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Emphysema Complications

The most common emphysema complications are erythrocytosis, recurrent respiratory infections, pulmonary hypertension and cor pulmonale.

High blood pressure is one complication of emphysema. [© Shutterstock, 2010]
© Shutterstock, 2010
High blood pressure is one complication of emphysema.

Emphysema Complications

The most common emphysema complications are erythrocytosis (increased red blood cell count), recurrent respiratory infections, pulmonary hypertension and cor pulmonale (enlargement of the right side of the heart). According to Johns Hopkins Medicine, approximately two million Americans have emphysema. Men comprise 61 percent of cases. This disease can result in death from serious complications, pneumonia or respiratory failure.

Description of Emphysema

Ninety percent of emphysema cases can be attributed to smoking. This lung disease develops over the course of decades as the walls of the air sacs in the lungs, called alveoli, lose their elasticity or rupture. This restricts the ability of the alveoli to completely contract which makes breathing more difficult and inefficient. Shortness of breath is the primary symptom of emphysema and these patients may develop a barrel chest as the lungs continue to overinflate.

The remainder of emphysema cases is primarily attributable to a genetic defect. This mutation results in the lack of a protein called alpha1-antitrypsin (AAT). This protein normally protects the lungs from an enzyme that helps fight bacteria and break down dead lung tissue. In the absence of AAT, however, this enzyme also attacks healthy lung tissue which can result in the inherited form of emphysema. Inherited emphysema can begin causing symptoms before the age of 40. People of northern European descent have the greatest risk.

Erythrocytosis From Emphysema

Erythrocytes are red blood cells that are produced in the bone marrow and carry oxygen from the lungs to the rest of the body. Patients with emphysema frequently develop a high red blood cell count, called erythrocytosis, as a compensatory response to the impaired functioning of the lungs. Erythrocytosis is diagnosed when there are more than 5.72 million red blood cells per microliter (mcL) in men and greater than 5.03 million per mcL in women, according to the Mayo Clinic. Symptoms of erythrocytosis are varied and can include bruising, skin redness, necrosis, blood in the stool, blood clots, warmth in extremities, weight loss, fever and itching.

Recurrent Respiratory Infections From Emphysema

Patients with advanced emphysema must use great effort to expel the carbon dioxide from their lungs. According to Net Wellness, this inability to empty the lungs completely makes it more difficult to clear the lungs secretions which increase the chances of developing life-threatening respiratory infections such as pneumonia.

Medications used in the treatment of emphysema such as antibiotics and steroids can also increase the risk of fungal infections in the lungs.These medications are normally required for a prolonged period and begin to lose their effectiveness over time. Fungi are able to adapt to the antibiotics and the bodys cells will stop responding to the steroids.

Patients with emphysema frequently need supplemental oxygen which requires a breathing tube. This tube may become colonized with bacteria or fungi which may then be inhaled into the lungs. It is therefore essential to clean or replace the tube on a regular basis in order to prevent respiratory infections.

Pulmonary Hypertension

The small arteries that carry blood to the lungs can become narrowed or even destroyed as a case of emphysema progresses. This makes it more difficult for the blood to flow through these vessels, resulting in pulmonary hypertension. Pulmonary hypertension may also be caused by genetic defects, medications and medical conditions such as blood clots in the lung, other lung diseases or heart valve disease. It is called primary pulmonary hypertension when the cause is unknown; otherwise, this condition is more specifically known as secondary pulmonary hypertension.

Cor Pulmonale From Emphysema

The left side of the heart pumps blood to the body and normally produces much higher blood pressure than the right side which only has to pump blood to the lungs. Any condition such as emphysema that leads to pulmonary hypertension increases the strain on the right side of the heart. Pulmonary hypertension causes the right ventricle of the heart to work harder and may eventually cause it to become distended. The right ventricle may weaken and eventually be unable to pump properly against these unusually high pressures or even fail completely. This condition is called pulmonary heart disease, or cor pulmonale. Almost any chronic lung disease or condition that causes a low level of blood oxygen may lead to cor pulmonale.

Prognosis of Emphysema

Emphysema can also be fatal due to respiratory failure or other complications, but there are few good predictors of outcome. The progression of this disease is primarily determined by the speed with which the lungs lose their ability to take oxygen in and remove carbon dioxide from the body. Patients usually experience a progressive decline and eventually become short of breath, even when they are resting.

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