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Are COPD Patients at Risk for Barrel Chest?

doctor with xray, xray, emphysema, barrel chestBarrel chest – a term that best describes a bulging, rounded chest that resembles the shape of a barrel. The term “barrel chest” commonly relates to people who have chronic obstructive pulmonary disease (COPD), namely emphysema in its later stages. In emphysema, the lungs are chronically (persisting over a long period of time) over-inflated with air, causing the rib cage to stay partially expanded all of the time. This causes a barrel-shaped appearance to the chest. Barrel chest itself is not treated, but the underlying disease that causes the condition is.[1]

What is Emphysema?

Emphysema is a chronic lung disease in which the tiny alveoli (air sacs) of the lungs become damaged reducing the amount of oxygen that reaches your bloodstream. People with emphysema aren’t able to empty their lungs as quickly or as completely as they should and some of the air gets trapped in the lungs. Over time, the lungs get larger and you find it more difficult to breathe.

What Causes Emphysema?

There are two main causes of emphysema:[2]

  • Smoking – by far, smoking is the leading cause of emphysema, although secondhand smoke may also play a role in its development. Smokers are 6 times more likely to develop emphysema than non-smokers. The good news: quitting may help slow the progression of lung damage caused by the disease.
  • Alpha-1-antitrypsin (AAT) deficiency – AAT is a protective protein ordinarily made by the liver. Its job is to help maintain normal lung function. A deficiency of AAT leads to lung tissue destruction and sometimes, emphysema. AAT deficiency is an inherited condition that you get from both parents. If only one parent passes the gene, you are considered a carrier of AAT deficiency. This means you don’t have the disease, but you could pass it along to your children.

Symptoms of Emphysema

The most common symptoms of emphysema are as follows:2

  • Shortness of breath
  • Rapid breathing
  • Wheezing
  • Cough, with or without mucus production
  • Decreased tolerance for exercise
  • Loss of appetite; weight loss
  • Barrel chest
  • Clubbing of fingers (rounding of the nailbeds due to lack of oxygen; may occur in late stages of the disease)
  • Cyanosis (bluish tint to lips, nailbeds, earlobes due to lack of oxygen; may occur in late stages of the disease)

Treatment of Emphysema

cigarettes, pack of cigarettes, smoking, emphysema, barrel chestTreatment of emphysema can reduce symptoms and the risk and severity of COPD exacerbations, and improve health status and tolerance to exercise. Treatment options include:[3]

  • Smoking cessation – the single most important treatment for prevention and management of emphysema is to quit smoking. Doing so may help slow the progression of the disease.
  • Vaccinationsinfluenza (flu) vaccine is recommended for all COPD patients. The pneumonia vaccine is recommended for COPD patients > 65 years of age and younger COPD patients with co-existing illnesses, including heart and lung disease.
  • Inhaled bronchodilators – first-line treatment for emphysema. Help to relax the airways making it easier to breathe. For people with persistent shortness of breath, a combination of long-acting Beta2 agonist (LABA) bronchodilator and long-activing anti-muscarinic (LAMA) bronchodilator may work best.
  • Inhaled corticosteroids (ICS) – reduce swelling and inflammation in the airways. Long-term treatment with inhaled corticosteroids alone is not recommended but may be considered in addition to a LABA for patients with a history of COPD exacerbations despite treatment with long-acting bronchodilators.
  • Phosphodiesterase (PDE) 4 inhibitors – help reduce inflammation in the airways. Add to treatment regimen for patients with exacerbations despite treatment with long-acting bronchodilators and ICS.
  • Antibiotics – Recent studies show that prophylactic (taken daily to prevent exacerbations) treatment with antibiotics may reduce the COPD exacerbation rate but this practice remains controversial. Antibiotics are usually reserved for COPD exacerbations caused by a bacterial infection.
  • Mucolytics – a class of drug that aids in the clearance of mucus from the airways. Only recommended for a select group of patients. Ask your doctor if mucolytics are right for you.
  • Oxygen Therapy – long-term oxygen therapy (LTOT) is generally recommended for patients whose blood oxygen levels are less than or equal to 55 mg Hg or oxygen saturation levels of 88% or lower.
  • Pulmonary rehabilitation – appropriate for most patients with COPD. Helps improve shortness of breath, overall health status and tolerance to exercise.
  • Opioids – low-dose and long acting opioids, taken by mouth or in IV form, may be considered for patients with shortness of breath and severe disease.
  • Lung surgery – including bullectomy, lung volume reduction surgery (LVRS) and lung transplant. Available to a select group of patients who meet very strict criteria.

Prevention of Emphysema

The best way to prevent emphysema all together or prevent it from getting worse is to quit smoking if you’re a smoker. Other preventative strategies include:

  • Avoid other airway irritants including secondhand smoke, fumes from paint, automobile exhaust and chemicals in the workplace, dust and air pollution.
  • Exercise regularly to strengthen your muscles and significantly increase your lung capacity.
  • Get vaccinated, as described in the above section.
  • Avoid contact with sick people, including those who have a cold or the flu and large crowds. This helps prevent exacerbations. If you must venture into a crowded place, wear a face mask that’s meant to keep germs from entering your respiratory tract through your nose and mouth.
  • Wash your hands frequently with soap and warm water for at least 20 seconds. If water is unavailable, use an alcohol-based hand sanitizer.

Although barrel chest may not go away with emphysema treatment, treatment will help manage your symptoms and make you feel better. For more information about barrel chest and emphysema, talk to your primary care provider.

[1] Olson, Eric J., MD. Barrel chest: What causes it? Mayo Clinic. January 16, 2016.

[2] WebMD. What is Emphysema? Last reviewed November 21, 2016.

[3] Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease. 2018 Report.


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