Dear Dr. Roach: I am male, age 65. I exercise regularly. A shortness of breath led me to get a chest X-ray, which showed that I have emphysema. I smoked for 10 years, but quit 33 years ago.
As an avid runner, this revelation was perplexing and depressing.
Is it possible that other factors contributed to me getting emphysema, and how do I minimize this disease, if possible?
T.W.
Emphysema is most often caused by smoking in North America or by cooking fires in many parts of the world. The exact type of emphysema you have can help tell what caused it, but that usually requires a biopsy, which is generally not necessary for diagnosis or treatment.
Although X-rays and CT scans can help with the diagnosis, the definitive study is the pulmonary function test.
For this test, you must breathe in and out more times and in more ways than you ever thought was possible, with a respiratory technician and a lot of machines.
(When I was a fourth-year medical student, I had my own PFTs done as a learning experience — thank you, Dr. Julian Solway — and have respect for how hard they are to perform correctly.)
Besides smoke exposure, another cause is the genetic Alpha-1 antitrypsin deficiency, which can affect the liver as well. This diagnosis is made by blood testing and confirmed by DNA testing through a genetic counsellor.
I always consider this diagnosis in a person with emphysema who is a nonsmoker or has minimal smoking history. If you do have AAT deficiency, there may be other treatments available, but specific treatment requires special expertise.
Regardless of the cause behind your emphysema, you have already made the most important change by quitting smoking.
Avoiding secondhand smoke and other lung irritants is important, too.
There are no treatments to reverse emphysema, but many can improve symptoms. These include medication (such as inhalers), pulmonary rehabilitation, and oxygen in people with emphysema that is severe enough to cause low blood oxygen levels.
Most people who quit smoking have a very slow progression of the disease.
However, it’s important to quit smoking as soon as possible so that there is enough reserve lung function.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
