Emphysema: Leaving you breathless

THERE are three things that make a man to become instantly breathless: Watching a tsunami before it engulfs you, meeting a beautiful woman, and puffing cigarettes. Generally, people who have been smoking for a long time develop “smoker’s cough” which medical science called as emphysema.
"The main symptom of emphysema is shortness of breath, which is likely to get worse gradually over a period of years," writes Dr. Gary S. Sy in his column which appeared in a national daily. "If you have emphysema, your chest may become distended into a barrel-like shape. If you also wheeze, cough, and bring up phlegm, these are symptoms of bronchitis and asthma, which frequently coexist with emphysema."

Emphysema is a long-term, progressive disease of the lung(s) and occurs when the alveolar walls are destroyed along with the capillary blood vessels that run within them. This lessens the total area within the lung where blood and air can come together, limiting the potential for oxygen and carbon dioxide transfer.

"In early emphysema," explains Dr. Ben Wedro, who practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin, “there is associated inflammation of the small airways or bronchioles that limits the amount of air that can flow to the alveoli. In more severe emphysema, there is also loss of elasticity in the alveolar walls that have not been destroyed.”

"When the person breathes out, the alveoli and small airways collapse. The loss of elasticity of the lung tissue makes it harder for air to get to the periphery or furthest part of the lung during inhalation, and also harder for air to exit the damaged part of the lung during exhalation," the American doctor adds.

As more of the lung is destroyed and the lung cannot maintain oxygen concentrations in the bloodstream, the body compensates by gradually increasing the breathing rate. After a while, even hyperventilation cannot maintain adequate oxygen levels, and the arteries in the lung begin to constrict or narrow.

"The heart has to work harder to push blood into these narrower blood vessels, causing the blood pressure in the lung arteries to increase," Dr. Wedro says. "Over time, the extra work requirement causes the heart muscle to enlarge and can cause heart failure."

Although emphysema is usually irreversible, there are some things a patient can do to deemphasize the disease and breathe easier. Here’s how to make that happen:

1. Stop smoking now! Yes, you’re doctor has already told you. But the point can’t be stressed enough. “When you stop smoking, you slow the deterioration of your lungs, and that’s probably the best thing you can do once you’ve been diagnosed with emphysema,” says Dr. Mark J. Rosen, chief of the Division of Pulmonary and Critical Care Medicine at Beth Israel Medical Center in New York City. “Besides that, you will boost longer your feeling of well-being. And you’ll be able to exercise longer, which will improve your comfort in breathing.”

2. Get your heart pumping. Most experts agree that regular exercise is vitally important to the emphysema sufferer. “Aerobic exercise is very important for people with emphysema because it strengthens the heart and can help improve your breathing,” says Dr. Rosen. “Walking is probably the best thing you can do, and you should try to do it every day.”

3. Build your body, too. What good are bulging biceps when you have trouble breathing. “The muscles in your shoulders, arms and upper chest comprise one of the two muscle groups that participate in breathing,” says Dr. Barry Make, director of pulmonary rehabilitation at the National Jewish Center for Immunology and Respiratory Medicine in Denver. (The other, if you care to know, is diaphragm.)

Whether it’s doing some simple exercises while holding wrist or hand weights or starting a full-fledged weight-training program, anything you can do to build your upper body strength will help your breathing. But make sure you breathe correctly while pumping iron: Exhale through pursed lips as your lift, and inhale as you relax.

4. Eat little and often. Since people with emphysema cannot fully exhale, the lungs enlarge with trapped air. The enlarged lungs push down into the abdomen, leaving less room for the stomach to expand -- making eating uncomfortable. That’s why six small meals will make sufferer better than three large ones. “Besides eating a lot of little meals, it’s also important to take small bites, to eat slowly and to chew your food well, which will make it easier on your breathing,” Dr. Make says.

5. Try eating vitamin C-rich foods. “Some evidence suggests that vitamin C may help protect against a decline in lung function,” says Dr. Joel Schwartz, an epidemiologist and senior scientist at the US Environmental Protection Agency. “It may be a very minimal effect in those with emphysema, but eating food rich in vitamin C certainly won’t hurt and may help.” Good sources of vitamin C include citrus fruits, guava, mango, pineapple, strawberries and other fruits, as well as pepper and broccoli.

6. Relax. “If you cognitively view the disease as a threat, you’ll arouse some physiological mechanisms that can make your emphysema worse,” says Dr. Francisco Perez, a clinical assistant professor of neurology and physical medicine at Baylor College of Medicine. “When you’re in constant state of alarm, you’re demanding a lot of oxygen in the process. Alarm is created by the thought process, which you can control. That means you can also control the physiological mechanisms.”