emphysema

 

Description of Emphysema

Emphysema is classified as a type of Chronic Obstructive Pulmonary disease (COPD), a condition that makes it hard for a person to breathe.[1]Emphysema, therefore, is a lung condition that is characterized by shortness in breath. The breathing system’s function is compromised in two main points: the air sacs and the breathing tubes. These are crucial in breathing given that the breathing tubes allow the movement of air while the air sacs facilitate absorption of oxygen and the release of Carbon dioxide.[2]For good breathing, the breathing tubes such as the trachea and bronchi are required to remain open. However, under this condition, these tubes collapse due to the destruction of the tissues that keep them open hindering air from flowing freely. The air sacs’ walls, on the other hand, are destroyed with the result being enlarged sacs which lowers the surface area of oxygen absorption. Ultimately, one experiences shortness of breath. The major cause of Emphysema is the habitual smoking of cigarettes. Other airborne irritants have also been found to lead to this condition. These include chemical fumes and other forms of air pollution.[3]

History of Emphysema

The history of Emphysema has only dated as far the available records. It is documented that in the earlier days, physicians were often erroneous in classifying emphysema as asthma.[4]It was only later on in the 17^th century when doctors realized that several characteristics set it apart from asthma. Theophile Bonet, Swiss physician described emphysema as a different condition after having performed many autopsies. He observed that cadavers who had suffered from this disease suffered from unusually large lungs.[5]The 19^th century brought further enlightening into the condition after a different physician Rene Laennec accurately described this condition as a breakdown of tissue in the air sacs and tubes.[6]This clearly set Emphysema apart from asthma, eliminating the confusion. Given that smoking was not very rampant at the time, Rene concluded that emphysema was mainly caused by genetic factors and air pollution.[7]Further research in the 20^th Century led to the invention of devices that are essential in the diagnosis of the condition such as the FEV1 that was used to measure expiratory flow.[8]Today, Emphysema is well understood as lung disease, together with its causes, symptoms, diagnosis, treatment, prevention, and risk factors.

 

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Anatomy of the Breathing System

Emphysema affects the respiratory system.[9]This is the system responsible for gaseous exchange i.e. the absorption of oxygen for respiration and the release of CO₂ which is a byproduct of respiration.[10]It consists of various organs including the nose, pharynx, and larynx which form the upper part of the respiratory tract while the lower tract is composed of the trachea, bronchi, and alveoli. The nose enables the intake of air from the atmosphere which then moves down through the pharynx and the breathing tubes including the trachea and the bronchi. Eventually, the air gets into small sacs found in the lungs, referred to as air sacs. These sacs have a rich supply of blood vessels. It is important that the blood vessels are in close contact with the alveoli for air to diffuse across. The gaseous exchange then occurs at this point whereby, the oxygen diffuses across into the blood while CO₂ in the blood gets into the lungs and is breathed out. This process is repeated continuously to sustain respiration in the body.[11]

Effects on the Circulatory System

Emphysema can extend its effect to the circulatory system which consists of the heart, blood, and the blood vessels. Both the respiratory and the circulatory system are closely related. The heart pumps deoxygenated blood to the lungs through the pulmonary artery where the gaseous exchange occurs, returning oxygenated blood to the heart via the pulmonary vein. Severe emphysema can create high pressure in this artery due to expanded alveoli. The result is high pressure in the heart causing it to expand and ultimately weaken.[12]

Cause of Emphysema

Emphysema has been found to be caused by the inhalation of airborne substances that irritate the respiratory system. These substances include the leading cause which is cigarette smoking, dust, and other forms of fumes. Second-hand smokers are not exempted from the risk. Besides air pollution, a hereditary factor has also been found to be a cause of Emphysema. This factor is the deficiency of alpha-1 antitrypsin, a protein that is essential in the protection of the lungs from damage. Besides these causes, there are several risk factors that expose one to this disease such as smoking, exposure to smoking, and age.[13]

Signs and Symptoms

The major symptom of this condition is the shortness of breath. It should, however, be noted that this develops gradually. At first, this symptom is only experienced during demanding physical activities and might be dismissed as a normal occurrence. With time, the shortness of breath occurs even during resting periods.[14]

Diagnosis of Emphysema

Primarily, the diagnosis of Emphysema is done using breathing tests, although it should be noted that such a diagnosis can also be done with the help of a chest CT scan. When it comes to a breathing test, a patient exhales into a machine that has the capacity to measure airflow obstruction. Additionally, damage to the air sacs can be determined using the breathing test whereby, fluctuations in the value of air exhaled suggests damage. Using the breathing test accompanied by several questions such as whether the patient is a smoker, the physician can determine whether the patient is suffering from emphysema.[15]

Complications, Treatment, and Side Effects

Unfortunately, currently, the damage done to the lungs cannot be treated. However, there are treatments available for managing the condition. These treatments are known as bronchodilators.[16]They are inhaled to keep the breathing tubes open. Most importantly, it is strongly recommended that affected persons stop smoking immediately and avoid exposure to polluted air. In extreme cases, oxygen may be prescribed. In situations where the damage to the lung is excessive, an operation can be done to remove the badly affected parts.

Failure to adhere to such treatment can result in severe complications including heart problems, collapsing of the lungs, and bullae. Heart problems result from increased pressure in the pulmonary artery leading to the expansion and consequent weakening of the heart. Collapsing of the lungs is due to severe emphysema while bullae refer to large empty spaces within the lungs which limit the volume of lung expansion.[17]

Conclusion

Currently, research is ongoing in attempts to find a cure for Emphysema. So far, the outcome of such research has been promising with recent reports of a possibility of blocking a molecular pathway to prevent further damaging inflammation associated with emphysema.[18]If this effort is successful, then we will obtain a cure for this condition. For now, however, the condition can only be managed. People can prevent themselves from this condition by ensuring that they avoid smoking and other harmful air pollutants that irritate the lungs.

 

References

[1] Lareau, S. C., Fahy, B., Meek, P., & Wang, A. (2019). Chronic Obstructive Pulmonary Disease (COPD). American journal of respiratory and critical care medicine, 199(1), P1-P2.

 

[2] Lareau, S. C., Fahy, B., Meek, P., & Wang, A. (2019). Chronic Obstructive Pulmonary Disease (COPD). American journal of respiratory and critical care medicine, 199(1), P1-P2.

 

[3] Lareau, S. C., Fahy, B., Meek, P., & Wang, A. (2019). Chronic Obstructive Pulmonary Disease (COPD). American journal of respiratory and critical care medicine, 199(1), P1-P2.

 

[4] Porpodis, K., Zarogoulidis, P., Spyratos, D., Domvri, K., Kioumis, I., Angelis, N., … & Tsakiridis, K. (2014). Pneumothorax and asthma. Journal of thoracic disease, 6(Suppl 1), S152.

 

[5] Guimarães, M., Bugalho, A., Oliveira, A. S., Moita, J., & Marques, A. (2016). COPD control: Can a consensus be found?. Revista Portuguesa de Pneumologia (English Edition), 22(3), 167-176.

 

[6] Medeiros, B. J. D. C. (2018). Subcutaneous emphysema, a different way to diagnose. Revista da Associação Médica Brasileira, 64(2), 159-163.

 

[7] Medeiros, B. J. D. C. (2018). Subcutaneous emphysema, a different way to diagnose. Revista da Associação Médica Brasileira, 64(2), 159-163.

 

[8] Pirozzi, C. S., Gu, T., Quibrera, P., Carretta, E., Han, M. K., Murray, S., … & Martinez, C. (2018, January). Heterogeneous Burden of Emphysema and Functional Small Airway Abnormalities in Smokers with FEV1/FVC Ratio Above Lower Limit of Normal but Below 0.7. In American Thoracic Society International Conference Abstracts. Am J Respir Crit Care Med (Vol. 197, p. A6397).

[9] Lareau, S. C., Fahy, B., Meek, P., & Wang, A. (2019). Chronic Obstructive Pulmonary Disease (COPD). American journal of respiratory and critical care medicine, 199(1), P1-P2.

 

[10] Jaeger, J. M., Titus, B. J., & Blank, R. S. (2019). Essential anatomy and physiology of the respiratory system and the pulmonary circulation. In Principles and practice of anesthesia for thoracic surgery (pp. 65-92). Springer, Cham.

 

[11] Jaeger, J. M., Titus, B. J., & Blank, R. S. (2019). Essential anatomy and physiology of the respiratory system and the pulmonary circulation. In Principles and practice of anesthesia for thoracic surgery (pp. 65-92). Springer, Cham.

[12] Mirabelli, M. C., Boehmer, T. K., Damon, S. A., Sircar, K. D., Wall, H. K., Yip, F. Y., … & Garbe, P. L. (2018). Air quality awareness among US adults with respiratory and heart disease. American journal of preventive medicine, 54(5), 679-687

 

[13] Lareau, S. C., Fahy, B., Meek, P., & Wang, A. (2019). Chronic Obstructive Pulmonary Disease (COPD). American journal of respiratory and critical care medicine, 199(1), P1-P2.

 

[14] Lareau, S. C., Fahy, B., Meek, P., & Wang, A. (2019). Chronic Obstructive Pulmonary Disease (COPD). American journal of respiratory and critical care medicine, 199(1), P1-P2.

 

[15] Medeiros, B. J. D. C. (2018). Subcutaneous emphysema, a different way to diagnose. Revista da Associação Médica Brasileira, 64(2), 159-163.

[16] van Geffen, W. H., Kerstjens, H. A., & Slebos, D. J. (2017). Emerging bronchoscopic treatments for chronic obstructive pulmonary disease. Pharmacology & therapeutics, 179, 96-101.

 

[17] Kontogianni, K., Gerovasili, V., Gompelmann, D., Schuhmann, M., Hoffmann, H., Heussel, C. P., … & Eberhardt, R. (2017). Coil therapy for patients with severe emphysema and bilateral incomplete fissures–effectiveness and complications after 1-year follow-up: a single-center experience. International journal of chronic obstructive pulmonary disease, 12, 383.

 

[18] Tsantikos, E., Lau, M., Castelino, C. M., Maxwell, M. J., Passey, S. L., Hansen, M. J., … & Anderson, G. P. (2018). Granulocyte-CSF links destructive inflammation and comorbidities in obstructive lung disease. The Journal of clinical investigation, 128(6).

 

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