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Information provided by the American Lung Association and used here with permission.

Chronic obstructive pulmonary disease (COPD): A Growing Problem

Chronic obstructive pulmonary disease, a term that generally applies to chronic bronchitis and/or emphysema, has increased by a dramatic 87.5 percent between 1970 and 1987.

Today, chronic bronchitis and emphysema combined constitute the most common chronic lung disease, affecting 14.8 million people in the U.S. The number of lives claimed by chronic lung disease has increased sharply, too. In 1979, it accounted for about 50,000 deaths. In 1982, the number rose to 59,000, and by 1987, the number of deaths reached 78,000.

What is Emphysema?

Emphysema is a condition in which there is over-inflation of structures in the lungs known as alveoli or air sacs. This over-inflation results from a breakdown of the walls of the alveoli, which causes a decrease in respiratory function (the way the lungs work) and often, breathlessness. Early symptoms or emphysema include shortness of breath and cough.

How Serious is Emphysema?

  • Emphysema is a widespread disease of the lungs. In 1987, 2.0 million people in the U.S. had emphysema.
  • It is estimated that 70,000 to 100,000 Americans living today were born with a deficiency of a protein known as alpha 1-antitrypsin (AAT) which can lead to an inherited form of emphysema.
  • Emphysema ranks ninth among chronic conditions that contribute to lack of activity: over 42% of individuals with emphysema report that their daily activities have been limited by the disease.
  • Many of the people with emphysema are older men, but the condition is increasing among women. Males with emphysema outnumber females by 64%.

Causes of Emphysema?

It is known from scientific research that the normal lung has a remarkable balance between two classes of chemicals with opposing actions. The lung also has a system of elastic fibers. The fibers allow the lungs to expand and contract. When the chemical balance is altered, the lungs lose the ability to protect themselves against the destruction of these elastic fibers. This is what happens in emphysema.

There are a number of reasons this chemical imbalance occurs. Smoking is responsible for 82% of chronic lung disease, including emphysema. Exposure to air pollution is one suspected cause. Irritating fumes and dusts on the job also are thought to be a factor.

A small number of people with emphysema have a rare inherited form of the disease called alpha 1-antitrypsin (AAT) deficiency-related emphysema, or early onset emphysema. This form of disease is caused by an inherited lack of a protein called alpha 1-antitrypsin (AAT).

How Does Emphysema Develop?

Emphysema begins with the destruction or air sacs (alveoli) in the lungs where oxygen from the air is exchanged for carbon dioxide in the blood. The walls of the air sacs are thin and fragile. Damage to the air sacs is irreversible and results in permanent "holes" in the tissues of the lower lungs. As air sacs are destroyed, the lungs are able to transfer less and less oxygen to the bloodstream, causing shortness of breath. The lungs also lose their elasticity. The patient experiences great difficulty exhaling.

Emphysema doesn't develop suddenly--it comes on very gradually. Years of exposure to the irritation of cigarette smoke usually precede the development of emphysema.

A person may initially visit the doctor because he or she has begun to feel short of breath during activity or exercise. As the disease progresses, a brief walk can be enough to bring on difficulty in breathing. Some people may have had chronic bronchitis before developing emphysema.

Treatment for Emphysema

Doctors can help persons with emphysema live more comfortably with their disease. The goal of treatment is to provide relief of symptoms and prevent progression of the disease with a minimum of side effects. The doctor's advice and treatment may include:

  • Quitting Smoking -- the single most important factor for maintaining healthy lungs.
  • Bronchodilator drugs (prescription drugs that relax and open up air passages in the lungs) -- may be prescribed to treat emphysema if there is a tendency toward airway constriction or tightening. These drugs may be inhaled as aerosol sprays or taken orally.
  • Antibiotics -- if you have a bacterial infection, such as pneumococcal pneumonia.
  • Exercise -- including breathing exercises to strengthen the muscles used in breathing as part of a pulmonary rehabilitation program to condition the rest of the body.
  • Treatment -- with Alpha 1-Proteins Inhibitor (A1PI) only if a person has AAT deficiency-flatted emphysema. A1PI is not recommended for those who develop emphysema as a result of cigarette smoking or other environmental factors.
  • Lung Transplantation -- Some recent reports have been encouraging. Experience at this point in time is limited.

Prevention of Emphysema

Continuing research is being done to find answers to many questions about emphysema, especially about the best ways to prevent the disease.

Researchers know that quitting smoking can prevent the occurrence and decrease the progression of emphysema. Other environmental controls can also help prevent the disease.

If an individual has emphysema, the doctor will work hard to prevent the disease from getting worse by keeping the patient healthy and clear of any infection. The patient can participate in this prevention effort by following these general health guidelines.

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