Emphysema Overview

Introduction

Emphysema is a lung condition that affects the air sacs in the lungs known as alveoli. These air sacs become damaged, and over time, can cause shortness of breath and further complications. Emphysema is usually caused by excessive smoking. It is a type of Chronic Pulmonary Obstructive Disorder (COPD) which is a long-term lung disease that greatly impacts a person's quality of life.

What is emphysema?

In healthy lungs, there are millions of tiny air sacs known as alveoli. Within these tiny air sacs is where there is an exchange of oxygen and carbon dioxide . The oxygen is breathed into the body and carbon dioxide and other waste gases are expelled out. People who smoke tend to have these air sacs damaged as the inhaled cigarette particles can damage the walls and the alveoli. Once the air sac walls become compromised, they break and merge into larger sacs, creating holes in the lungs. It is suggested that 80% of all emphysema is caused by smoking.1

People with emphysema generally find it difficult to breathe due to the enlargement of the alveoli. Due to the increased surface area of the sacs, they become baggy and filled with air, which then affects the amount of oxygen that enters the lungs when it inflates. 

According to the National Institute for Health and Care Excellence (NICE), over 3 million people have been living with COPD since 2016. Two million of these people are undiagnosed. Most people are usually not diagnosed until the age of 50 as there is no single diagnostic testing for COPD. NHS Digital Data also highlights that approximately 1.17 million people in England have been diagnosed with COPD.

There are 3 main types of emphysema:

  1. Centriacinar/Centrilobular: the most common type of emphysema which is generally associated with smoking. It usually starts in the bronchioles and spreads in the upper area of the lungs.
  2. Panacinar: occurs in the lower half of the lungs, causing damage to the air sacs walls.
  3. Paraseptal (distal acinar): associated with other lung disorders such as pulmonary fibrosis. It is caused by the scarring of the tissues of the lungs that is between the alveoli.

Symptoms

The symptoms for Emphysema may differ from individual to individual, however the most common symptoms include:

  •  Shortness of breath on exertion.
  • Chesty cough with increased mucus production
  • Wheezing
  • Chest tightness.

Most symptoms do not usually manifest until 50% of the lung tissue is damaged.Symptoms can eventually worsen to the point where you find it difficult to breathe even while at rest.

Causes

The main cause of emphysema is smoking, accounting for 80% o in active smokers. Other causes include: 

Risk factors

A study had shown that people with small airways, which was not proportionate to the size of their lungs may have decreased breathing capacity and, therefore, be at risk of developing COPD even if they are non-smokers or have no other risk factors.2 

When you breathe, air moves through your airways, starting with the windpipe or trachea. This then branches out to smaller airways called bronchi and bronchioles. As we grow, our airways generally develop in relation to our lungs, but in some people, their airways may grow either smaller or larger than predicted— this is known as dysanapsis. It is unclear why this happens and is often very rare.

Other risk factors include:

  • Exposure to air pollution.
  • Working with chemicals, dust and fumes
  • A history of childhood respiratory infection.

According to the American Lung Association, women smokers are 13 times more likely to develop COPD than non-smoking women; also, male smokers are 12 times more likely to develop the condition than male non-smokers.

You can reduce your risk of emphysema by making a few changes to your lifestyle

The following lifestyle factors have the greatest impact on your risk of emphysema. We will also look at what you can do to reduce your risk from today.

Nutrition

Surprisingly, what you eat can impact the quality of your breathing. Eating foods less in Carbohydrates and more fats makes it easier for patients suffering from COPD to breathe. So, what’s the science behind this?

When carbohydrates are broken down in the body, one of the by-products is carbon dioxide. Carbohydrates produce the most amount of carbon dioxide in relation to the amount of oxygen produced as opposed to fats and protein. People with COPD conditions such as emphysema, tend to have a build-up of carbon dioxide in their system known as Hypercapnia. Therefore, eating foods that generate less carbon dioxide as a by-product is essential to manage the symptoms of emphysema.3

Physical activity

Physical activity is greatly reduced in patients with emphysema due to the breathlessness they experience during exertion. Often times simple tasks such as climbing up the stairs or going for short walks can be very challenging for most people with COPD. However, the American Lung Association suggests that moderate exercise such as stretching, swimming, walking and weight training can improve the body’s use of oxygen, increase energy levels and improve shortness of breath. 

Obesity

If a person is overweight, it puts more pressure on the lungs as the lungs have to work harder to accommodate for the surplus weight. Therefore, keeping fit and adopting a healthy low carbohydrate diet to lose weight is vital to manage symptoms of Emphysema.

Alcohol

Research shows that excessive alcohol use can have a negative impact on the healthy functioning of the lung as it causes breathing problems and further respiratory complications.4 Excessive alcohol reduces the level of glutathione in your body. This helps to prevent lung damage.5 However, there is no evidence to suggest that drinking within the daily alcohol guidance will impact on COPD conditions.

Hydration

Studies indicate that dehydration contributes largely to triggering COPD symptoms. Water is essential in keeping nasal passages and lung tissues moist. Drinking water is also known to thin mucus which makes it easier for patients with emphysema to breathe easier.6

Sleep

The symptoms of COPD can often be a hindrance to your sleep pattern as you may find yourself waking up several times in the night. Studies suggest that people with COPD conditions tend to have poor sleep quality and that improving/managing the symptoms of COPD could improve on sleep disturbances.7,8

Mental health

People suffering from emphysema often experience shortness of breath which can lead to constant fear and anxiety. It is estimated that people with COPD conditions are 40% more likely to experience depression and 36% more likely to experience anxiety as a cause of the physical aspects of the condition.9 Talk to your healthcare professional if you’re feeling bouts of anxiety or depression. They could prescribe medication that will help manage your symptoms.

Wellness

Keeping your emotional health balanced is necessary for your physical health. Self-care is important for overall good health.

Connecting with others who also suffer from COPD or know what it's like living with the condition may be beneficial for your well-being. Talking always helps to curb the fears and gives you a sense of not being alone. There are plenty of support groups such as Better Breathers Club that can help with this.

Conclusion

Emphysema is a type of COPD (lung condition) caused by excessive smoking. People with this condition often find it difficult to breath and carry out daily activities which impacts on their quality of life. Adopting a healthy lifestyle such as regular exercise and a healthy low-carb diet can help manage and improve symptoms.

Diagnostic testing

At Klarity we use the latest technology when it comes to diagnostic testing. Our home blood tests give you health insights and personalised recommendations. Find out which test you should take.

References

  1. Terzikhan N, Verhamme KMC, Hofman A, Stricker BH, Brusselle GG, Lahousse L. Prevalence and incidence of COPD in smokers and non-smokers: the Rotterdam Study. Eur J Epidemiol [Internet]. 2016 Aug [cited 2022 Oct 7];31(8):785–92. Available from: http://link.springer.com/10.1007/s10654-016-0132-z
  2. Smith BM, Kirby M, Hoffman EA, Kronmal RA, Aaron SD, Allen NB, et al. Association of dysanapsis with chronic obstructive pulmonary disease among older adults. JAMA [Internet]. 2020 Jun 9 [cited 2022 Oct 7];323(22):2268. Available from: https://jamanetwork.com/journals/jama/fullarticle/2766866
  3. Poon CS, Tin C, Song G. Submissive hypercapnia: Why COPD patients are more prone to CO2 retention than heart failure patients. Respiratory Physiology & Neurobiology [Internet]. 2015 Sep [cited 2022 Oct 7];216:86–93. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1569904815000464
  4. Kaluza J, Harris H, Linden A, Wolk A. Long-term unprocessed and processed red meat consumption and risk of chronic obstructive pulmonary disease: a prospective cohort study of women. Eur J Nutr [Internet]. 2019 Mar [cited 2022 Oct 7];58(2):665–72. Available from: http://link.springer.com/10.1007/s00394-018-1658-5
  5. Arsalane K, Dubois CM, Muanza T, Bégin R, Boudreau F, Asselin C, et al. Transforming growth factor-beta1 is a potent inhibitor of glutathione synthesis in the lung epithelial cell line A549: transcriptional effect on the GSH rate-limiting enzyme gamma-glutamylcysteine synthetase. Am J Respir Cell Mol Biol. 1997 Nov;17(5):599–607.
  6. Lin VY, Kaza N, Birket SE, Kim H, Edwards LJ, LaFontaine J, et al. Excess mucus viscosity and airway dehydration impact COPD airway clearance. Eur Respir J [Internet]. 2020 Jan [cited 2022 Oct 7];55(1):1900419. Available from: http://erj.ersjournals.com/lookup/doi/10.1183/13993003.00419-2019
  7. Luyster FS, Wang J, Sciurba FC, Bon J. Longitudinal associations between sleep disturbance and disease severity in patients with COPD. Sleep Science Practice [Internet]. 2020 Dec [cited 2022 Oct 7];4(1):12. Available from: https://sleep.biomedcentral.com/articles/10.1186/s41606-020-00046-y
  8. Soemarwoto RA, Mustofa S, Rusmini H, Triwahyuni T, Sukma AN. The correlation of sleep quality on symptoms and lung function in copd patients at the harum melati clinic, pringsewu, lampung province, indonesia. European Respiratory Journal [Internet]. 2021 Sep 5 [cited 2022 Oct 7];58(suppl 65). Available from: https://erj.ersjournals.com/content/58/suppl_65/PA940
  9. Wang J, Willis K, Barson E, Smallwood N. The complexity of mental health care for people with COPD: a qualitative study of clinicians’ perspectives. npj Prim Care Respir Med [Internet]. 2021 Dec [cited 2022 Oct 7];31(1):40. Available from: http://www.nature.com/articles/s41533-021-00252-w

Kadi Ajilogba

Master of Science - MS, Adult Health Nurse/Nursing, Keele University, England


With over 10 years of experience working within the healthcare industry, in both acute and mental health settings, I pride myself in being able to cater to the patient's needs using a holistic approach. I am an advocate for promoting patient safety and wellbeing and I also embrace the notion of making every contact count with patients of different backgrounds and cultures.

I have worked in mental health settings which means that I am able to deal with patients presenting with challenging behaviours or those perhaps going through a crisis. I am trained in PMVA (Prevention Management of Violence and Aggression) as well as Team Teach which looks at teaching positive behaviour management in order to support young people going through a mental health crisis.

Klarity is a citizen-centric health data management platform that enables citizens to securely access, control and share their own health data. Klarity Health Library aims to provide clear and evidence-based health and wellness related informative articles.