The Surgeon General is right. Cigarette smoking is hazardous—even lethal—to your health.

Affecting an estimated two million Americans, emphysema is a chronic respiratory condition, nearly always caused by the destruction of lung tissue by toxins contained in cigarette smoke. This in turn leads to chronic overinflation of the lungs, greatly decreasing their ability to function.

Like chronic bronchitis, emphysema is a chronic obstructive pulmonary disease (COPD) that evolves over a period of time. Specifically, emphysema destroys the structural architecture of the lungs and results in destruction of the alveoli, the approximately three million tiny air sacs in the lungs. Oxygen is delivered to the lungs and carbon dioxide is carried from the lungs across the walls of the alveoli; as more and more alveoli are damaged, it becomes harder and harder for the lungs to function, causing one or more of the following symptoms:

As the disease progresses, breathing becomes increasingly difficult. In its most severe stage, virtually any physical activity becomes extremely difficult, if not impossible. (To feel what it's like to have emphysema, try the following: take a very deep breath then, without exhaling, try to continue breathing in and out.)

What Causes Emphysema?

According to Dr. Joseph Zibrack, associate director of pulmonary and critical care medicine at Boston's Beth Israel Deaconess Medical Center, "Like chronic bronchitis, over 90% of all cases of emphysema are caused by long-term smoking of cigarettes or other tobacco products. [In rare cases], emphysema is inherited and results from a deficiency of a protein known as alpha-1 proteinase inhibitor (alpha-1)."

Diagnosis and Treatment

When a patient complains of the chronic presence of the symptoms of emphysema, a physical exam and various lung capacity tests are done to confirm the diagnosis. Chest x-rays may also be performed, but are only informative for moderate to later stages of emphysema.

Since, at present, emphysema cannot be cured, the goals of treatment are to:

Relieving Symptoms

To relieve symptoms, one or more of the following treatments may be used:

In recent years, three types of surgery have been performed to treat patients with severe COPD, emphysema, and chronic bronchitis. These include:

• Bullectomy: removal of blebs on the lungs, sometimes performed via laser
• Lung transplant
• Lung volume reduction surgery, where seriously damaged portions of the lungs are removed, allowing the less diseased and healthy portions to expand and work more efficiently

Both forms of surgery remain experimental, and at present, are only available to a small number of patients with COPD at hospitals and medical centers that are participating in research concerning these surgical procedures.

Stop Smoking

The treatments noted above can only help limit and relieve the symptoms of emphysema. To slow its progression, the agent causing emphysema must be removed. And since long-term smoking of cigarettes or other tobacco products causes the overwhelming number of cases of emphysema, the only effective way to slow the progression of emphysema is to quit smoking.

Prevention

To prevent the onset (or worsening) of emphysema, you should take the following steps:

As noted, emphysema does not suddenly occur. It develops over a long period of time. Unfortunately, many sufferers ignore their condition until it becomes serious, at which point treatment options are less effective. Therefore, at the first sign of any of the symptoms listed above, it is imperative that you immediately consult your health care provider. Time is of the essence!

Last reviewed January 2005 by Lawrence Frisch, MD, MPH

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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