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Health Topics
C.O.P.D. and Emphysema

Chronic Obstructive Pulmonary Disease is a group of conditions the produce difficulty with expiration (breathing out). The group includes chronic bronchitis, emphysema, chronic obstructive airways disease and some cases of asthma. There may be an inherited tendency to the disease. Exposure to chemical fumes or dust in the workplace is another possible cause but cigarette smoking is responsible for about 90% of cases of C.O.P.D.

The are various symptoms including early morning cough, shortness of breath on exertion, persistent coughing, mucus and phlegm, wheezing, repeated chest infection, leg swelling and blue lips.

There is no cure for C.O.P.D. and treatment is aimed at relieving symptoms. Patients should stop smoking and avoid other airborne irritants. Pulmonary rehabilitation programmes can improve respiratory symptoms and can increase exercise capacity and mobility. Vaccinations against flu and pneumonia are often recommended as these infections can worsen existing C.O.P.D. Patients are often prescribed inhalers to reduce muscle spasm and inflammation. Physiotherapy can also help to educate sufferers about exercise, breathing techniques, improving respiratory muscle function and relaxation. It is important to have adequate fluid intake so that secretions don’t become thick and hard to cough up. Some of those with severe symptoms may need oxygen therapy.

Some dietary supplements may be of help. Vitamin C, Zinc and Echinacea may be useful for the immune system. Antioxidants, such as vitamin E, grape seed extract and selenium may help with inflammation. Garlic might help to combat bacterial infection and omega-3 fatty acids may also be of benefit.

Emphysema is one of the conditions leading to C.O.P.D. It prevents adequate oxygen from reaching the blood. There is destruction of the small air sacs in the lungs with over-inflation of the lungs. This causes a loss of elasticity in the lungs, preventing gases from being exchanged properly. This in turn interferes with the levels of oxygen and carbon dioxide in the blood. Emphysema is nearly always caused by smoking and occurs most often in smokers over fifty years of age. There is no cure but careful management can improve symptoms and prolong life expectancy. Eventually the disease will progress to either right-sided heart failure or respiratory failure.

A different condition called pulmonary interstitial Emphysema can occur in newborn babies. The air leaks out through the alveoli into the surrounding space and affects babies with poor lung function such as those on mechanical ventilators, premature births and those with respiratory distress syndrome. The condition usually resolves over days or weeks.

The symptoms of Emphysema do not appear until at least one third of lung function has been compromised. The symptoms include shortness of breath, cough or wheeze, barrel-shaped chest due to over-inflation of the lungs, weight loss and little or no mucus produced when coughing.

The best way to prevent Emphysema is to stop smoking. Even those already with the condition will benefit from stopping. This is the only treatment known to reduce the rapid decline in lung function. The condition requires ongoing monitoring and treatment. The main aim of the treatment is to prevent chest infections and inflammation in the lungs. This can include antibiotics and anti-inflammatory drugs. As the condition progresses the patient may need an oxygen mask at home. The oxygen therapy is particularly necessary when sleeping as oxygen loss and hyperventilation is greater when lying down. The activity levels of sufferers may become increasingly restricted.

Surgical treatment is rare but possible. Lung volume reduction surgery involves removing the damaged portions of the lung (usually about 20-30% of each lung) to improve oxygen exchange and elasticity. It is an option for severe cases in people under 75 years of age. Short-term results are good but temporary and lung function usually deteriorates again after two or three years. For this reason it is not often recommended. Total lung transplantation will restore the lung function to normal but the mortality rates following this surgery are high (50% in five years) and because of the shortage of donor organs, it is only considered in a very young patient.

Further information is available from the Irish Thoracic Society on its website:

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Kevin McCormack B.Sc. Pharm. MPSI