Enfisema

What is emphysema?

Emphysema is a lung condition that causes shortness of breath and cough. Over time, the inner walls of the air sacs in the lungs (alveoli) are weakened and the lining of the alveoli becomes damaged. This causes a smaller number of larger air spaces instead of lots of normal small ones.

The smaller number of larger air sacs causes a reduction in the overall surface area of the lungs. This means that less oxygen can be transferred from the air being breathed into the lungs into the bloodstream.

La mayoría de las personas con enfisema también tienen una afección llamada bronquitis crónica. La bronquitis crónica causa inflamación en los tubos (bronquios) que llevan el aire hacia y desde los pulmones. Esto conduce a una tos persistente y reduce aún más el aire que se respira en los pulmones. El enfisema y la bronquitis crónica son las dos condiciones que conforman enfermedad pulmonar obstructiva crónica (EPOC).

Emphysema symptoms

Los principales síntomas del enfisema son falta de aire y a cough, which usually begin gradually. As the emphysema in the lungs becomes worse, the symptoms also deteriorate.

Emphysema is a long-term condition that usually progresses over a number of years. Progress is often slow but can be faster in some people. There may be no symptoms for a long time and sometimes emphysema is found on chest x-rays even in people with no or few symptoms.

As the shortness of breath and the cough become progressively worse, it can become difficult to continue with normal activities and mobility. Emphysema eventually causes shortness of breath even at rest.

Stages of emphysema / COPD

Stage 1 - mild

Lung function is reduced to around 80% and symptoms are mild. They can often be assumed to be "just a smoker's cough". The cough increases at this stage and often there is production of phlegm. The most important action in this mild stage is to stop smoking which can reduce the worsening of emphysema. Exercise is important as well to try and increase the functioning of the lungs.

Stage 2 - moderate

Lung function is reduced to between 50 and 79%. This is the commonest stage for emphysema and COPD to be diagnosed as the symptoms are more troublesome. The symptoms are usually the same as in mild emphysema but more persistent with daily cough and phlegm.

Stage 3 - severe

Lung function is reduced to between 30 and 49% of normal. Symptoms are worse and more frequent at this stage. It is common to get more frequent infections as the lungs are no longer able to work to expel bacteria and viruses. It is usually difficult at this stage to exercise without getting out of breath very quickly.

Stage 4 - very severe

Lung function is reduced to less than 30%. This stage is also called "end-stage" emphysema or "end-stage" COPD because it is so severe and can be life-threatening; however, it is common to live for several years at this stage, but with reduced quality of life. Weight loss is common at this stage.

How common is emphysema?

In the UK it is thought that around 1.2 million people have COPD. This number represents 2 out of every 100 of the population, or between 4-5 out of 100 of all people aged over 40. It is much commoner in the North of England and in deprived areas. The rates of emphysema and COPD in the 10% most-deprived areas is double that in the least-deprived areas. The numbers of people with emphysema and COPD has not decreased in recent years, unlike most chronic health conditions.

Risk factors for and causes of emphysema

Factors that increase the risk of developing emphysema include:

• Fumar. Emphysema is most likely to develop in cigarette smokers; however, cigar and pipe smokers also are susceptible. The risk for all types of smokers increases with the number of years and amount of tobacco smoked. Around 50% of smokers will develop emphysema with around 20% of smokers developing more severe symptoms. 80% of deaths from COPD are related to smoking.

• Edad. Although the lung damage that occurs in emphysema develops gradually, most people with tobacco-related emphysema begin to experience symptoms of the disease between the ages of 40 and 60.

• Fumar pasivo. This means breathing in the smoke from someone else's cigarette, pipe or cigar. Being around secondhand smoke increases the risk of emphysema.

• Exposure to fumes or dust. People breathing fumes from certain chemicals or dust from grain, cotton, wood or mining products, are more likely to develop emphysema. This risk is even greater if they also smoke.

• Exposure to indoor and outdoor pollution. Breathing indoor pollutants (such as fumes from heating fuel), as well as outdoor pollutants (such as car exhaust) increases the risks of emphysema.

• Deficiencia de alfa-1-antitripsina. There is a rare genetic disorder called alpha-1-antitrypsin deficiency which leads to an inherited deficiency of a protein which protects the elastic structures in the lungs. People with this condition have a significantly higher risk of emphysema at a young age if they smoke. This can be diagnosed with a simple blood test.

Diagnosing emphysema

¿Qué pruebas se necesitan?

La prueba más común utilizada para ayudar a diagnosticar la condición se llama espirometría. Otras pruebas incluyen un radiografía de tórax y análisis de sangre para ayudar a excluir otras condiciones graves. Ocasionalmente, un especial tomografía computarizada (TC) del tórax - se necesita una TC de alta resolución.

Emphysema treatment

La parte más importante del tratamiento es reducir la exposición a cualquier causa, especialmente evitar fumar, incluido el tabaquismo pasivo. El tratamiento para muchas personas con enfisema es el mismo que para enfermedad pulmonar obstructiva crónica (EPOC) and includes inhalers and tablets to try and reduce the volume of phlegm produced.

Surgery (such as lung volume reduction surgery or a lung transplant) may be considered for advanced severe emphysema.

En el Reino Unido, el Instituto Nacional para la Excelencia en Salud y Atención (NICE) recomienda que la inserción de válvulas endobronquiales para reducir el volumen pulmonar puede considerarse como una opción de tratamiento. Un endobronchial valve es una pequeña válvula unidireccional, que se coloca en una vía aérea (bronquio), generalmente utilizando un broncoscopio. La válvula permite que el aire salga del pulmón al exhalar, pero bloquea la entrada de aire a ese pulmón al inhalar. Esto ayuda a eliminar el exceso de aire atrapado en los pulmones en el enfisema.

Complications of emphysema

People who have emphysema are also more likely to develop:

• Infecciones del pecho. These can occur frequently.

• Collapsed lung (pneumothorax). A collapsed lung can be life-threatening in people who have severe emphysema, because the function of their lungs is already so compromised. This is uncommon but serious when it occurs.

• Problemas del corazón. Emphysema can increase the pressure in the arteries that connect the heart and lungs. This can cause failure of the right side of the heart, which pumps blood to the lungs (this condition is called cor pulmonale).

• Large holes in the lungs (bullae). The bullae can be as very large. These bullae reduce the transfer of oxygen into the bloodstream and also increase the risk of a pneumothorax.

Preventing emphysema

This risk of emphysema can be greatly reduced by:

• No fumar.

• Avoiding passive smoking.

• Wearing a mask to protect the lungs if working with chemical fumes or dust.