[Narrator:] This is Mr. Mack, on the way to his doctor's office.
Mr. Mack has emphysema.
He knows that this is a chronic lung disease,
causing the shortness of breath he has had for years.
The day is warm and bright with sun. A day for enjoying life.
For Mr. Mack, this sauntering gait is a necessity.
He cannot move faster,
and even at this pace must stop to catch his breath.
Lung trouble is not new to Mr. Mack.
He has had pulmonary tuberculosis, many bouts of pneumonia,
bronchitis, and numerous chest colds in his lifetime.
A younger brother died of emphysema six years ago.
He first noticed shortness of breath twenty years ago,
if he hurried upstairs or when he pushed his lawnmower.
At the time he thought this natural for a man fifty years of age.
As the years passed,
he found that less and less exertion caused him to be short of breath.
Now a few stair steps are his limit.
He moves in a world that pushes by him at a rapid pace.
Seventy years old, he feels the weight of the past twenty years.
Unable to work in his garden,
or to pursue simple normal activities comfortably,
he finds his disease a physical as well as a financial burden.
As a result Mr. Mack suffers periods of depression,
feeling useless and frustrated.
What is emphysema?
How did Mr. Mack get the disease?
Can he be helped?
How many other people have emphysema?
Mr. Mack has known his doctor for years.
The doctor has helped his patient through several attacks
of respiratory infection that almost caused his death.
Today Mr. Mack is to have a physical checkup.
Taking off his coat and other garments for a chest examination
causes the patient to be short of breath.
He paces his activity to hide the difficulty.
He moves slowly so as not to overtax his breathing capacity.
Although deliberately slowing his movements,
Mr. Mack suffers from a lack of oxygen.
The demand of his muscles for oxygen
is greater than the lungs can supply.
An oxygen debt results,
and his body economy cannot continually run into debt.
Work must stop.
The oxygen debt must be paid.
Even while he rests, breathing is difficult,
and the breath short.
During this period,
even conversation must be interrupted for breathing.
The chest cage is rigid, moving very little.
The back is bowed,
and the chest appears to be enlarged from front to back.
The patient leans forward in his chair to make breathing easier.
His shoulders are held high and his elbows are on his thighs.
He uses his neck muscles to help get air in.
Pursed lips help the patient to expel used air
from his lungs more easily.
Paroxysms of cough are frequent and produce sputum,
as much as a cupful a day.
The whole faces assumes a deepened color,
but particularly the lips are dark.
The arterial blood is not getting enough oxygen.
A normal chest sounds like rustling leaves,
but the doctor hears little air moving in Mr. Mack's lungs.
Poor distribution of the inspired air
is a major problem in this disease.
On deep expiration, a wheeze may be audible,
or sputum may gurgle, indicating the airway obstruction present,
and probable bronchial infection.
The chest x-ray shows many of these abnormalities.
The lungs are over-distended,
too large for the chest.
The boney cage is large,
and diaphragms are low,
as though the lungs were pushing everything out of the way.
The heart is small,
as if it were compressed by the large lungs.
The match test is a simple means of finding this disease.
The object is to blow out a lighted book match,
held six inches from the mouth, which must be wide open.
This is easy for a normal person,
but Mr. Mack cannot get air to flow
out of these lungs rapidly enough
to extinguish the flame,
so serious is the obstruction of the airways.
Mr. Mack's physician may use other tests
to measure the airway obstruction.
This instrument is a spirometer,
which will measure the rate at which the airflows out of the lungs.
The technician instructs Mr. Mack to breath in
as deeply as possible,
and then blow the air out as rapidly as he can.
The pen writing on ruled paper
follows the flow rate during expiration.
The slow delivery of the air may be seen from such tracings.
Here it takes Mr. Mack eight seconds or more
to expel the air from his lungs.
A normal individual, in comparison,
will do the same thing in three seconds or less.
In the normal lung, fresh air is distributed
through the bronchial airways to minute air sacs.
In the latter the exchange of oxygen and carbon dioxide takes place.
To breathe in, the muscles concerned with inspiration
expand the chest cage and lower the diaphragm,
much like the action of a piston in a cylinder.
The pressure in the pleural sac surrounding each lung
is reduced and the lung expands.
Fresh air is evenly distributed to the air sacs.
In expiration, the muscles relax in a normal person,
allowing a small rise in pressure in the pleural sac.
The lung, because of its elasticity,
returns to the resting volume somewhat like the recoil
of a stretched rubber band.
Pressure in the pleural sac throughout inspiration and expiration
remains below atmospheric levels.
In emphysema, the resting lung volume is larger than normal.
The lung has lost much of its elasticity and its ability to recoil.
In inspiration the chest volume increases,
but the pressure drop in the pleural sac
is less marked than in a normal chest.
The air sacs fill unevenly,
and some have inadequate amounts of fresh air for gas exchange.
With loss of elasticity, the lung will not empty well.
To exhale, the patient must push the chest wall down on the lung.
As a result the pressure becomes positive in the pleural sac.
This positive pressure will collapse the airways as well as the air sacs.
Airway obstruction results.
So this is emphysema,
a disease of obstruction to airflow so that respiration is work.
Mr. Mack's disease is in an advanced stage.
The lungs are damaged too severely to be restored,
and complete relief of symptoms is impossible.
Since it is known to aggravate this condition,
Mr. Mack should give up smoking.
Aerosols to clean the airways and dilate bronchi,
and antibiotics to combat infection
afford temporary relief.
Years ago the disease process might have been halted
and this stage avoided,
If treatment had started when cough and sputum
were the only symptoms,
and an abnormal expiratory flow rate the only sign,
the crippling disease you see here might've been prevented.
At present, relief is always incomplete.
When symptoms are very severe,
mechanical aids to breathing are added to the therapy.
These ventilate the lungs more adequately
and administer aerosols effectively.
Although the cause of emphysema is unknown,
much research is being done to solve the puzzle of this disability.
The structural damage to the lung is being studied.
How severe is it?
What part of the lung is affected?
Even the proper preparation of the lung for such a structural study,
without introducing errors, is a problem.
Bacterial as well as viral agents
are being considered as causes of lung damage.
Emphysema is common in patients with tuberculosis.
Other types of infections are also suspected
of being associated with the condition.
Public health and environmental research studies
indict smoking, air pollution, and occupational exposure
as contributing to the progress of the disease.
Whether these agents alone will result in emphysema,
or whether other factors must be added is not known.
Several diseases may end in this crippling condition.
Pulmonary function in this disease is deranged in many ways.
Abnormal distribution of air and blood in the lung,
the work of breathing, and the abnormalities
of the pulmonary membrane between air and blood are under study.
Epidemiological, sociological, and psychosomatic studies are increasing
and answers to some of our questions will be forthcoming.
Emphysema is not only an individual, but a community problem.
This graph shows the mortality statistics in California
for three diseases commonly mixed in their reporting:
chronic bronchitis, asthma, and emphysema.
At least some of the deaths from asthma and bronchitis
may as well be classified as emphysema.
Also shown is the death rate for tuberculosis in California.
It is evident that emphysema deaths are increasing,
in contrast to deaths from tuberculosis.
Some patients, who in the past would've died of their tuberculosis
are now living long enough to have emphysema.
National foundations for the diseases shown here
provide an estimate of the number in the United States
today suffering from each malady.
Muscular dystrophy, active tuberculosis,
cancer of all types,
heart disease including both heart and blood vessels,
are a few for which figures are available.
The incidence of emphysema varies from eight to 30 percent
of the population, depending upon the sample.
A minimal figure of ten percent of the adults in the United States
would give approximately 12 million people in some stage of this disease.
The total problem of emphysema is as large or larger
than many other diseases, and is increasing in magnitude.
Emphysema as a community problem has received little recognition.
In this respect it is like tuberculosis,
when Mr. Mack had it forty-five years ago.
A chronic disease without known cure and little public interest in it.
But tuberculosis is being controlled through the cooperation of science
and an enlightened public.
The same tools may be used to control emphysema.
There need not be Mr. Macks in our future.
Education of the public regarding the contributing causes,
emphasis on early case-finding, rehabilitation of the disabled,
treatment of the seriously ill,
and an intensive investigative effort will succeed.
Emphysema, too, can be conquered.