Emphysema
Medical Author: Benjamin Wedro, MD, FAAEM
Medical Editors: George Schiffman, MD, FCCP
and Melissa Conrad Stöppler, MD
Emphysema from Crack Cocaine?
Medical Author: Benjamin Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD
- Amy Winehouse has emphysema...
- Amy Winehouse doesn't have emphysema...
- Amy Winehouse may get emphysema one day...
Pick a story and you may be right. The story goes that the 24 year-old
collapsed at home and was admitted to the hospital. Her father reported that she
had developed emphysema from her cigarette smoking and crack cocaine use. A few
hours later he and her publicist said that perhaps the emphysema diagnosis
wasn't quite right, instead suggesting that there was a possibility of future
emphysema if Amy didn't change her lifestyle.
OK, so what is there to learn from this story?
Is it that a rock star was smoking cigarettes? No news here. But it is true
that smoking cigarettes will lead to COPD (chronic obstructive pulmonary
disease), either emphysema or chronic bronchitis. No other consumer product can
be purchased routinely that can kill its users with cancer, heart attack, and
lung disease.
It can't be that cocaine is bad. We know that cocaine is a nasty actor that
changes brain chemistry by stimulating dopamine and adrenaline release. The highs
that it generates make it very addictive...
Introduction to emphysema
The lungs are a pair of organs in the chest that are primarily responsible
for the exchange of oxygen and carbon dioxide between the air we breathe and the
blood.
The lung is composed of clusters of small air sacs (alveoli) divided by thin,
elastic walls or membranes. Capillaries, the tiniest of blood vessels, run
within these walls between the alveoli and allow blood and air to come near each other. The distance between the air in the lungs and the blood in the
capillaries is very small, and allows molecules of oxygen and carbon dioxide to
transfer across the membranes.
Air reaches the alveoli via the bronchial tree. The trachea splits into the
right and left mainstem bronchi, which branch further into bronchioles and
finally ends in the alveolar air sacs.
When we breathe in, air enters the lung and the alveoli expand. Oxygen is
transferred onto hemoglobin molecules in the red blood cells to be transported
to the rest of the body for use. As oxygen attaches to the red blood cell,
carbon dioxide, the waste product of metabolism, detaches and crosses into the
alveoli to be exhaled. When we breathe out, the alveoli get squeezed by the
elasticity in their walls and air is pushed out of the lungs.
What is emphysema?
Emphysema is a long-term, progressive disease of the lung(s) and occurs when
the alveolar walls are destroyed along with the capillary blood vessels that run
within them. This lessens the total area within the lung where blood and air can
come together, limiting the potential for oxygen and carbon dioxide transfer.
In early emphysema, there is associated inflammation of the small airways or
bronchioles that limits the amount of air that can flow to the alveoli. In more
severe emphysema, there is also loss of elasticity in the alveolar walls that
have not been destroyed. When the patient breathes out, the alveoli and small
airways collapse. This makes it hard for air to get out of the lungs and makes
it even harder for new air to enter.
As more of the lung is destroyed and the lung cannot maintain oxygen
concentrations in the bloodstream, the body compensates by gradually increasing
the breathing rate. After a while, even hyperventilation (hyper=more +
ventilation=breathing) cannot maintain adequate oxygen levels, and the arteries
in the lung begin to constrict or narrow. The heart has to work harder to push
blood into these narrower blood vessels, causing the blood pressure in the lung
arteries to increase (pulmonary hypertension). Over time, the extra work
requirement causes the heart muscle to enlarge (hypertrophy) and can cause
heart
failure.
Next: What are the causes or risk factors for emphysema? »
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