Emphysema (Lung Condition) (cont.)

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What causes emphysema?

As stated previously in the risk factors section, there can be many causes for the development of emphysema. However, the majority of cases of emphysema (COPD) in the United States and other countries are caused by exposure to cigarette smoke. Although genetics may play a role, the inflammation mediated by the body's cells (neutrophils, macrophages and lymphocytes) is usually triggered by exposure to inflammatory compounds, many of which are found in tobacco smoke. The response of the body's immune system leads to destruction of elastin and other structural elements in the lungs, ultimately producing areas in the lungs that cannot function normally.

People with alpha-1 antitrypsin deficiency have an inherited autosomal condition that results in increased breakdown of elastin in the lungs, resulting in COPD (emphysema). When foreign irritants and substances enter the alveoli, usually by inhalation, an inflammatory process is initiated. Chemical messages are sent out recruiting white cells to remove this foreign material. These cells release enzymes that destroy this substance. Normally, these enzymes, often trypsins (protein desolving enzymes) work to remove this material. The body has anti-trypsin enzymes that destroy the trypsin when the foreign substance is no more. In the case of the genetic alpha one antitrypsin deficiency, these enzymes continue to work unabated destroying normal adjacent lung tissue, resulting in emphysema. This is often referred to as the "innocent bystander" effect.

What are the signs and symptoms of emphysema?

In most people, emphysema starts to produce signs and symptoms as the person ages; usually symptoms start developing around age 50, but many can develop symptoms even before age 50.

The onset often develops gradually, and disease is well established before symptoms occur.

The first symptoms frequently vary depending on the degree of emphysema verses bronchitis that the individual has. If more bronchitis is present, the person may cough producing sputum and/or acute chest discomfort also occurs.

As emphysema progresses the most significant symptom becomes breathlessness, especially with any exertion. Wheezing also may occur. It is common for a middle aged person with emphysema to complain that they are unable to keep up with their partner when walking.

People with alpha–1 antitrypsin deficiency usually experience the above symptoms, but at a much earlier age and also may have liver dysfunction.

Medically Reviewed by a Doctor on 4/16/2014

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