Emphysema

Pulmonary emphysema leads to overinflation or damage to the alveoli. The air space in the lungs is abnormally enlarged by the emphysema of the lungs. The overinflation cannot be reversed. The walls of the alveoli are damaged and destroyed.

The exchange of breathing gases between blood and alveolar air takes place in the microscopic alveoli - that is, oxygen enters the body with the help of the alveoli and carbon dioxide is given off. Due to the damage to the alveoli, less or too little oxygen is supplied to the body in the course of the disease.

The symptoms include in particular shortness of breath (initially during exertion, in the advanced stages also at rest). There is also a cough. In addition, a severe form of emaciation can appear (cachexia). Pulmonary emphysema is chronic. It develops over years and progresses slowly.

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What are the causes of emphysema?
How is the diagnosis made?
How is the treatment carried out?
Whom can I ask?

What are the causes of emphysema?

Pulmonary emphysema occurs in connection with diseases, such as chronic obstructive pulmonary disease (COPD). During the development and course of COPD, chronically inflamed bronchi and / or damaged or distended alveoli (emphysema), some of which are also destroyed. The constant narrowing of the airways makes breathing, the absorption of oxygen and the release of carbon dioxide more difficult. For those affected, this means an insufficient supply of oxygen, which affects the entire body. The cardiovascular system and muscles are impaired and are no longer fully efficient. In addition, organs can be damaged if the respiratory function is severely impaired. The risk of a so-called exacerbation, an acute deterioration, increases especially with severe illness. See COPD for more information.

Pulmonary emphysema is particularly affected by smokers. Passive smoke and other pollutants in the air or at the workplace (air pollution, fine dust, quartz dust, exhaust gases, etc.) can also lead to emphysema. More information on smoking and air pollutants.

Pulmonary emphysema can be the result of a rare, genetically determined metabolic disease - alpha-1-antitrypsin deficiency - in which the inborn deficiency of a certain protein causes damage to lung tissue, among other things.

Also age-related can lead to lung overinflation due to a loss of elasticity. An expansion of the alveoli also occurs in diseases associated with fibrosis.

How is the diagnosis made?

The diagnosis is based on the medical history and various examinations. Among other things, the following are carried out:

Physical examination (e.g. auscultation),
Spirometry,
Blood gas analysis,
possibly x-ray of the chest area as well
possibly CT.

A possible alpha-1 antitrypsin deficiency is clarified by means of a blood test.

How is the treatment carried out?

Therapy includes various measures, e.g.

Avoiding harmful substances. Stop smoking, avoiding passive smoke and other pollutants (fine dust pollution). More information about quitting smoking.
Medicines to widen the airways (bronchi), anti-inflammatory preparations and antibiotics (for bacterial infections).
Further therapies and measures. Oxygen therapy (with portable and / or stationary systems), respiratory physiotherapy, strength and endurance training, healthy nutrition, possibly weight normalization.
Surgical interventions. With advanced emphysema, emphysema bubbles that displace “healthy” lung tissue can be surgically removed (bullectomy). Lung tissue that has been damaged by emphysema can also be removed in order to achieve a reduction in lung volume (bronchoscopic lung volume reduction - LVR). In very severe cases, a lung transplant is considered.
Treatment of the underlying disease that leads to emphysema, e.g. COPD, alpha-1-antitrypsin deficiency) and other diseases that can occur in the course of emphysema, e.g. right heart failure.

Whom can I ask?

The contact persons are pulmonologists (pulmonologists). The family doctor can also be consulted in the event of complaints and referrals can be initiated. Occupational physicians can also be involved.

Spirometry can be performed by resident pulmonologists, appropriately trained internists, general practitioners or in hospitals. Other specialists (e.g. for internal medicine) can be involved in the therapy. A referral can also be made to the respective departments of a clinic / hospital.

Respiratory physiotherapists and other professional groups (health professions) (e.g. dieticians, nutritionists, etc.) can also be involved in the treatment.