Medical opinion: Prevention is the only cure - don't smoke!

Editor's note: Board-certified specialists from a panel of Yuma-area physicians provide to-the-point answers to questions submitted by Sun readers. The answers are only the opinions of the answering physicians and are not meant to be a substitute for medical consultation or physician care. Submit questions by e-mail to medicalopinion@ yahoo.com or via regular mail to Yuma County Medical Society, P.O. Box 4476, Yuma 85366.

Q - I was just told that I have a mild case of emphysema. Can you tell me more about it?
 
A - "I can't breathe," "not enough air," etc., are the frequently heard words of the "I can't quit" smokers. Emphysema and COPD (chronic obstructive lung disease) have become the common words describing one of the most common disabling lung diseases. It is preventable in most cases but is also found in patients with asthma and other chronic lung diseases.
 
A brief review of lung-anatomy and physiology helps one understand this usually irreversible disease. Muscles outside the rib cage bring in air by contracting. This pulls the diaphragm down the ribs upward. This increases the chest cage volume, causing air to flow down the air tubes and fill the air sacs with a larger volume of fresh air.
 
Pulling air into the lungs requires work but exhaling is normally a passive act, i.e. relaxes and you exhale. The air sacs are microscopic in size and are bound by elastic fibers that stretch when air comes in but contract like a deflated balloon when you relax and exhale.
 
Muscles can be used to exhale when a more rapid air exchange is needed. The small air tubes have muscle in their walls that can contract, decreasing the size of the tube and increasing the resistance to air flow. This is a small part of COPD but a major factor in asthma.
 
In the early stages of emphysema, the major problem is getting the air "out." Getting the air "in" is the problem in the late stages. The loss of elastic tissue causes the patient to work to get the air out.
 
Some of the air sacs become larger and larger. These become blebs that are numerous and enlarge to the size of small balloons and do not exchange air while only occupying large spaces in the chest. They reduce the ability of the patient to ventilate their microscopic air sacs that exchange oxygen and carbon dioxide. The work of breathing is increased while the actual air exchange is decreased.
 
Helping a COPD patient is difficult due to the destruction of tissue that allows air to be exchanged. Medication can help dilate the air tubes, pounding the chest can help remove secretions, surgery can remove large blebs, lung reduction surgery, oxygen supplements, etc., but results are variable and relief is short-lived.
 
Prevention is the only "cure." Don't smoke!


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Dale F. Webb, M.D., is a Fellow of American College of Chest Physicians.