Pulmonary emphysema

Overview: What is emphysema?

The lungs consist of several million small air sacs called alveoli. They have very fine bronchial walls that look like very thin films through which gas exchange takes place. In the case of emphysema, the alveoli dissolve and larger bubbles form. This leads to a slow over-inflation of the lungs. Due to the reduced number of alveoli, the gas exchange surface decreases and there is a lack of oxygen. Destroyed alveoli can no longer be regenerated or repaired.

Morphological classification

Depending on the location and severity of the destruction of the lung tissue, emphysema is divided into different types.

Frequency of pulmonary emphysema

Around 400,000 people in Switzerland suffer from COPD. A considerable proportion of them also have pulmonary emphysema. According to the World Health Organization, COPD is the fourth most common cause of death.

Causes and risk factors: smoke and dust

The most common cause of emphysema is smoking and the resulting inflammation of the airways, which leads to the destruction of the alveoli. Other triggers also have a similar harmful effect to tobacco smoke and can contribute to emphysema, such as particulate matter, gases, vapors and organic antigens. These inhaled toxins trigger inflammatory processes that release proteases and elastases in the body, which in turn destroy the alveoli.

Other possible causes of emphysema are

• a rare, congenital developmental disorder of the lower respiratory tract,
• Lack of antioxidants,
• certain gene polymorphisms,
• Alpha-1-antitrypsin deficiency syndrome, an inherited metabolic disorder.

Alpha-1-antitrypsin deficiency syndrome as the cause of emphysema

Alpha-1-antitrypsin is a protein in the body that has the task of inhibiting certain enzymes, the so-called proteinases. These proteinases dissolve large quantities of important proteins if they are not properly regulated.

Alpha-1-antitrypsin deficiency is an inherited metabolic disorder in which there is not enough alpha-1-antitrypsin in the body. The proteinases thus have free rein and can destroy important protein-containing structures in the lungs and liver.

Pulmonary emphysema usually manifests itself between the ages of 30 and 50. Substitution therapy is sometimes effective in people with lung complications. Alpha-1-antitrypsin is administered intravenously in this therapy.

Psychological stress

Any physical illness can also be associated with psychological stress. This can manifest itself in worry, tension, circling thoughts or sleep disturbances, among other things, and can complicate the course of treatment. If you or your relatives desire psychiatric-psychological counseling and support, our specialists at the USZ will be happy to assist you.

Symptoms: Shortness of breath

In order to make a diagnosis, a medical history is taken and a physical examination is carried out. We notice signs of pulmonary emphysema as soon as we palpate and listen to the lungs. Breathing sounds are absent in the affected lung region and the diaphragm is also low.

Examinations for the correct diagnosis

• Spirometry: With spirometry, we measure and record your respiratory volume and airflow velocities to assess your lung function. You simply breathe in and out via a mouthpiece-tube system.
• Whole-body plethysmography: In whole-body plethysmography, we measure the flow rate of the air we breathe. You sit in a cabin with a closed air volume that looks like a small telephone booth and blow into a special device.
• Six-minute walk test: This test helps to assess your physical performance. You are asked to walk for six minutes on level ground at your own pace – on a circuit or in a corridor. Breaks and changes of pace are permitted during this time.
• Blood gas analysis: This is the measurement of oxygen and carbon dioxide levels in the blood.
• Blood tests: They contribute to the detection of concomitant diseases.
• X-rays: X-rays of the chest show a horizontal course of the ribs, flattened diaphragms and often a bell-shaped structure of the chest. The color of the diseased part of the lung is changed.
• Computed tomography of the lungs: This is used to quantify the emphysema and to identify the distribution of the emphysema (e.g. homogeneous or heterogeneous).
• Bronchoscopy: Using a flexible instrument equipped with a mini camera, which is inserted through the mouth into the airways, we can see the mucous membranes of the trachea and bronchi and, if necessary, take tissue samples.
• Genetic test: It helps to detect a possible alpha-1-antitrypsin deficiency.

Prevention, early detection, prognosis: avoid triggers

You can prevent emphysema by avoiding risk factors, especially smoking. If you are already ill, it makes sense to stop smoking and avoid possible complications from other illnesses – primarily infections – by getting vaccinated, especially against influenza and pneumococci.

Course and prognosis

Pulmonary emphysema cannot be cured because the destroyed alveoli cannot regenerate. The prognosis depends on the severity of the disease, but also on starting treatment in good time (especially stopping smoking!). If you as a smoker give up tobacco consumption immediately, this has a very positive effect on the prognosis.

Pulmonary hypertension as a complication of pulmonary emphysema

Pulmonary hypertension increases vascular resistance and blood pressure in the pulmonary circulation. Pulmonary emphysema can lead to secondary pulmonary hypertension: Those affected suffer from severely reduced physical performance, shortness of breath, water retention in the legs and rapid fatigue. Further consequences can be circulatory disorders with chest pain and brief loss of consciousness. Diagnosis is possible with a heart ultrasound (echocardiogram) or with a catheter examination (right heart catheterization).