MEN'S HEALTH MATTERS: Emphysema – abnormal enlargement of the airspaces in the lungs
Q I am a heavy smoker and my doctor has told me that I have emphysema. I am not really sure what this means. Will my emphysema get better if I stop smoking?
A Emphysema is a lung condition which involves damage to the air sacs (alveoli) in the lungs. There is an abnormal enlargement of the airspaces in the lungs that are important for gas exchange and this enlargement is accompanied by destruction of the airspace walls.
These changes in the airspaces are permanent and irreversible and lead to difficulties with efficient exchange of gases in the lungs because of a reduced surface area for movement of oxygen from the blood in the pulmonary capillaries into the airspace or alveolus.
As a result, your body does not get the oxygen it needs. Emphysema makes it hard to catch your breath. You may also have a chronic cough and have trouble breathing during exercise. Emphysema occurs almost exclusively in the lungs of smokers.
Most patients with emphysema also have some evidence of obstruction to the flow of air in the airways during exhalation (or breathing out) as a result of changes in the airway walls and increased mucus production.
This is referred to as chronic bronchitis and the airflow obstruction seen in this condition is largely fixed or irreversible. Chronic bronchitis also develops as a result of smoking.
Thus most smokers will have evidence of both emphysema and chronic bronchitis in their lungs and the term used commonly to describe their condition is chronic obstructive pulmonary disease (COPD).
The most common cause of the disease is cigarette smoking. If you smoke, quitting can help prevent you from getting the disease. If you already have emphysema, not smoking might keep it from getting worse because the otherwise relentless progression of the damage to the lungs is very much slowed down whereas with continued smoking the damage gets progressively worse.
The damage to the lungs with emphysema is permanent: once the airspace walls have been destroyed they cannot be rebuilt. Quitting smoking will also slow down the rate of progression of chronic bronchitis and airflow obstruction in the airways.
Stopping smoking is the only measure which has been proven to slow the accelerated decline in lung function, which happens in patients with COPD.
The use of inhalers and other treatments to alleviate the symptoms of this condition have not been shown to be as successful as cessation of smoking.
Slowing down the rate of damage by stopping smoking will slow down the rate of progression of symptoms, reduce the frequency of chest infections and improve your quality of life.
Stopping smoking will also diminish your increased risk of lung cancer and reduce the risk of other smoking-related diseases and events such as stroke and heart attack.
Q I am 63 years old and have noticed a diminished urinary stream for the past 12 months. I went to see my doctor and he examined me and I also had the prostate blood test (PSA). It has come back at a level of six and my doctor has advised me to have a biopsy of my prostate. Is this necessary and what is involved?
A Your PSA (prostate specific antigen) or prostate blood test is slightly raised and is just a warning signal that there may be a problem with the prostate gland. Your doctor is correct to recommend a biopsy to rule out a prostate cancer. The vast majority of men with a PSA the same level as yours will not have prostate cancer but you do need to be checked out. A biopsy of the prostate is performed using a small ultrasound probe, which is passed into your back passage.
Transrectal ultrasound (TRUS) of the prostate allows the doctor to see deep into the prostate, perhaps revealing abnormal areas that are difficult to find by digital rectal examination. Transrectal ultrasound can also tell us whether the seminal vesicles are normal, the size of the prostate, and in some cases can suggest if any other abnormalities are present.
No special preparation is required prior to your biopsy and you do not need to be fasting. Initially you will be given antibiotics to help prevent infection because the procedure is done through the back passage. You will then be asked to lie on your side. The ultrasound instrument is placed into the back passage in a similar fashion to the doctor examining the prostate with a finger.
You will then be given a local anaesthetic and a fine biopsy needle is guided with the help of the ultrasound probe and multiple biopsies are taken. The entire procedure takes less than 15 minutes and may be a little uncomfortable but is not usually painful. You will be kept fully informed throughout the procedure.
In general this is a very safe procedure and most people have no trouble.
Occasionally after a biopsy some bleeding will occur. There may be blood in the urine, mixed with the sperm or blood on the bowel motions. If this occurs it usually settles after a day or two and increased fluid intake helps.
You may also experience some mild transient difficulty passing urine.
This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James’s Hospital, Dublin with a contribution from Dr Deirdre O’Riordan, consultant physician, St James’s Hospital, Dublin