Emphysema

Diagnosis

The diagnosis of emphysema often involves discussing the symptoms, evaluating the medical history, and performing a physical examination. During the physical exam, the doctor will use a stethoscope to listen to the lung sounds. The doctor will tap on the chest and listen for a hollow sound. A hollow sound indicates that the lungs are holding air.

If the doctor suspects emphysema, several tests will be required to confirm the diagnosis.

• Imaging tests: 
  • Chest X–ray: This procedure can examine the lungs. X–rays are frequently ineffective at detecting early stages of emphysema. It can show normal findings even with emphysema. They are more effective in detecting moderate to severe emphysema. This test can also assist in ruling out other reasons for shortness of breath. 
  • CT scan: It creates a three–dimensional image of the lungs. Emphysema can be detected and diagnosed using CT scans. It is also required for people who are candidates for lung surgery. A CT scan produces clearer images than an X–ray. 
• Lab tests: Blood testing and genetic studies may be requested to rule out alpha–1 antitrypsin deficiency as the cause of emphysema. Blood drawn from an artery in the wrist can be examined to see how well the lungs carry oxygen into the circulation and eliminate carbon dioxide.
• Lung function tests: The tests assess the efficiency with which the lungs inhale and exhale air. Spirometry may be used in testing. Spirometry measures the flow of air through the lungs using a spirometer machine. It also calculates how much air is in the lungs.

Treatment

There is no cure for emphysema, and the treatment primarily focuses on alleviating symptoms and enhancing an individual’s quality of life. As emphysema can worsen over time, the focus of treatment is on slowing down the progression of the disease and optimizing the function of the healthy lung tissue that remains.

The specific type of treatment for emphysema is dependent on the severity of the condition. In addition to quitting smoking, the treatment may consist of medication, therapy, or surgery. 

• Medications: Common medications to manage the symptoms of emphysema include:
  • Bronchodilators: These drugs relax the muscles that surround the airways. These medications can help reduce coughing, shortness of breath, and other breathing difficulties. They are more effective than oral drugs. Bronchodilators are also used to treat asthma and other lung diseases. 
  • Inhaled steroids: Corticosteroid drugs are often taken every day to help avoid the symptoms of emphysema. Inhaled corticosteroids diminish edema and mucus production in the airways. It reduces inflammation and may aid in the relief of shortness of breath. 
  • Antibiotics: These aid in the treatment of bacterial infections such as pneumonia, bronchitis, and other lung diseases. 
• Therapy 
  • Pulmonary rehabilitation: Breathing exercises and techniques can assist with minimizing the shortness of breath and enhance one’s capacity for physical activity. 
  • Dietary therapy: Nutritional guidance may be necessary in the early and late stage of emphysema. In most cases, people in the early stage may need to lose some weight, while those in the late stage may need to put on weight. 
  • Supplemental oxygen: Oxygen treatment can help if the lungs aren’t delivering enough oxygen to the blood. Most people with emphysema use oxygen the entire day. It is normally given through a machine via a nasal catheter or a facemask. Utilizing oxygen at home and during exercise might offer some comfort to people with severe emphysema and low blood oxygen levels. 
• Surgery: One or more surgical procedures may be recommended to manage the emphysema. This includes:
  • Lung volume reduction surgery: Eliminating the unhealthy tissue allows the remaining lung tissue to expand and function more efficiently, improving breathing. Doctors use this surgery to remove tiny wedges of diseased lung tissue.
  • Bronchoscopic lung volume reduction: In bronchoscopy lung volume reduction, a one–way valve is inserted into the airway. The valve permits air to exit but not enter in certain regions of the lungs. This reduces the amount of trapped air in the lungs, making breathing easier.
  • Lung transplant: In severe cases of emphysema, a lung transplant is typically viewed as a final option when all other alternatives have been explored. The procedure involves the replacement of one or both damaged lungs with healthy lungs obtained from a donor.