Emphysema

Diagnosis

Diagnosis of emphysema involves a combination of medical history review, physical examination, and specific tests to assess lung function and structure.

Medical and physical evaluation:
Your healthcare provider will ask about your smoking history, exposure to lung irritants, and family medical history. A physical examination includes listening to your lungs to detect abnormal breath sounds.

Imaging tests:

• Chest X-ray: This test may reveal lung damage caused by emphysema and helps rule out other possible causes of symptoms, though mild emphysema might not always appear on X-rays.

• CT scan: A computerized tomography (CT) scan provides detailed cross-sectional images of the lungs, offering greater clarity than X-rays. It helps identify the extent of lung damage, detect emphysema, and assess whether surgery may be beneficial. It can also be used to screen for lung cancer.

Lung function tests:
Also known as pulmonary function tests, these measure how well your lungs move air and transfer oxygen to your blood.

• Spirometry: The most common test for diagnosing emphysema. You blow into a tube attached to a machine that measures how much air your lungs can hold and how quickly you can exhale. This test helps determine airflow obstruction.

• Additional tests: These may include lung volume measurement, diffusing capacity test, six-minute walk test, and pulse oximetry to evaluate oxygen levels in your blood.

Lab tests:
While blood tests don’t directly diagnose emphysema, they provide supporting information.

• Arterial blood gas analysis: Measures how effectively your lungs are supplying oxygen and removing carbon dioxide.

• Alpha-1-antitrypsin (AAT) deficiency testing: Determines if a hereditary enzyme deficiency is contributing to emphysema development.

Treatment

Treatment for emphysema aims to manage symptoms, prevent complications, and slow disease progression.

Quitting smoking:
The most critical step in treatment is to stop smoking. Quitting prevents further lung damage and helps maintain breathing capacity. Healthcare providers can recommend nicotine replacement therapy, medications, and support programs to assist with quitting.

Medications:
Most medications are inhaled, delivering medicine directly to the lungs for fast relief and minimal side effects.

• Bronchodilators: Help relax airway muscles, reduce coughing, and make breathing easier. They may be short-acting (used before activity) or long-acting (used daily).

• Inhaled steroids: Reduce airway inflammation and prevent flare-ups (exacerbations). Possible side effects include hoarseness and mouth infections.

• Combination inhalers: Contain both bronchodilators and steroids for enhanced effectiveness.

• Antibiotics: Used when bacterial infections such as pneumonia worsen symptoms.

• Oral steroids: Short courses may help during severe flare-ups, but long-term use can cause serious side effects like diabetes, osteoporosis, and weight gain.

Lung therapies:

• Pulmonary rehabilitation: A comprehensive program combining exercise, education, and counseling to improve lung function and quality of life.

• Nutrition therapy: Early-stage patients may need to lose weight, while advanced cases may require nutritional support to gain weight.

• Oxygen therapy: For severe emphysema, extra oxygen delivered through nasal tubes or masks can help ease breathing, especially during activity or sleep.

Managing exacerbations:
During flare-ups, treatment may involve antibiotics, oral steroids, or oxygen therapy. In severe cases, hospitalization may be needed. Preventing future episodes is key through consistent medication use and avoiding triggers.

Surgical options:

• Lung volume reduction surgery: Removes damaged lung tissue, allowing healthier areas to expand and function more effectively.

• Endoscopic lung volume reduction (endobronchial valve surgery): A minimally invasive procedure using valves to collapse damaged lung sections.

• Bullectomy: Removes large air sacs (bullae) that interfere with normal breathing.

• Lung transplant: For advanced cases, a transplant can restore function, though it carries serious risks such as organ rejection and lifelong immunosuppressive medication.

Alpha-1-antitrypsin deficiency management:
If emphysema is linked to AAT deficiency, treatment may include protein replacement therapy along with standard emphysema management. This therapy helps prevent further lung damage and slow disease progression.