Deep in your lungs are 300 million tiny air sacs (alveoli), where oxygen enters the bloodstream and carbon dioxide leaves it. Your alveoli are naturally elastic. They expand when you inhale, and contract when you exhale. But the alveoli of long-time smokers lose their elasticity, and become permanently stretched. Many rupture. As a result, they can’t move oxygen and carbon dioxide in and out of the blood as they used to. People with emphysema suffer chronic oxygen starvation, and feel like they’re slowly suffocating, which they are.

Symptoms of Emphysema

The main symptom of emphysema is shortness of breath, which ofen grows worse over time. Even minor physical activity becomes a challenge. As you struggle to breathe, your chest becomes enlarged and barrel-shaped. In advanced emphysema, to get around, you may need an electric wheelchair, and to breathe, supplemental oxygen from a tank fitted with tubes that run into your nose. Not a pretty picture, which is one of many reasons why no one should smoke, and why every smoker should quit—now.

Causes of Emphysema

Although smoking is the overwhelming cause of emphysema, long-term exposure to dust, air pollutants, chemical vapors, and a hereditary deficiency of the enzyme that maintains the alveoli’s elasticity may also play a role.

Quitting smoking can help prevent you from getting emphysema, and if you already have emphysema, quitting may keep it from getting worse. Emphysema treatments depend on whether you have mild, moderate or severe symptoms, and you should consult your doctor to discuss options. Treatments include inhalers, oxygen, medications and sometimes surgery to relieve symptoms and prevent complications.

There are also some alternative and complementary therapies that may help you feel better and improve your quality of life.

Quit Smoking

Quitting smoking stops the progression of emphysema, but does not reverse it, says family practitioners Anne Simons, M.D., an assistant clinical professor of family and community medicine at the University of California’s San Francisco Medical Center. Alveolar damage is permanent, and emphysema symptoms remain. For help quitting, ask your doctor, or contact the American Lung Association (ALA), or pick up a copy of The No-Nag, No-Guilt, Do-It-Your-Own-Way Guide to Quitting Smoking by Tom Ferguson, M.D. (Ballantine).

Lifestyle Modifications

The American Lung Association suggests:

• Avoid irritants. Stay away from smokers, dust, barbecue fires, and chemical vapors.
• Plan ahead. Figure out the most efficient, least strenuous ways to accomplish what you need to do.
• Pace yourself. Instead of bursts of activity, maintain a slow, steady pace. Eat slowly. Chew slowly. Schedule rest periods frequently during the day.
• Forget fashion. Wear jogging suits whenever possible. They’re easy to pull on and take off. Use suspenders instead of a belt. Wear open-neck shirts. After bathing, instead of drying yourself with a towel, simply slip on a thick terry cloth robe and let it dry you.
• Sit to survive. When bathing, dressing, shaving, or applying makeup, sit on a stool.
• Labor saving savvy. Consider a microwave oven, remote-controlled TV, cordless phone, electric automobile windows and doorlocks—anything that helps eliminate exertion.
• Watch out for winter. Cold air can be especially hard to breathe. Wear a soft scarf or cold air mask (available at pharmacies) over your mouth and nose to warm incoming air. As much as possible, breathe through your nose.

Breathing Exercises

• A book on the belly. “In my experience,” says Gerald Epstein, M.D., an assistant clinical professor of psychiatry at Mt. Sinai Medical Center in New York and author of Healing Visualizations, “I’ve been amazed at the intimate connection between breathing disturbances and anxiety.” That anxiety leads to shallow, rapid breathing, which aggravates shortness of breath and heightens anxiety. To break this vicious cycle, Richard Firshein, D.O., Medical Director of the Firshein Center for Comprehensive Medicine in New York City, recommends slow, deep diaphragmatic breathing, also known as “belly breathing:” Lie on your back. Place a book on your abdomen. Then breathe so that the book moves up and down several inches with each breath.
• Strive for “ssssssss.” That’s the sound you make when you breath through pursed-lips. The ALA suggests pursed-lip breathing for people with emphysema. Keep your lips shut tight except for a tiny opening at the center. Inhale and exhale slowly, with steady pressure, making an “sssss” sound. Try to exhale for twice as long as you inhale.

Visualization

Imagine breathing freely. In addition to breathing exercises, Dr. Epstein suggests the following anxiety-relieving visualization to help you breathe more easily. Practice it for a minute or two every few hours:

• Close your eyes and focus on your breathing, telling yourself that you can rid yourself of anything that interferes with normal breathing. Then open your eyes.
• Close your eyes again and take three breaths. If you cough, just accept it, and keep breathing. Open your eyes.
• Close your eyes again and repeat the three breaths. Focus on how your breathing is changing, deepening. Open your eyes.
• Repeat the exercise, focusing on breathing from your diaphragm, not your upper chest.

Diet

• Low Fat Diet. Emphysema makes it difficult to exercise, which, in turn, makes it hard to control your weight. It takes extra strength to carry extra pounds, strength you probably don’t have. To help control your weight, eat a low-fat, high-fiber diet (see Chapter 3, VEGETARIANISM, and Chapter 4, LOW-FAT). Low-fat eating also gives you more nutrients per bite, which is important when emphysema makes chewing a chore.
• “C” to breath free. A recent ALA study shows that a diet high in vitamin C can help prevent emphysema’s sister condition, COPD. British researchers in Nottingham studied 2,633 adults, about one-quarter of whom were smokers. The more vitamin C they consumed from foods, the better their lung function. This study corroborates other research showing that vitamin C also helps prevent asthma attacks and other respiratory illnesses.
• Fish story. University of Minnesota researchers correlated the fish consumption and lung function of longtime smokers. Compared with smokers who ate fish less than twice a week, those who ate it two or more times a week enjoyed significantly better breathing. “Fish and fish oil supplements are high in omega-3 fatty acids,” says Alan Gaby, M.D., past president of the American Holistic Health Association and a professor of nutrition at Bastyr University, the naturopathic medical school near Seattle. “Their anti-inflammatory action helps reduce the lung damage caused by smoking.”

Supplementation

• The promise of vitamin A. Researchers at Georgetown University School of Medicine have, for the first time, successfully reversed emphysema in mice by injecting them with retinoic acid, an antioxidant in the vitamin A family. The treated mice grew healthy new alveoli. This research is a far cry from a cure for emphysema: You have to be cautious about pilot studies and animal tests. But it’s certainly intriguing, and it dovetails with a great deal of research showing that antioxidant nutrients are crucial to lung health. For example, as dietary antioxidants increase, lung cancer risk decreases. And as dietary and supplemental vitamin C increases, asthma risk and severity decreases. It can’t hurt to eat more foods high in vitamin A: yellow-orange fruits and vegetables— carrots, cantaloupe, and apricots, and eggs, dairy foods, and salmon. As for supplementation, Connecticut clinical nutritionist Shari Lieberman, Ph.D., recommends 50,000 to 100,000 International Units (IU) of beta-crotene daily.
• Strike oil. Fish oil, that is. If you don’t like fish, or if you’d like some extra omega-3 fatty acids, Dr. Gaby suggests taking a fish oil supplement.They’re available at health food stores. Follow package directions.

Exercise

• Do it daily. When you have emphysema, it’s hard to exercise. It’s also important. The ALA recommends daily walks, or other nonstrenous activities: for example, gardening or swimming.
• No sweat qigong. Sports medicine researchers at Life College in Marietta, Georgia, measured the respiratory efficiency of five men and five women before they learned a 20-minute qigong routine. After the class, the participants’ respiratory efficiency increased 20 percent, suggesting that qigong would help treat a variety of respiratory conditions, among them, emphysema. The beauty of qigong for people with emphysema is that it’s very gentle and non-strenuous.
• Try Trager. Trager psychophysical integration is a gentle form of bodywork that combines massage and movement. In one study, physical therapy researchers measured the lung function of people with COPD. After two weeks of Trager work, their lung function improved significantly.

Chinese Medicine

• Strengthen weakness. Chinese medicine views emphysema as a weakness and deficiency of the Lung and Spleen, according to San Francisco Chinese physician Efrem Korngold, L.Ac., O.M.D., co-author (with is wife and practice partner, Harriet Beinfield, L.Ac.) of Between Heaven and Earth: A Guide to Chinese Medicine. Formulas to treat it include strengthening herbs: ginseng, schizandra, perilla seed, aster root, and orange peel.
• Needle it. In one study, 12 matched pairs of people with COPD received either true or sham acupuncture. After three weeks, the true acupuncture group reported breathing more easily and walked farther in a six-minute walking test. Acupuncture points Dr. Korgold recommends include: Lung 9 on the inner forearm, on the thumb side, in the hollow between the wrist bone and the crease of the wrist, and Spleen 6, four finger widths above the inner anklebone close to the back of the shinbone.

Immunization

Foil flu. If you have emphysema and catch the flu, you’re at considerable risk of developing potentially fatal flu-related pneumonia. To prevent the flu, get a flu shot every autumn.

Herbal Medicine

Meet mullein. “If I had emphysema,” says Maryland botanist/herbalist James Duke, Ph.D., author of The Green Pharmacy, “I’d take mullein tea. Mullein is rich in a soluble fiber called mucilage that soothes the respiratory tract. That’s why the flowers and leaves of this velvety herb have a long history of folk use in treating colds, flu, and bronchitis. Many herbalists I respect recommend mullein for emphysema.” Dr. Duke suggests 1 to 2 teaspoons of dried, crushed mullein leaves or flowers per cup of boiling water. Steep 10 minutes.

Social Support

Group inspiration. Your local ALA office may be able to refer you to a support/rehabilitation group. There is some evidence that these groups decrease risk of respiratory crises that require hospitalization.

Meditation

Mindful lung-full. At the University of Massachusetts Medical Center in Worcester, psychologist Jon Kabat-Zinn, Ph.D., director of the Stress Clinic, has been experimenting with mindfulness meditation as a treatment for emphysema. Mindfulness involves focusing intently on some aspect of daily living, typically an object, but in this case, breathing. Dr. Kabat-Zinn’s preliminary studies suggest that mindfulness helps people with emphysema breathe more efficiently and reduces respiratory crises that send them to emergency rooms.

Homeopathy

Help from Hepar. Berkeley, California, homeopath Dana Ullman, M.P.H., author of several books including The Consumer’s Guide to Homeopathy, says that Hepar sulph (sulfide of calcium) and Phosphorus may help treat emphysema.

And Finally…

Physicians can prescribe the kind of bronchodilators used to treat asthma, but these provide only temporary relief. The key to treating emphysema is to quit smoking.