When Non-Smokers Get Emphysema
Emphysema is a lung disease that makes it difficult to breathe. Characterized by a progressive loss of lung functioning, smoking is the primary cause of this problem. A study published in the journal Clinical Pulmonary Medicine in 2008 estimates that about 10 percent of emphysema cases actually occur in non-smokers. While the disease looks similar in both groups, researchers noted that it seems to present in non-smokers earlier in life than it does with smokers.
Emphysema Risk Factors
"Some of the known emphysema causes besides smoking include: exposure to fumes, indoor cooking with open fires (common in the developing world), HIV, several kinds of nutritional deficiencies including anorexia nervosa, illicit drug use, and multiple genetic conditions linked to some of the lung protective enzymes," says Thomas R. Gildea, MD MS FCCP, head of the bronchoscopy section of Cleveland Clinic's Respiratory Institute and a recipient of an AlphaOne Foundation's Physician Development Award.
Although few genetic factors have been associated with emphysema, one inherited condition—alpha 1-antitrypsin deficiency (A1AD)—can cause emphysema but only about one in every 5,000 to 7,000 people have this condition. Screening tests are now available to detect the genetic defect that causes A1AD.
Gildea says that the signs of emphysema can often mimic other respiratory ailments, such as asthma. The most prominent symptom is shortness of breath with activity. "As the disease worsens, there can also be a feeling that the chest is full and you can't fit [in] anymore air," he says. While smokers and non-smokers who have emphysema will usually be affected equally by this condition, people who smoke can also be at increased risk for secondary problems, such as airway constriction or chronic bronchitis. Many emphysema patients find themselves cutting back on their activities more and more over time, and as a result get out of shape.
If you suspect emphysema, Gildea advises seeing your physician to undergo a thorough physical exam. "Your doctor will look for other clues separate from smoking, particularly a family history of A1AD, diet, nutritional issues, and the use of other drugs or inhalants. Occupational history can also be significant, especially if you were exposed to chemical fumes," he says. Lung function testing, X-rays, and CT scans may also be recommended. You'll probably undergo a few other tests to rule out other respiratory conditions like asthma.
Exactly what emphysema treatment approach you take depends on how it affects you and what other conditions might be making your emphysema symptoms worse. In general, most people will get some relief using a bronchodilator, and Gildea also recommends getting influenza and pneumococcal vaccines to reduce exposure to illnesses that can weaken your respiratory system. In some cases, inhaled steroids can also be helpful, as can a new class of medicine that reduces infection. It's also important to eat a balanced diet and avoid second-hand smoke, fumes, and chemicals.
American Thoracic Society and the European Respiratory Society. "American Thoracic Society/European Respiratory Society Statement: Standards for the Diagnosis and Management of Individuals with Alpha-1 Antitrypsin Deficiency." American Journal of Respiratory Critical Care Medicine 168 (2003): 818-900.
Fabro, Delano S. Jr; Frenia, Douglas S. "Emphysema in the Nonsmoker." Clinical Pulmonary Medicine 15(1): 1-7, Jan. 2008. Web. 25 Jan. 2013.
Gildea, Thomas R., MD MS FCCP, Head, Section of Bronchoscopy, Respiratory Institute, Department of Pulmonary, Allergy and Critical Care Medicine & Transplant Center, Cleveland Clinic. Email interview 24 Jan. 2012.
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