Emphysema

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: George Schiffman, MD, FCCP
    George Schiffman, MD, FCCP

    George Schiffman, MD, FCCP

    Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.

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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 risk factors for emphysema?

The major factors that increase the risk for developing emphysema are:

Smoking: Smoking is one of the major risk factors for developing emphysema; the risk increases as the number of years the person has been smoking increases, and is related to the amount of tobacco smoked (for example, three cigarettes a day versus a pack and a half per day); smoking is a major risk factor also for developing lung cancer.

Exposure to secondhand smoke: the risk factors or emphysema increase for people exposed to secondhand smoke according to the number of years exposed to secondhand smoke, and the amount of smoke the person is exposed to.

Exposure to fumes or dust in the environment: People that work in close association with chemical fumes or dusts generated in mining, chemical plants or other industries are higher risks for developing emphysema; these risks are further increased if the person smokes tobacco.

Pollution: Air pollution caused by fumes from vehicles, electrical generating plants that use coal and other fumes produce increases the risk of emphysema.

In the underdeveloped parts of the world, indoor air pollution primarily from open wood flames used for cooking is the primary mechanism for acquiring emphysema.

Medically Reviewed by a Doctor on 3/4/2016

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