Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

Emphysema is the most common chronic lung condition and the major cause of pulmonary dysfunction. It has been estimated that more than 10 million Americans have emphysema, and more than twice that number have lung conditions bordering on emphysema.

The name emphysema comes from a Greek word meaning "to puff up with air." This disease is the condition which results from over-dilation of air sacs and the tiniest bronchi in the lungs making them first into small cysts which break open into adjacent small cysts to make ever-enlarging cysts. They can be as small as the naked eye can barely see, and up to as large as a football. The condition can result from anything causing chronic coughing or wheezing, such as asthma, chronic bronchitis, smoking, or air pollutants. Smoking is by far the main culprit. Once it has occurred it is permanent, due to the actual destruction of the walls of the air sacs.

There is also the kind of emphysema caused by breathing certain types of dust such as some particles of silica or other dust particles. Some people get emphysema because they have had asthma in early life which causes breaking of the tiny partitions between air sacs in the lungs with subsequent emphysema. There is also the kind of emphysema which comes from whooping cough and other childhood illnesses in which there is coughing. There are many other reasons why people get emphysema.

Emphysema is generally first diagnosed between the ages of 55 and 65. It is approximately nine times as common in men as in women, perhaps due to the difference in smoking habits and exposure to air pollutants.

Shortness of breath due to the collapse of the airways is the most common symptom of emphysema. The difficulty is greatest on exhaling, or breathing out. The neck veins often stand out from the effort, and the patient commonly purses the lips and breathes through the mouth to help keep the air passages open. Wheezing may be present on expiration. Breathing in is generally rapid and short. The patient may breathe 25 to 30 times per minute and still receive an inadequate supply of air.

People with long-term emphysema often develop clubbing enlargement of the end of the fingers. Sometimes patients with emphysema are referred to as "pink puffers" because of the ruddy color which the face may take on. Over a period of time, the patient develops a barrel-shaped chest which is very characteristic of emphysema. The chest appears to be overinflated. The emphysema patient often speaks in short, jerky phrases and commonly appears gaunt and anxious. Minor activity may produce extreme shortness of breath and exhaustion.

The human body requires a great deal of oxygen. The average grown man takes in about a pint of air with each breath. If he breathes about 14 times per minute, he takes in about seven quarts of air each minute. The lungs take in about 600 to 1,000 cubic feet of air each day. A person requires about a square yard of lung space for each 2.2 pounds of body weight. A grown man needs lung space about as large as a tennis court. It would seem impossible to get this much lung space inside the human chest, but our Creator made provision for all our needs.

The trachea or windpipe, branches off into two divisions called bronchi. In the lung, the bronchi divide into smaller branches which then branch off into the even smaller bronchioles. These bronchioles end in hundreds of millions of little air sacs called alveoli. The walls of alveoli are extremely thin, consisting of a single layer of cells only 0.0004 inch thick. The average alveolus is only 250 microns in diameter; forty of them placed side-by-side would measure only 2/5 of an inch!In emphysema, a large portion of the walls of the alveoli (terminal air sacs in the lungs) are destroyed. The surface area of the pulmonary membrane becomes reduced, sometimes to less than one-fourth of the normal value. Aeration of the blood is diminished as a result of these losses.‍

Treatments for Emphysema

Avoiding Irritants and Pollution‍

The first objective must be to remove all lung irritants, smoke, fumes, pollens, animal dander, house dust, aerosols, etc. Inhaled irritants, narcotics, sedatives, and unnecessary surgery may all aggravate the symptoms of emphysema.

Air filters may be used to remove pollutants and particles from the air. A room humidifier used during winter months may allow dust particles to settle. Avoid dusting and sweeping. Keep the kitchen well-ventilated.

The chances of a male between the ages of 50 and 70 dying of a lung disease such as bronchitis or emphysema is twice as great if he lives in an area with a high level of air pollution. Persons living in these areas may profit by a move to a less polluted area. Avoid outdoor activities when air pollution levels are high.

If the emphysema patient continues to smoke all treatment is ineffective. Studies show a relationship between smoking and decreased ability to force air out of the lungs. The average heavy smoker has only half the ability to force air out of his lungs as a nonsmoker. Cough and sputum production are often improved when the patient stops smoking.

‍Keeping Hydrated

‍The fluid intake should be kept high to keep sputum thin and easy to raise. Avoid drugs which suppress coughs and dry up secretions. Vaporizers may be used in the bedroom or nebulized water inhalations may be given to humidify the bronchial tree and thin sputum.‍

Dressing Warmly

‍Use a warming scarf or mask over the mouth and nose when outdoors in cold weather. Keep the body warm at all times. It is especially important that the extremities be kept warm at all times to avoid congestion of the chest.

‍Avoiding Infections‍

Emphysema patients should avoid contact with individuals who have any type of respiratory tract infection and should keep the immunity always at the highest possible level. Promoting proper drainage helps prevent infection. Three to five inch blocks can be placed under the foot of the bed which will help prevent the accumulation of mucus in the lower parts of the lungs during the night.

Postural drainage exercises should be carried out daily. Each position should be utilized for 5 to 15 minutes. Postural drainage may be performed by lying on a tilt table or bed with the foot elevated 18 inches. The patient lies on his back, right side, left side, and stomach to allow clearing of all segments of the lungs. It is best to change sleeping positions every two or three hours to promote drainage from all portions of the lungs.‍

Practicing Health Laws‍

For people with emphysema there is a premium on the eight natural laws of health: good nutrition, exercise, water, sunshine, temperance, fresh air, rest, and trust in Divine power. These laws should be followed to the letter.‍

Best Location

‍Patients living at a high atmosphere (above 4,000 feet) may be benefited by a move to lower altitude.‍

Eating Right

‍The patient should be given a low-calorie, fat-free diet designed to maintain optimal weight and easier breathing. This means avoidance of all free fats including margarine, mayonnaise, fried foods, cooking fats, salad oils, dairy butter, cream, peanut butter, and other nut butters made by high-speed grinding. The oxygen carrying capacity of the blood is decreased by a high fat diet. The most favorable diet for emphysema is the totally vegetarian diet, and a low-salt diet is also recommended.

Generally, the thinner the patient, the smaller the amount of flesh that must be supplied with oxygen and nutrients, and the better the patient will fare. Obesity and constipation decrease the patient's resistance to respiratory infections.

Hard-to-chew foods tire the patient and should be avoided. Gas forming foods cause distention, restricting movement of the diaphragm. Never overeat.

Excessively hot or cold foods may induce coughing and should be avoided.

Do not eat when emotionally upset or angry.‍

Breathing Exercises‍

Exercise trains skeletal muscles to function more efficiently. Exercise to tolerance should be part of the daily program of every emphysema patient. Besides keeping the breathing muscles strong, it keeps the air passages cleared. Breathing exercises are often helpful:

• The patient should blow his nose to clear the air passages at the start. Patient should attempt to make this type of breathing habitual.
• The patient sits in a straight chair, with legs spread apart and feet flat on the floor. Placing a small pillow firmly against his abdomen, he should bend forward over it, breathing out slowly through pursed lips as if blowing out a candle.
• The patient lies on the floor on his back and raises his head, shoulders, and arms to reach below his knees. He should simultaneously contract the muscles of the abdomen, breathing out until he feels the urge to breathe in again. As he relaxes back to the horizontal position he should breathe out slowly. The purpose of these exercises is to train the patient to breathe with his abdominal muscles rather than with the upper thorax. Thoracic breathing is common in emphysema patients and in people who have changed their breathing habits because of the constricting effects of girdles and other types of binders. Exercises may induce wheezing and coughing, but the patient should be assured that this is expected.
• The patient should be taught an exercise called "controlled coughing" in which he inhales slowly and deeply, exhales through pursed lips, and coughs in short "huffing" bursts rather than vigorously.
• The patient should be instructed that slow, deep breathing relieves shortness of breath more quickly than rapid and shallow breaths.