Shortness of Breath

Any illness that is gradually choking to death a million or more Americans might be expected to be a well-known subject of intensive attack by medical scientists. But the progressive and eventually fatal shortness of breath that doctors call emphysema (pronounced em-fe-see-muh) is so little known that it has no common English name. Until recently few laymen even realized that it existed,* and most doctors thought it was rare. But emphysema is rapidly changing its status. It is now recognized as probably the most common disabling disorder of the respiratory system.

Two-Way Stretch. Strictly speaking, the University of Arkansas' Dr. Richard V. Ebert told a meeting of the New York Heart Association, emphysema is a more or less permanent inflation of the lungs resulting from the loss of elasticity in their deepest recesses. There the tiny alveoli, or gas-exchange cells, give up carbon dioxide and take in oxygen. Clustered around small arteries, they are so numerous that they create a huge area for gas exchange--about 85 sq. yds. in the average adult.

In emphysema, not only do many of the individual alveoli lose their elasticity, so that they do not exchange enough carbon dioxide and oxygen, but much of the lung wall itself loses its stretch. The lungs tend to remain inflated. What the patient is aware of, said Dr. Ebert, is shortness of breath--especially when he begins to exert himself. The condition gets progressively worse until the victim finds himself winded after less and less exertion. Ultimately he is out of breath even when sitting still.

There has been much confusion between chronic bronchitis and emphysema, and some British authorities are inclined to believe that they are the same disease. Not so, said Dr. Ebert. Bronchitis, by definition, is inflammation and consequent obstruction of the branches of the windpipe. Post-mortem examinations have recently shown that one victim may have suffered from severe bronchitis and a little emphysema while another may have had the reverse. To distinguish between these two types in living patients with labored breathing, said Dr. Ebert, is surprisingly difficult. In fact, there is a continuous spectrum ranging from patients with pure bronchitis and no emphysema to those rare cases with pure emphysema and no bronchitis. Most, Dr. Ebert said, have a bit of both.

Perhaps the most baffling thing about emphysema is that it resembles the normal effects of aging. Even in healthy men, the lungs lose some of their stretch with advancing age. Emphysematous damage to some part of the lungs has now been found to occur in a majority of men over 60, whether or not they ever complained of shortness of breath. It is more common among men than women, more common among smokers than nonsmokers, and particularly evident where there is severe air pollution.

Drugs & Detergents. What the physician can do for shortness of breath depends largely on its cause. Many cases of bronchitis are the result of infection, and can be largely relieved, if not actually cured, by treatment with antibacterial drugs. Other cases are relieved by inhaling substances that help to break up the mucous secretions. But emphysema is stubborn. Since its basic causes are still unknown, doctors have as yet no hope of finding a true cure or general preventive. Yet treating its effects is important because emphysema neglected overtaxes the heart in a manner that may cause death.

There are several devices for both home and hospital use to help severely ill emphysema victims get more breath during a crisis. These machines can mix drugs or mucus-dissolving detergents with the breathing mixture. They supply this under pressure through a mask that the patient can hold to his face for a couple of minutes or strap on if he needs longer treatment.

* n Though it is familiar as "the heaves" or "broken wind" in horses. Emphysema comes from a Greek word meaning to puff up or inflate.

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