Dr. Gott: Emphysema treatable but not curable

Dear Dr. Gott: I have emphysema. When I walk a short distance, I am out of breath. I have to stop, sit and wait until I get all my breath back before going on. At home, I am on 15 liters of oxygen, and, when I go out, I have to use a tank on wheels that goes only up to 10 liters. I take nine pills every day. I was told I had one blocked lung.

I don’t do much at home but really feel good. I don’t even have chest pain. I have been to the hospital five times but only for three or four days at a time to have tests. They told me it was to check my lungs and heart valves.

I started smoking when I was 14 but quit in 1982. As long as I take all my medicine, use the oxygen and don’t get out of breath, I’m OK. I am still able to work in the yard raking leaves. I always work slowly and use my oxygen.

My reason for writing is that a friend told me that emphysema is incurable. Is this true?

Dear Reader: Based on your brief letter, I can only give you general information about emphysema. Since you do not give your age, gender, how long you have had the condition, what medications you are on and what procedures and treatments you have had before, I ask that you forgive me if I repeat anything you may have already tried.

First, I’ll answer your question. Yes, emphysema is incurable; however, it is treatable. But before I get into that, I will explain a bit about the condition, causes and symptoms.

Emphysema is a progressive lung disorder. It results from damage to the small air sacs and airways within the lungs that reduces airflow when breathing out. This means that “bad” air cannot be exhaled completely, which causes an inadequate amount of “good” air to be inhaled. The final result is shortness of breath, even during minimal exertion.

Symptoms in the early stages are generally so mild that they go unnoticed. Once they become more persistent and annoying, irreversible damage may have already been done. The primary symptom is shortness of breath. Others include fatigue (due to lack of oxygen), loss of appetite and weight loss (due to difficulty breathing while eating) and, uncommonly, a mild, chronic, dry cough.

Because the shortness of breath worsens as the disease progresses, most physical activity is difficult, if not impossible. In later, more severe stages, even breathing while lying down can be compromised. It is at this point that breathing requires most of the body’s energy, leaving little for other activities, such as walking or even eating.

The most common cause for emphysema is smoking. This means that by not smoking (and avoiding secondhand smoke), your chances of developing emphysema are incredibly low.

Another cause is alpha-1 antitrypsin protein deficiency, which is a hereditary condition. It occurs only when two defective genes (one from each parent) are passed on to a child. Millions of people are carriers, meaning they have only one of these genes. Often, they do not have problems, but some may develop mild to moderate symptoms or other lung or liver disorders.

The type of emphysema caused by this condition generally develops earlier than the more common form of emphysema. Anyone who develops emphysema before age 40 should undergo genetic testing. Those found to be positive for the protein deficiency should inform close family members so they, too, may undergo testing. Early treatment can prevent or reduce symptoms.

Treatment includes supplemental oxygen, bronchodilators and inhaled steroids. Antibiotics may be given if bronchitis, pneumonia or influenza are also present. It is also important to get flu and pneumonia shots to reduce or prevent the chance of getting these illnesses. Rarely, surgery or lung transplants are recommend only as a last resort if other options do not work.

Many people experience improvement when enrolled in a pulmonary rehabilitation program. It is also important to quit smoking, as smoking will only worsen symptoms.

Return to your pulmonologist. He or she will also be able to give you more information about other treatment options that may be beneficial to you.

To give you related information, I am sending you a copy of my Health Report “Pulmonary Disease.” Other readers who would like a copy should send a self-addressed, stamped envelope No. 10 and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.