Q & A Library
Undoing Lung Damage?
How bad can emphysema be? I just found out I have it. I am 20 years old, and I am a smoker.
Answer (Published 9/27/2002)
Emphysema is a very serious lung disease, but it is quite unusual to develop it at your age. If you haven't already, I would suggest getting a second opinion to make sure your diagnosis is correct. Your best bet would be to get an evaluation by a pulmonary specialist, who can check for an inherited cause of emphysema known as Alpha-1 Antitrypsin (AAT) deficiency. Lack of this protein can result in early-onset emphysema, usually between ages 20 and 40; the effects are significantly worsened by smoking. A simple blood test can determine whether you have this genetic abnormality. If so, treatment is replacement therapy to raise the level of the missing protein enough to slow the progression of the lung disease. Unfortunately, the treatment is not curative, which is why smoking cessation is a must. If you have ATT deficiency, smoking may shorten your lifespan by as much as 10 years.
On its own, cigarette smoking is the most common cause of emphysema in older people. Components of tobacco smoke appear to trigger the release within the lungs of chemicals that damage the walls of the air sacs (alveoli). As a result, the sacs no longer have the same ability to bring oxygen from the lungs into the bloodstream. Over time, damage to the air sacs worsens, leading to shortness of breath, a chronic cough and wheezing. Other symptoms may include anxiety, fatigue, weight loss, and eventually loss of mobility.
If you do have emphysema, the best thing you can do for yourself is to stop smoking immediately, which can prevent lung damage from worsening. Emphysema is typically treated with bronchodilators and corticosteroids to improve breathing. Your physician may also recommend that you use low-flow oxygen when you're exercising or if you have breathing problems at night or suggest pulmonary rehabilitation to improve your tolerance for exercise. Beyond that, treatment options are few. Lung transplants are available for those with severe disease. Lung reduction surgery to remove damaged portions of the lung and allow normal parts to expand more fully is under study; I do not recommend it at this time.
Here are some suggestions to protect your lungs from further damage:
Andrew Weil, M.D.
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