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Emphysema is one of several chronic lung diseases usually seen in patients with longstanding smoking histories. Patients with emphysema most commonly complain of breathlessness - at first with moderate levels of activity (such as stair climbing), and later with lower levels of activity or even at rest. The diagnosis of emphysema is established after a physician obtains the typical history of breathlessness, certain clinical findings on examination of the lungs (including wheezing, poor flow of air and overinflation of the chest), specific chest x-ray changes, and abnormal pulmonary function tests. Symptoms of breathlessness are caused by a combination of destruction of lung tissue (emphysematous changes) as well as obstruction to flow of air in and out of the chest; both of these findings are usually consequences of smoking. A small percentage of early onset emphysema cases may be related to a genetically inherited deficiency of a certain protective lung protein known as alpha-1 antitrypsin. Once a patient is shown to have emphysema, it is all but inevitable that the disease will progress if the patient continues to smoke. Frequently the disease stabilizes (and occasionally improves) after smoking cessation. Unfortunately, a large part of the disease process is not reversible. Treatment of emphysema revolves around preventative measures such as smoking cessation, influenza and pneumonia vaccinations, as well as therapy with bronchodilators and other pulmonary medications. Select patients with proven alpha-1 antitrypsin deficiency who have quit smoking may be candidates for intravenous alpha-1 antitrypsin replacement treatment. Some patients with advanced emphysema may benefit from home oxygen therapy.

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