Symptoms of stage 3 and 4 emphysema can be severe enough to significantly affect a person’s ability to perform daily activities, such as showering. People may also experience frequent flare-ups.
Emphysema is a form of chronic obstructive pulmonary disease (COPD). While mild emphysema also involves symptoms of shortness of breath and cough, these symptoms
In certain cases, people with severe emphysema may lose up to 9 years of their life expectancy. Treatment cannot reverse the damage to the lungs, but it can help provide relief and comfort.
This article discusses severe emphysema symptoms and how they compare with mild symptoms. It also examines life expectancy, treatment, and when to contact a doctor.
There are four stages of COPD. At stages 3 and 4, a person has severe emphysema symptoms.
Stage 3: Severe
Symptoms become intense, and people can experience:
- frequent flare-ups
- worsening shortness of breath
- worsening cough
Additionally, during this stage, people can experience:
- frequent colds
- swelling in the ankles, feet, and legs
Stage 4: Very severe
During stage 4, blood oxygen levels become very low. People may experience:
- difficulty catching their breath
- more frequent and potentially life threatening flare-ups
- increased risk of heart or lung failure
After diagnosis, a doctor will give a person an individualized action plan to help them identify a flare-up and what to do when it occurs. An action plan will specify the symptoms that require notifying a doctor and the symptoms that necessitate going to the emergency room.
The symptoms below are examples of those that pose a danger and require immediate medical attention:
- severe shortness of breath
- chest pains
- coughing up blood
- bluish, grayish, or whitish color of lips or nails
- high fever or chills
Classifying emphysema using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines involves completing tests and questionnaires to determine how severe the condition is.
Once someone receives a COPD diagnosis, doctors classify the severity of the airflow limitation in the lungs. They do so by measuring the amount of air a person can exhale in a second — this is known as FEV1.
Measuring airflow limitations can help determine the following:
- the impact COPD has on a person
- the risk of exacerbations (flare-ups)
- a treatment plan
The GOLD guidelines for classifying airflow limitation are as follows:
|Stage||Predicted FEV1 percentage|
|GOLD 1 (mild)||80% or greater|
|GOLD 2 (moderate)||50–79%|
|GOLD 3 (severe)||30–49%|
|GOLD 4 (very severe)||less than 30%|
Assessing symptoms and flare-ups is also necessary for determining someone’s COPD group. This follows from the staging process and requires people to answer a questionnaire.
The questionnaire may ask about symptoms, including breathlessness. The GOLD guidelines use the following classifications to measure symptom severity:
- Group A: low risk of flare-ups and fewer symptoms
- Group B: low risk of flare-ups and more symptoms
- Group C: high risk of flare-ups and fewer symptoms
- Group D: high risk of flare-ups and more symptoms
Following diagnosis, doctors may offer treatment. However, these options will not cure the condition.
Also, treatment cannot repair the lung damage that emphysema causes. Instead, it reduces further symptoms. The options include:
Unless a person quits smoking or avoids secondhand smoke and other pollutants, their emphysema will worsen. Due to the link between smoking and emphysema, quitting is vitally important.
Other lifestyle practices that may help include:
- engaging in regular physical activity
- eating a nutritious diet
- getting enough sleep
Making these lifestyle changes can delay COPD progression.
Inhaled bronchodilator medications
These open the breathing airways in the lungs, which make it easier to exhale or breathe out.
For the best results, people often use both long-acting and short-acting inhalers. Typically, long-acting medications involve once- or twice-daily use, while short-acting medications need to be used every 4–6 hours.
This is a program that
- exercises to build strength, stamina, and flexibility
- nutritional counseling to help ensure adequate intake of nutrients
- psychological counseling to help manage stress and cope with co-occurring mental health conditions, such as depression
- breathing techniques to prevent feeling out of breath
- education to help quit smoking, conserve energy, and develop a plan to manage flare-ups
Doctors prescribe this when someone’s oxygen level falls below 88%. Supplemental oxygen can help a person breathe better and
The type of surgery a doctor recommends depends on various factors.
One type involves the removal of damaged parts of the lung so they will not hamper the function of the healthier parts. Another type entails the insertion of one-way valves into the lungs’ breathing tubes, which permits air to leave the healthy parts of the lung.
A lung transplant
The life expectancy of an individual with emphysema depends on various factors.
Doctors use scoring systems to help determine a person’s life expectancy. For example, using the GOLD system, a doctor may predict that someone with stage 4 group D symptoms has a shorter life expectancy than someone with stage 1 group A symptoms.
Another useful scoring tool is the BODE index. It uses the following components, which help give the index its name, to generate a score:
- B: uses the body mass index (BMI)
- O: the extent of airflow obstruction, also uses FEV1
- D: dyspnea (shortness of breath) assessment
- E: exercise capacity, usually measured using the 6-minute walking test
The BODE index is particularly good at predicting survival and exacerbations, including those that require admission to a hospital.
If a person with mild emphysema notices worsening shortness of breath or cough, they could be developing severe emphysema symptoms. These symptoms can have a significant effect on a person’s ability to perform daily activities.
Once emphysema advances to the severe stage, individuals may lose an average of 9 years of life expectancy.
Various treatment options are available, with doctors reserving surgery for the most severe cases.
Getting treatment early and quitting smoking can make a difference in a person’s outlook. A person should speak with a doctor when they first start experiencing shortness of breath during an activity that would not normally seem taxing.