Emphysema is a type of chronic obstructive pulmonary disease (COPD). In this condition, the air sacs in the lungs become damaged and stretched. This results in a chronic cough and difficulty breathing.
Smoking is the most common cause of emphysema, but other factors can also cause it. There is currently no cure, but quitting smoking can help improve the outlook.
In the United States, around 3.8 million people (1.5% of the population) have received a diagnosis of emphysema. In 2017, 7,085 people (2.2 people in every 100,000) died with the condition.
Keep reading to learn more about emphysema, including the causes, symptoms, and treatment options.
The walls of the air sacs break down or are destroyed, narrowed, collapsed, stretched, or over-inflated. This means that there is a smaller surface area for the lungs to take oxygen into the blood and remove carbon dioxide from the body.
This damage is permanent and irreversible, but there are ways of managing the condition.
The key symptoms of emphysema include:
- shortness of breath, or dyspnea
- a chronic cough that produces mucus
- wheezing and a whistling or squeaky sound when breathing
- tightness in the chest
At first, a person may notice these symptoms during physical exertion. However, as the condition progresses, they can also start to happen during rest.
Emphysema and COPD develop over a number of years.
In the later stages, a person may have:
- frequent lung infections and flare-ups
- worsening symptoms, including shortness of breath, mucus production, and wheezing
- weight loss and reduced appetite
- fatigue and a loss of energy
- blue-tinged lips or fingernail beds, or cyanosis, due to a lack of oxygen
- anxiety and depression
- sleep problems
The Emphysema Foundation of America have expressed concern about how COVID-19 might affect people with emphysema.
They urge people with COPD to familiarize themselves with the symptoms of COVID-19. These can resemble the symptoms of COPD and emphysema. A person should contact their doctor if they have any unusual symptoms or a high fever.
They recommend taking full precautions to avoid exposure to the virus, including:
- frequently washing the hands and encouraging others to do the same
- avoiding people who may have had contact with the virus
- frequently wiping surfaces
- wearing a face covering such as a mask in public places
- avoiding crowded gatherings
They also advise:
- maintaining at least a 30-day supply of medication
- keeping a stock of household necessities, including food and other basics
- checking with local providers about plans to maintain oxygen supplies
- making a plan in case of sickness
The Global Initiative for Chronic Obstructive Lung Disease sets out the stages of COPD.
Generally, the stages are based on a combination of airflow limitation, symptoms, and exacerbations.
A doctor can use a breathing test to measure lung capacity. The test measures the forced expiratory volume in 1 second (FEV1).
Based on FEV1, the stages are as follows:
- Very mild, or stage 1: FEV1 is about 80% of normal.
- Moderate, or stage 2: FEV1 is 50–80% of normal.
- Severe, or stage 3: FEV1 is 30–50% of normal.
- Very severe, or stage 4: FEV1 is less than 30% of normal.
The stages help describe the condition, but they cannot predict how long a person is likely to survive. Doctors can carry out other tests to learn more about how serious a person’s condition is.
In most cases, emphysema and COPD result from cigarette smoking. However, up to 25% of people with COPD have never smoked.
Other causes appear to be genetic factors, such as an alpha-1 antitrypsin deficiency, and exposure to environmental irritants, including secondhand smoke, workplace pollutants, air pollution, and biomass fuels.
People with small airways in proportion to their lung size may be more at risk than those with wider airways, according to a 2020 study.
In addition, not all people who smoke develop emphysema. It may be that genetic factors make some people more susceptible to the condition.
Emphysema is not contagious. One person cannot catch it from another.
Treatment cannot cure emphysema, but it can help:
- slow the progress of the condition
- manage the symptoms
- prevent complications
- boost a person’s overall health and well-being
Supportive therapy includes oxygen therapy and help with quitting smoking.
The sections below will look at some specific treatment options in more detail.
The main medications for emphysema are inhaled bronchodilators, which can help relieve symptoms. They relax and open the airways, making it easier for a person to breathe.
The inhaler delivers the following bronchodilators:
- beta-agonists, which relax bronchial smooth muscle and help clear mucus
- anticholinergics, or antimuscarinics, such as albuterol (Ventolin), which relax bronchial smooth muscle
- inhaled steroids, such as fluticasone, which help reduce inflammation
If a person uses them regularly, these options can improve lung function and increase exercise capacity.
There are short-acting and long-acting drugs, and people can combine them. Treatment may also change over time and as the condition progresses.
People can take steps to manage their symptoms, improve their quality of life, and slow the progression of emphysema. The sooner a person takes these steps, the more helpful they will be.
Some things to try include:
- quitting or avoiding smoking
- avoiding places where there are air pollutants, if possible
- following or developing an exercise program
- consuming a healthful diet
- drinking plenty of water, to loosen mucus and help keep the airways open
- breathing through the nose in cold weather or using a face covering to keep out cold air
- practicing diaphragmatic breathing, pursed-lip breathing, and deep breathing
Pulmonary rehabilitation is a program of care that encourages people with emphysema to learn about and manage their condition. There is a focus on developing and maintaining healthful lifestyle choices.
Making these changes may not alter the overall course of the condition, but it can help people manage the symptoms, improve their exercise capacity, and boost their quality of life.
People should also ensure that they meet with their healthcare provider regularly and receive their routine vaccinations, including those for flu and pneumonia.
In time, breathing can become more difficult, and a person may need oxygen therapy some or all of the time. Some people use oxygen overnight, for example.
Various devices are available, including large tanks for home use and portable oxygen kits for traveling.
People should discuss the most suitable options with their healthcare provider.
People with severe emphysema may sometimes need to undergo surgery to remove damaged lung tissue and reduce large spaces that develop in the lungs due to the condition.
Transplantation of one or both lungs can improve a person’s quality of life. However, there are some risks involved, such as the chance of infection.
A healthcare provider will help the person decide whether or not surgery is a good idea for them.
Other treatment options can help during a flare-up or if complications arise. These options may include:
- oxygen therapy, to relieve worsening symptoms
- antibiotics, to treat a bacterial infection
- corticosteroid drugs, to reduce inflammation
- other medications, to relieve severe coughing and pain
The outlook for a person with emphysema will depend on individual factors and how well they manage their condition. It takes several years to progress to the final stages of COPD or emphysema, but lifestyle factors play a role.
Quitting smoking can significantly improve the outlook. According to the National Heart, Lung, and Blood Institute, COPD can progress quickly in people with alpha-1 antitrypsin deficiency who also smoke.
Research suggests that for those who have never smoked, COPD will modestly reduce their life span. People who do smoke, however, can expect their life span to be significantly shorter.
Emphysema and COPD affect not only life span, but also a person’s quality of life. Taking lifestyle measures to manage the condition can help a person maintain a good quality of life for longer.
Emphysema is a type of COPD, and there are different types of emphysema, depending on which part of the lungs it affects.
- paraseptal emphysema
- centrilobular emphysema, which affects mainly the upper lobes and is most common in people who smoke
- panlobular emphysema, which affects both the paraseptal and centrilobular areas of the lungs
During diagnosis, a CT scan can show which type of emphysema is present. The type does not affect the outlook and treatment.
A doctor will carry out a physical examination and ask about the person’s symptoms, lifestyle habits, and medical history.
They may also recommend tests to confirm the diagnosis and rule out other conditions.
If the person has never smoked but appears to have emphysema, the doctor may suggest testing for an alpha-1 antitrypsin deficiency.
The following sections will look at some diagnostic tests for emphysema in more detail.
Lung function tests
Lung function tests measure the lungs’ capacity to exchange respiratory gases. They can:
- confirm a diagnosis of emphysema
- monitor disease progression
- assess response to treatment
Spirometry is one type of lung function test. It assesses airflow obstruction by measuring FEV.
For this test, a person blows as fast and hard as they can into a tube. The tube is attached to a machine that measures the volume and speed of the air that they blow out. FEV1 determines the stages of emphysema.
Other tests include imaging, such as a chest X-ray or CT scan of the lungs, and arterial blood gas analysis, to assess oxygen exchange and carbon dioxide levels.
Avoiding or quitting smoking is the best way to prevent emphysema from developing or getting worse.
Other strategies include:
- eating a healthful diet
- establishing and maintaining a moderate weight
- avoiding air pollution, if possible
- taking steps to prevent infection, such as receiving routine vaccinations
Emphysema involves irreversible damage to the lungs, which can eventually be life threatening. It mostly affects people who smoke, but people who do not smoke can develop it, too.
Seeking early treatment and taking measures to manage the condition can help enhance a person’s health and well-being and may improve their life span.