Emphysema: Stop smoking to prevent suffocation
5:00 AM, May. 25, 2011|
The patient had a loose-sounding cough
and a history of fever and chills. A
stethoscope revealed tiny popping sounds
during respiration. I was strongly suspicious
“Do you still smoke?” I asked.
The answer was a slow but clear “yes.”
I knew the patient would need antibiotics
and an inhaler. But he genuinely seemed to
be troubled by his continued smoking, and
I felt he was approachable. I decided to
spend the time to counsel him on quitting
smoking. It was time for a lesson about
Emphysema is a disease of the lungs that
most often is brought on by smoking. It
actually involves a protective defect in the
body because of the digestive enzyme
trypsin. Think of a child’s latex balloon.
When blown up and released, the balloon
discharges air, spontaneously propelling it
around the room. Inflated lungs work in a
similar fashion because of elastin in the
lung soft tissues.
When we inhale, air expands the lungs.
However, exhalation is mostly an act of
relaxation. After a deep breath, the
stretched lungs collapse and force the air
out. This air contains carbon dioxide. The
subsequent inhalation fills the lungs with
oxygen-rich air again and the process is
Without this elastic nature of the lungs, we
have difficulty exhaling air. In fact, filling
the lungs of a person with emphysema is a
bit like blowing up a paper bag. It expands
full of air, but does not collapse on its own.
People with emphysema do not have
trouble breathing in so much as they
cannot breathe out. The elasticity of their
lungs has been destroyed.
In fact we now know that trypsin, a
digestive enzyme in the gut which dissolves
proteins, can be found in small amounts in
the blood stream. However, an enzyme in
the liver and lungs called alpha-antitrypsin
deactivates trypsin, except in smokers.
It appears that smoking prevents or inhibits
alpha-antitrypsin’s protective effect so that
trypsin gradually dissolves the stretchy lung
tissue. This is the cause of emphysema.
In essence, smoking can cause the stretchy
tissues of the lungs to be digested. The
result is slow suffocation.
In the case of my patient, I think this lesson
“I never knew that,” he emphatically
When he left my office he had a very
With prescriptions in hand, he walked away
to begin his treatment for his lung infection
and to hopefully start the first day of the
rest of his life without cigarettes.
Only time will tell if he succeeds, but I am
very hopeful. He had the look of someone
determined to breathe the fresh air of the
great Northwest for a change, instead of
continuing this slow suffocation.
Amen for that!
Dan Gold is a board-certified family
physician who treats U.S. military
veterans in Great Falls. E-mail him at