End-stage emphysema, or stage 4 emphysema, can mean living with a decade or more of breathing problems, tiredness, heart problems or other health concerns that impact your ability to live your life to your fullest.
Because emphysema, like other forms of COPD, reduces the amount of oxygen that can reach your bloodstream, the heart works harder to spread oxygen throughout the body. A person with severe emphysema may get tired easily, may have chest pains or palpitations, or experience headaches, sleep problems, and irritability.
“There is no cure for emphysema or COPD, but our goal is to help slow the progression of the disease,” said Faisal Khan, MD, a Greenwood pulmonologist who practices at Franciscan Health Indianapolis.
What Is Emphysema?
Emphysema is a lung disease that damages the air sacs in the lungs, leading to shortness of breath and reducing how much oxygen is delivered into the bloodstream.
Emphysema permanently damages the alveoli, or air sacs, in your lungs, making it harder for your body to breathe. Emphysema weakens and ruptures these air sacs. With less air sacs there is less area for oxygen to reach your bloodstream.
Although treatment may slow progression of the condition, it can't reverse the damage.
What Is The Difference Between Emphysema And COPD?
Emphysema, along with chronic bronchitis, falls under a group of lung diseases known as COPD (chronic obstructive pulmonary disease). These lung diseases cause airflow blockage and breathing problems.
How Common Is End-Stage Emphysema?
Stage 3 emphysema is when you have less than 50% lung function remaining, and stage 4 (or end-stage emphysema) is when you have less than 30% lung function left.
More than 140,000 people in Indiana and about 65,000 people in Illinois have emphysema, and about one-third of those patients have severe emphysema (stage 3 and 4).
In all, COPD is the third-leading cause of death in the US and affects 373,000 people in Indiana.
What Causes Emphysema?
Smoking is the leading cause of emphysema, which makes it one of the most preventable respiratory diseases. Emphysema is most common in men between 50 and 70 years of age. Cigarette smoking is the cause in about 9 in 10 people with emphysema. A smoker is 10 times more likely to die from COPD than a nonsmoker.
If a smoker quits before emphysema develops, the decline levels off until it is nearly normal for the person's age. Smokers who quit also see an improved life expectancy.
Scientists believe that other factors are involved in the disease, because only 3 in 20 to 1 in 5 smokers develops emphysema. Other factors that may contribute to emphysema include air pollution, fumes, and dust in the workplace.
There is also a rare, inherited form of the disease called alpha 1-antitrypsin (AAT) deficiency-related pulmonary emphysema or early onset pulmonary emphysema.
What Are The Symptoms Of Emphysema?
Emphysema usually comes on slowly, as the disease destroys lung tissue gradually. Early emphysema symptoms include occasional shortness of breath and fatigue, but the lung disease is often not diagnosed for years, until it has damaged more than half of your lungs’ air sacs.
Symptoms of emphysema include:
- Shortness of breath, particularly during light exercise
- Long-term cough
- Feeling of not getting enough air
- Mental fog
- Wheezing
- Ongoing mucus production
- Constant fatigue
- An enlarged heart because of damaged lungs
- Swelling of the ankles, legs or abdomen
- A bluish tinge to skin, lips and nails due to poor oxygen supply.
Can Emphysema Be Cured?
Emphysema cannot be cured, as lung tissue cannot be regrown, but treatment may slow the progression of the disease.
How Do You Treat Emphysema In The Lungs?
“Our goal when treating people with severe emphysema is to help them live more comfortably with emphysema, control emphysema symptoms, and prevent emphysema from advancing to a later stage, or getting worse,” Dr. Khan said. Oftentimes antibiotics, inhalers or other medications can help relieve shortness of breath.
There is no way to repair or regrow the damaged lung tissue.
Depending on the severity of your emphysema, your treatment plan may include:
- A pulmonary rehabilitation program to strengthen the muscles you use for breathing and exercise the rest of your body. “It's tempting to not exercise when you have emphysema, but regular physical activity can actually improve your health,” Dr. Khan said.
- Antibiotics for bacterial infections
- Staying away from the smoke of others and removing other air pollutants from your home and workplace
- COPD medicines (bronchodilators) that widen the airways of the lungs, and can be either taken by mouth or inhaled
- Getting the flu and pneumococcal vaccines
- Nutritional support since you may develop malnutrition and lose weight
- Other types of oral and inhaled medicines that are used to treat symptoms such as coughing and wheezing
- Oxygen therapy when medications are not doing enough for you.
- Quitting smoking, whether from traditional cigarettes, cigars or vaping.
How Do You Treat End-Stage Emphysema?
As emphysema becomes more severe and the disease progresses to later stages, surgical options may be considered. These include surgery to remove the damaged area of the lung or a lung transplant if lungs are too damaged to benefit from surgery. However, lung reduction surgery and lung transplants are only helpful in a small group of patients with end-stage emphysema, and there is severe risk in these surgeries. There is no way to repair or regrow damaged lung tissue.
However, a new, less invasive procedure is now available for people with severe or end-stage emphysema (stage 3 or stage 4 emphysema). Franciscan Health now offers an endobronchial valve system to treat breathing problems. The Zephyr® valve procedure, available at Franciscan Health Indianapolis, is a treatment option for people with severe emphysema. Patients report being able to take full breaths immediately after the procedure and within a few days are back to doing everyday tasks with ease.