Emphysema

Emphysema is a chronic lung disease that damages the air sacs (alveoli) in the lungs, making it difficult to breathe. It is a type of chronic obstructive pulmonary disease (COPD) and is primarily caused by long-term exposure to cigarette smoke or other lung irritants. Over time, emphysema reduces the lungs’ ability to exchange oxygen, leading to shortness of breath, wheezing, and other respiratory symptoms. While there is no cure, treatments can help manage symptoms and improve quality of life.

Causes of emphysema

Emphysema occurs when the alveoli (tiny air sacs in the lungs) become irreversibly damaged. This results in:

• The destruction of tissues between air sacs, forming air pockets.
• Air getting trapped in these pockets, leading to lung expansion and difficulty in breathing.

Main Causes:

1. Smoking: Smokers are about six times more likely to develop emphysema than nonsmokers. Cigarette, marijuana, and cigar smoke damage lung tissues, irritate airways, and impair the cilia, which clear debris and mucus from the lungs. Damaged cilia contribute to airflow obstruction and breathlessness.
2. Alpha-1 Antitrypsin (aat) Deficiency: A genetic disorder that prevents the production of aat, a protein that protects lung tissue. Without enough aat, white blood cells damage the lungs, particularly in smokers. aat deficiency may also cause liver problems.

Other Contributing Factors:

• Secondhand Smoke: Prolonged exposure increases the risk of lung damage.
• Air Pollution: Long-term exposure is believed to contribute to lung disease, though difficult to quantify.

Symptoms of emphysema

Emphysema symptoms develop slowly and may be mistaken for normal aging. Common signs include:

• Shortness of breath (initially during physical activity, later even at rest)
• Persistent cough, with or without mucus
• Wheezing
• Chest tightness
• Fatigue due to the increased effort required to breathe
• Unintentional weight loss
• Frequent respiratory infections
• Cyanosis (bluish tint to lips or fingertips due to low oxygen levels)

As the disease progresses, individuals may struggle to breathe even while resting.

Stages of emphysema

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) categorizes COPD, including emphysema, into four stages:

• Stage I (Mild): Lung function is 80% or more of normal capacity.
• Stage II (Moderate): Lung function is 50%-79% of normal capacity.
• Stage III (Severe): Lung function is 30%-49% of normal capacity.
• Stage IV (Very Severe): Lung function is less than 30% of normal capacity

Diagnosis

Doctors use multiple tests to confirm emphysema:

• Physical Examination: Checks for barrel chest, wheezing, clubbing of fingers, pursed-lip breathing, and cyanosis (bluish lips from low oxygen levels).
• Pulmonary Function Tests (PFTs): Measures lung capacity, airflow speed, and oxygen retention.
• Chest X-ray & CT Scan: Identifies enlarged lungs and alveoli damage.
• Blood Tests: Checks for oxygen levels and red blood cell count.

Physiotherapy treatment

Physiotherapy plays a crucial role in managing emphysema by improving lung function, reducing breathlessness, and enhancing overall quality of life. The main goals are to improve breathing efficiency, increase exercise tolerance, and clear mucus from the lungs.

1. Breathing Exercises for emphysema

These help reduce breathlessness and improve oxygen exchange:

 Pursed-Lip Breathing

• Inhale through the nose for 2 seconds.
• Exhale slowly through pursed lips for 4 seconds.
• Helps prevent airway collapse and improve ventilation.

Diaphragmatic (Belly) Breathing

• Place one hand on the chest and the other on the belly.
• Inhale deeply through the nose, making the belly rise.
• Exhale slowly through pursed lips while tightening abdominal muscles.

Active Cycle of Breathing Technique (ACBT)
A structured method for mucus clearance, combining:

• Breathing control (gentle, relaxed breathing)
• Deep breathing exercises (to expand the lungs)
• Forced expiration techniques (huffing or coughing to remove mucus)

2. Airway Clearance Techniques

For patients with mucus buildup:

Huffing Technique – A controlled way of exhaling to remove phlegm.
Postural Drainage – Using gravity to help drain mucus (e.g., lying on the side or stomach).
Percussion & Vibration – A physiotherapist may tap the chest to loosen mucus.

3. Pulmonary Rehabilitation (Exercise Therapy)

Regular exercise helps strengthen respiratory muscles and improve endurance:

 Aerobic Exercises (low to moderate intensity):

• Walking, cycling, swimming
• Improves heart and lung efficiency

 Strength Training:

• Light resistance exercises (e.g., lifting small weights)
• Strengthens breathing muscles

 Stretching & Flexibility Exercises:

• Yoga and stretching improve posture and chest expansion.

 Guidelines:

• Start slow and gradually increase duration.
• Monitor for shortness of breath (stop if severe).
• Use oxygen therapy if prescribed during exercise.

4. Posture Training

Correct posture helps expand the lungs and makes breathing easier.

• Tripod Position: Leaning forward with hands on the knees (reduces breathlessness).
• Standing Tall: Keeps the chest open for better lung expansion.

5. Education & Lifestyle Modifications

• Smoking cessation (if applicable).
• Energy conservation techniques (e.g., pacing daily activities).
• Nutritional advice to prevent weight loss and muscle wasting.

6. Assistive Devices

• Incentive Spirometry: A device to encourage deep breathing.

Flutter Device: Helps loosen mucus using vibrations.