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Emphysema Life Expectancy

Emphysema Life Expectancy
Emphysema is an irreversible lung disease that negatively affects the quality of life and survival rate of the patient. The following write-up provides information on the pulmonary function tests and other criteria that are used to assess emphysema life expectancy.
Ningthoujam Sandhyarani
X-Ray Lungs
Emphysema
Emphysema is a progressive lung disease that primarily affects chronic smokers. It is classified under the group of lung diseases that are collectively termed as Chronic Obstructive Pulmonary Disease (COPD). It is characterized by the decreased elasticity of the lung tissues and formation of irregular pockets in the alveoli, which are microscopic air sacs that are located at the distal end of the bronchioles. 
Long-term exposure to toxic chemicals due to smoking is believed to be the leading cause of emphysema. Airway reactivity and deficiency of an enzyme called alpha-1 antitrypsin could also put a person at an increased risk of developing this condition.

The prognosis of emphysema could vary, depending on the stage of emphysema. Though Gold emphysema staging system and the BODE index have been developed to determine the severity of this condition, these may not be able to ascertain the life expectancy and survival rate for emphysema. The statistics that are available on emphysema life expectancy and prognosis may not be completely reliable, and the life expectancy or survival rate could vary from person to person.
What Causes Emphysema?
Bronchial tubes are the two branches of trachea that carry inhaled air to the lungs. The bronchial tubes are further divided into smaller airways called bronchioles. At the distal end of the bronchioles are clusters of tiny air sacs called alveoli. The transfer of oxygen and carbon dioxide takes place in the small blood vessels that lie within the alveolar walls. It is due to the presence of elastic fibers in the alveoli that these sacs are able to inflate and deflate. In case of people affected by emphysema, the damage to the lining of the alveoli restricts the amount of air that flows into the alveoli.
Symptoms of Emphysema
  • As the lung tissue around the bronchioles gets damaged, bronchioles may collapse and this may cause the air to get trapped within the lungs. When air pockets develop in the lungs, the surface area of the lungs may increase. Under such circumstances, the affected individual is likely to experience labored breathing.
  • As the alveolar walls, blood vessels, and the elastic fibers get damaged, the amount of inhaled air reduces and the amount of oxygen reaching the lungs also becomes less. Due to the damage to the elastic fibers, the affected individual usually struggles to exhale in an attempt to force the trapped air out of the lungs. This gives rise to shortness of breath.
  • Rapid breathing and shortness of breath (particularly during exertion) are notable signs of this chronic ailment. Other symptoms that may be experienced by the patient include wheezing, chronic cough, chest tightness, and weight loss. The tolerance for exercise or physical activities also decreases.
Life Expectancy and Prognosis
The incidence of emphysema is higher in men who are above 65 years of age. Symptoms usually appear when 30% to 50% of the lung tissues are damaged. Despite the significant advancements in medical science, determining emphysema life expectancy and survival rate accurately still remains a challenge for health experts.

GOLD staging is a popularly adopted approach for staging this pulmonary disease. It has been introduced by the Global Initiative for Chronic Obstructive Lung Disease. Under the GOLD staging system, a spirometer is used to measure the FEV1 (forced expiratory volume per second). This is the percentage of air that can be exhaled in a second. The reading helps in estimating the life expectancy of patients. For a healthy individual, the spirometer reading usually falls between 80% to 100%.
GOLD Emphysema Staging System
Based on the test results, there are four successive stages of emphysema, viz., stage 1 (mild), stage 2 (moderate), stage 3 (severe) and stage 4 (very severe).
  • A person is diagnosed with Stage 1 emphysema, if the spirometer reading for FEV1 is more than 80% of the normal range. More than 8 out of every 10 patients survive for 4 years.
  • A person is diagnosed with Stage 2 emphysema, when the FEV1 factor is lower than 80% of the normal, but greater than 50%. Out of every 10 patients diagnosed with stage 2 emphysema, about 6 to 7 survive for four years.
  • A person is diagnosed with Stage 3 emphysema, in case the FEV1 reading of patients is below 35%. 50% of the patients are likely to survive for about 4 years.
  • As far as very severe cases of emphysema are concerned, the life expectancy is believed to be very low. Patients are likely to experience uncontrolled weight loss and find it difficult to walk normally.
Though GOLD staging is useful for prognosis, the survival rate estimated with the help of this system is not always true. At times, patients who are expected to live for shorter periods survive for many years and vice versa. Other factors are therefore taken into consideration in addition to the pulmonary function test results in order to study the prognosis.

BODE (Body mass index, Obstruction, Dyspnea, and Exercise capacity) index is a tool or a staging symptom that takes factors such as patient's weight (abnormally low weight is dangerous), the ability to cover ground by walking for a particular time duration, and the extent of shortness of breath during exertion, into consideration. It uses the aforementioned four variables to assess the health risks posed by emphysema or chronic obstructive pulmonary disease. BODE index is believed to be a better tool in determining emphysema life expectancy and prognosis than the GOLD staging system.
BODE Index
For calculating BODE index, points are added as per the threshold value given for each variable. The index value ranges from 0 to 10. In severe cases, the score lies between 7 to 10.
  • Body mass index (B) refers to a measure of a person's weight in relation to his/her height.
    The score is 0 if the BMI is greater than 21.
    1 point should be added if the BMI is equal to or less than 21.
  • Obstruction refers to airflow obstruction that is measured by checking forced expiratory volume per second.
    The score is 0 if FEV1 is 65% or more.
    1 point should be added if FEV1 lies between 50% to 64%.
    2 points should be added if FEV1 is the range of 36% to 49%.
    3 points should be added if FEV1 is equal to or less than 35%.
  • Dyspnea, refers to shortness of breath, which is assessed by Modified Medical Research Council Dyspnea Scale.
    The score is 0 if you feel breathless with strenuous exercise, or if you get shortness of breath when hurrying on level ground or walking up a slight hill.
    1 point needs to be added if you walk slower than people of the same age on level ground because of breathlessness, or have to stop for breath when walking at your own pace.
    2 points need to be added if you stop for breath after walking for about 100 yards or after a few minutes on level ground.
    3 points need to be added if you feel breathless when dressing or feel too breathless to leave the house.
  • Exercise capacity (E) is measured by a 6-minute walk test.
    The score is 0 if you can walk for 350 meters or more in 6 minutes.
    1 point needs to be added if you can walk about 250-349 meters in 6 minutes.
    2 points need to be added if you can walk about 150-249 meters in 6 minutes.
    3 points need to be added if you can walk 149 meters or less in 6 minutes.
As discussed above, the survival rate of patients afflicted with COPD is higher, if this condition is diagnosed in the early stage. If this condition is left untreated, the survival rate could be 2 to 3 years or lesser than that. The life expectancy of a patient affected by emphysema is less, but a patient can survive for many years if he/she follows certain effective measures and prompt lifestyle changes. For instance, life expectancy may improve for patients who quit smoking.
Living with Emphysema
A patient in the final stage is likely to experience severe breathing problems and exercise intolerance. Excessive secretion of phlegm and cough are not unusual. Also, the patient is at a high risk of developing respiratory diseases, like pneumonia and acute bronchitis. Many a time, long-term oxygen therapy is prescribed for easy breathing and to increase the life expectancy of emphysema patients. The patient's condition can worsen if emphysema is accompanied by other diseases. This is the reason why most patients are given pneumonia and flu vaccine. Complications can also arise in case of diabetics or people affected by heart ailments.

The treatment of this lung condition involves following certain measures to slow down the progression of the disease. The most important tip is to stop smoking and avoid exposure to cigarette smoke and other environmental irritants. Drugs are also administered to reduce inflammation, infection, and for relaxation of the bronchial tubes. The affected individual would benefit by following the recommended activity guidelines and consuming healthy foods as per the doctor's advice.
On a concluding note, life expectancy of a person diagnosed with emphysema cannot be determined accurately. Though the survival rate would be adversely affected if this condition is left untreated, making lifestyle changes can certainly have a positive effect on the quality of life of an affected individual.

Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.