath, which can be mistaken for exacerbation of emphysema.⁵

It is important to differentiate both, emphysema exacerbation might come associated with cough and sputum and respond to medications such as inhalers, whereas anxiety attacks can happen suddenly and last for a small period and don’t respond to medications, but to stress management activities, like breathing exercises.

Health anxiety

Healthy anxiety, hypochondria, or illness anxiety disorder are names given to the extreme and sometimes exaggerated fear of being or becoming ill. People with health anxiety are constantly worried about their health and sometimes even think they are having symptoms of different diseases. These people often go to doctors and look for reassurance regarding their health, even looking exhaustively for online health content.

It can lead to the belief that some typical body sensations such as feeling tired, muscle twitching, muscle pain, and others can be due to severe disease and can lead to severe life distress.^6,7

In this case, having emphysema can lead the person to fear having exacerbations or to be afraid of the progression of the disease, causing huge distress and worrying about their health, which can exacerbate the symptoms of anxiety.

Social anxiety

Social anxiety, also known as social phobia, is a disorder triggered by the fear of facing social interactions. People with emphysema might experience this due to the fear of presenting symptoms like coughing, breathlessness, chest tightness, and others in public. This increases anxiety involving social situations, which they try to avoid, and facing these situations might lead to panic attacks.⁸

Co-managing emphysema and mental health conditions

Although emphysema does not have a cure, certain management techniques can be done to delay the progression of the disease and increase the quality of life. Treatment involves medication, lifestyle changes, and pulmonary rehabilitation. Controlling emphysema and its exacerbation can also help in controlling anxiety. Therapy, breathing exercises, and meditation can also help in controlling anxiety, although some cases might require medications.⁹

Talk to your doctor about interactions between your medications 

Whenever you feel that anxiety is not being well managed by non-medicinal therapies, your doctor should be contacted to help you in managing anxiety with medications. It is important to understand that medicines can interact with each other and these side effects should be considered. Certain anxiety medications can interact with your breathing pattern, and therefore, a doctor needs to be aware of the situation to help you to choose the best option for your treatment.⁹

If you’re worried about your or your loved one’s mental health

If you are worried about someone you love, it is important to understand how you can help them. Expressing your concerns and offering your help is the first step, but other strategies can be taken:

· Act normally – do not let the other person feel that you are acting differently towards them. 

· Reassure them – let them feel confident with your support.

· Listen – sometimes it is all the other person needs.

· Be patient – everyone has their own time in dealing with things and asking for help.

· If they don’t want support, don’t force it – try to understand their reasons without pushing them.

· Offer help with practical things – sometimes small and kind gestures of care are all they need to go through.¹⁰

Conclusion

Emphysema is a type of COPD where there is damage to the air sacs of the lungs (alveoli), causing them to be destroyed or lose their elasticity. This affects the blood gases exchange and less oxygen reaches the bloodstream, causing symptoms like breathlessness, coughing, sputum production, recurrent lung infections, and wheezing. Some of these symptoms like shortness of breath, increased respiratory rate and chest tightness might also be seen in anxiety and also trigger it, which is why anxiety is common in people with emphysema. 

Treating both conditions is important to increase the quality of life, but this should be done with a doctor's follow-up since some medications to control both conditions might interact and cause side effects. If you are worried about someone close to you having these symptoms, it is important to offer support and reassurance without judgment.