Pulmonary emphysema: stages, treatment and life expectancy

Pulmonary emphysema is a disease characterized by the rupture of the alveoli walls and the overinflation of the alveoli (alveoli).

The stages of emphysema

The criterion used for staging is the amount of air that a person can forcefully exhale.
This parameter is called expiratory one-second capacity FEV₁  (Forced Expiratory Volume in 1 second).

First stage
In this phase, emphysema is mild: the breath test shows normal results, the FEV1 value is at least 80% of normal capacity or higher.
The person may suffer from mild symptoms, such as:

• production of slimy sputum,
• slight cough.

Second stage
This phase is characterized by a slight restriction of air flow.
The emphysema is defined as moderate, the FEV1 value is:

• < 80%
• ≥ 50%

The symptoms are the same as in the first phase (cough and sputum), but they are more common.

Third stage
The third phase shows a significant deterioration in air flow, which already occurs in the second phase.
The emphysema is severe and the test shows an FEV1 value:

• < 50%
• ≥ 30%

Sputum and cough are greatly aggravated.
The affected person feels shortness of breath during physical activities such as:

• Go
• heavy physical work.

Fourth stage
This is the final phase of emphysema.
Two situations are possible:

• FEV1 < 30 % of normal value
• FEV1 < 50% of normal and blood oxygen saturation is low.

The patient has great difficulty breathing.
Even a simple walk can get the person out of breath.
At this stage, the patient suffers from respiratory or heart failure.

If the disease persists for a long time, the heart can become overloaded. The consequences are then heart disease.

Treatment of pulmonary emphysema

This is an irreversible respiratory disease and therefore cannot be cured. Nevertheless, medications may be helpful to:

• treat the inflammation,
• clean the airways,
• relieve the symptoms.

Quitting smoking
This is the only way to avoid exacerbation, especially since a complete cure is not possible.

Medicines
The treatment plan also involves taking certain medications to reduce symptoms.

• Bronchodilators (bronchodilators) help treat shortness of breath and cough.
• In addition, there are some corticosteroids for inhalation when patients suffer from asthma or bronchitis.
• Gastroesophageal reflux (GÖR) can worsen symptoms.
  To cope with this condition, patients need to take certain medications and change their lifestyle.
• Respiratory infections such as influenza, bronchitis and pneumonia are more common in patients with emphysema. Therefore, some antibiotics can be used against these infections.

Oxygen therapy Patients with breathing difficulties can receive relief from oxygen therapy
performed at home.
In some cases, this must be done 24 hours a day.

Rehabilitation Program
This is an intensive program and includes:

• Counseling: The patient with emphysema has limited autonomy. This can lead to anxiety and depression.
• Dietary advice: Obese patients must follow a diet to lose weight. In this way, the heart and lungs are relieved.
• Learning breathing techniques: Patients with emphysema must learn to breathe with half-closed lips to reduce shortness of breath.

In this way, breathing difficulties are reduced and the quality of life is improved.

Vaccination
Some doctors recommend an annual flu shot and a pneumonia vaccination that provides five years of protection.

Surgical intervention for pulmonary emphysema

If conventional therapy cannot improve the disease, patients may be advised to undergo surgery.
There are different types of surgery, such as:

Endoscopic procedure for insertion of unidirectional lung valves:

The microvalves are made of biocompatible material and:

• allow the air to escape when exhaling,
• block the air supply to the lung areas affected by emphysema.

In this way, the air is directed into the healthy lung areas.
This procedure is performed:

• endoscopic (without incisions),
• under local anesthesia,
• outpatient (the patient can return to his home on the day of the procedure).

Another option is to remove the diseased lung tissue to help the organ work more effectively.

In very severe cases, lung transplantation may be the only possible alternative.
A transplant is performed only in patients under 60 years of age.

Natural remedies for pulmonary emphysema

Breathing exercises for pulmonary emphysema

Physiotherapy of breathing is extremely important in patients with emphysema to clear the airways of mucus.
The physiotherapist performs certain maneuvers.
The patient must lie down in a certain position – depending on which lung area is to be freed.
The physiotherapist favors drainage by tapping or vibration.

There are breathing rehabilitation exercises that consist of lifting legs or arms to promote oxygenation to body tissues.
Recommended are breathing exercises with a glass bottle containing a small amount of water.
The patient must also perform the exercises every day at home to achieve a good result.

Diet and nutrition for pulmonary emphysema

Very heavy meals should be avoided. Better to eat little and more often, at least 5 times a day.
The preferred foods should be easily digestible, especially fruits and vegetables. It is better to avoid:

• Meat
• Cheese
• Sweet.

According to hygienism (a natural medicine), easily digestible foods are important for avoiding:

• gastroesophageal reflux, as the stomach empties quickly;
• Lung infections, as 60-70% of the body’s defences are formed in the intestine.

If a patient eats natural foods and keeps the correct combinations, the food only remains in the intestine for a short time.

In this way, it is possible to avoid:

• Fermentation
• putrefaction in the intestine due to the breakdown of proteins,
• Production of toxins that nourish harmful microorganisms.

If the intestine is overloaded by too much protein-rich food, fried foods, desserts and processed foods, this has consequences:

• unbalanced bacterial flora,
• weakened immune system.

A diet for weight loss is not required, since as the disease progresses, weight loss is a negative factor in the prognosis.

Holidays A stay by the sea is better than in the mountains, because there is a higher concentration of oxygen in the air.
Another risk in the mountains is pulmonary edema (accumulation of water in the lungs), which can occur when climbing rapidly to higher altitudes.
Air travel is contraindicated because the air on the plane is pressurized but has a lower oxygen concentration than the air you normally breathe.

How long do you live? Life expectancy and prognosis

Predictions about life expectancy and survival are difficult to make.
The gold standard is the measurement using a spirometer to determine the value of FEV1 (forced expiratory volume in one second).
This is the percentage of air that can be exhaled in one second. The measured value helps to estimate the life expectancy of the patient. For a healthy person, the spirometer shows values of 80-100%.

Life expectancy according to the stages of pulmonary emphysema

1. A person with emphysema is in the first phase, when spirometry shows an FEV1 level above 80% of normal.
   More than 8 in 10 people (80%) survive for at least 4 years.
2. Emphysema is in the second phase, when the FEV1 factor is between 50% and 80% of normal. 4-6 out of 7 patients (10-60%) have a survival rate of 70 years.
3. In the third phase, the FEV1 value is 30 % to 50 %. Only half of the patients can survive about 4 years.
4. The fourth (or final) stage of emphysema is characterized by an FEV1 value below 30%.
   These are seriously ill patients who die after a short time.
   Patients suffer from involuntary weight loss and can hardly walk.

This scheme is a guide to a prognosis, but the survival rate is not always reliable.
Sometimes the survival time is shorter or the patients live on for many years.
It is important to take other factors into account.
The BODE index (body weight index, physical performance, dyspnea and obstruction) is an instrument that takes into account various values, including:

1. body weight of the patient (if it is low, there is danger),
2. limited airflow (measured by pulmonary function tests),
3. ability to walk for 6 minutes,
4. Measurement of shortness of breath under stress.