Emphysema Explained Simply

"When you can't breathe, nothing else matters" - American Lung Association

The best way to explain emphysema as simple as possible is this. "I can inhale, but I cannot exhale." What I tell my patient's family members is to take a deep breath in. OK...now only blow out a little bit of that breath...now breathe on top of that. It is a very difficult thing to do for very long, but that is how people with COPD breathe. When Momma said, "In with the good air, out with the bad air," She was right. So there are a lot of things in the mechanics of breathing that is compromised when a person has emphysema.

1. They cannot exhale completely. Your Doctor might mention that your lungs are "hyperinflated."

One of the things that gets taught in Pulmonary Rehab is pursed lipped breathing. What this does is keep the airways open longer to allow just a little more "bad" air out. This is a very difficult thing to do when one is short of breath. So our Rehab patients are taught to do this before breathing becomes a crisis.

2. The air sacs in the lungs (alveoli) are not able to exchange oxygen (O2) with the blood vessels as well as they should, so the carbon dioxide (CO2) starts to build up in the system. As this happens, the body will try and compensate for it. If it happens too quickly, the person will become confused and very sleepy. It is essential to get this person to the hospital right away as they can eventually stop breathing.

Please note: If a person has home O2, do not keep turning up their Oxygen so that they can get more into their system. People with normal lungs, without COPD, breathe because our CO2 is climbing. This sends a signal to our brain that says, "take a breath". That signal becomes short circuited in people with Emphysema. The brain says that they need to take a breath because they need more oxygen. So the more that you turn up their O2, the less they feel the need to breathe until, eventually, they could stop breathing.

3. Because of the person not being able to exhale completely, the lungs become hyper-inflated and lose that ability to be elastic and spring back. It is like blowing up an balloon and deflating it and blowing it up again and deflating it...etc...eventually the balloon does not go back to it's original shape. That is the problem with the lungs also. It means that a person with emphysema has to depend on other muscles to help them breathe. You may see them doing a lot of "tummy breathing", or shoulder breathing.

When one comes to the hospital with a "COPD exacerbation" it means that they are in crisis. They feel that they cannot breathe. If they feel that they cannot breathe it is not up to family members or hospital staff to tell them to calm down. It is up to them to take action. Once a person gets to the hospital, they can do several things to help:

a. Oxygen - A lot of times a person with emphysema is already on oxygen. Again, do not turn the oxygen up too high on your loved one with this lung disease.

b. BiPap - This wonderful invention causes a positive pressure in the lungs keeping them open so that the COPDer can exhale, exchange gases, and blow off that ever rising CO2. It is a very uncomfortable, tight fitting mask that uses positive pressure to do it's work. Most people have a difficult time adjusting to it at first, but once they feel that they can finally breathe, some of our patients fall in love with it and it is difficult to make them take it off.

c. Medications - Contrary to popular belief, Albuterol will not cure everything. So what is given is some sort of nebulized medication that will open up the lungs such as Albuterol or Levalbuterol. Solumedrol to reduce the inflammation in the lungs, an inhaled corticosteroid such as pulmicort to also help reduce the inflammation. Something to calm. Believe me, if a person cannot breathe, they are going to be a bit anxious. It is a vicious cycle: Can't breathe-Anxiety-breathing worse-more anxiety-breathing worse-etc...

The thing that people say to these people who come into the ER is relax or calm down. I tell those well meaning people to put a pillow over their face until they can't breathe, but keep it there and try to stay calm...it is impossible. It is the fight or fight system in the body. One is not going to calm down until they can breathe...and the anxiety is making it harder for them to breathe, so medication is indicated.

The number one cause of emphysema is cigarette smoking. It can be first hand smoke or even worse, second hand smoke.

This is not a technical article, but one that does explain emphysema simply.
I hope that I was able to answer some questions.