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Emphysema can best be described as the ongoing destruction of the grape-like air sacs (alveoli) that carry out the lung's basic objective of exchanging oxygen in the atmosphere for carbon dioxide in the cardiovascular system.

The small air sacs can not completely deflate (remaining over inflated) and therefore are unable to fill with fresh oxygenated air for adequate ventilation. Emphysema can not be reversed, however it is manageable through medications, exercise and good nutrition.

When the emphysema has been caused by smoking, which makes up the majority of cases, the very small airways (bronchioles) that join the alveoli are damaged resulting in their walls lose elasticity.

As pockets of dead air form in the damaged lung areas, the ability to exhale is restricted, reducing normal lung function. Inhalation is not usually impaired in the early stages, but in the late stages of the disease, oxygen and carbon dioxide levels are abnormal and breathing becomes labored.

Emphysema patients have typically lost between 50% and 70% of their lung function by the time symptoms begin to appear.

Experts believe the process leading to emphysema is mostly due to an imbalance in chemicals that protect the lungs from infection and damage. Any condition that causes an imbalance in these substances may trigger emphysema.

Cigarette smoke contains irritants that inflame the air passages, setting off these biochemical events that damage cells in the lung, thus increasing the risk both for emphysema and lung cancer.

Because smoking is overwhelmingly the cause of emphysema and chronic bronchitis, they often develop together and frequently require similar treatments.

There also is a rare, inherited form of emphysema known as alpha-1-antitrypsin deficiency, in which both the walls of the bronchioles and connected alveoli are diseased.

Illustration: AMA

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Last modified: June 17, 2002