Emphysema

Inside your lungs are many branching tubes (bronchioles) that allow for the movement of air. At the end of these bronchioles are small balloon-like sacs called alveoli. When you breathe in, the alveoli fill up with fresh air.

Pulmonary emphysema is a chronic lung disease that damages the alveoli. The walls of the alveoli weaken, rupture, and become floppy. Old air becomes trapped, making breathing increasingly difficult.

Emphysema is an obstructive lung disease

Emphysema is considered an obstructive lung disease; it obstructs (prevents) you from exhaling all the old air properly.

It is one of several diseases that make up a condition called chronic obstructive pulmonary disease, or COPD. Chronic bronchitis, or long-term irritation of the airways, is another disease that makes up COPD, and many people with emphysema also have chronic bronchitis.

What causes emphysema?

Emphysema, like chronic bronchitis and other diseases related to COPD, is largely caused by heavy cigarette smoking.

Symptoms of emphysema

Symptoms of emphysema tend to develop gradually over time. They may be mild to start, or you may dismiss them as just a natural part of aging. However, emphysema is a serious medical condition that should not be ignored.

Common symptoms

You should talk to your doctor right away if you experience the following:

  • Chest tightness.
  • Chronic cough.
  • Feeling like you’re not able to get enough air.
  • Ongoing fatigue.
  • Shortness of breath, especially when you are doing physical activities.
  • Wheezing, a high-pitch whistling sound that happens when you breathe through your nose or mouth.

In severe cases

If you have severe emphysema, you may also experience:

  • Barrel chest: The lungs become chronically over-inflated with air because you’re not able to breathe out effectively. This can give the appearance of a slight barrel chest.
  • Clubbing: Your fingertips appear rounded
  • Pursed-lip breathing.

These symptoms do not necessarily mean you have emphysema. Regardless, you should talk to your doctor so that you can get a diagnosis.

Seek emergency medical attention if you or someone you know:

  • Are not mentally alert or become confused.
  • Are so short of breath that you can’t climb stairs.
  • Have fingernails that turn blue after physical activity.
  • Have shortness of breath accompanied by chest pain, jaw pain, or air pain.

Senior man stretching on running track hero

Causes and risk factors

Causes

Emphysema, like chronic bronchitis and other diseases related to COPD, is largely caused by heavy cigarette smoking.

Cigarette smoke irritates and damages the fragile, elastic tissue of the airways and alveoli. The chemicals in cigarette smoke are also toxic to your cells. Smoking is the number one culprit of emphysema and COPD.

Other causes of emphysema include:

  • Exposure to air pollution.
  • Exposure to chemicals, fumes, and lung irritants at work.
  • Heavy marijuana smoking.
  • Prolonged exposure to secondhand smoke, such as by living with someone who smokes.
  • Smoking tobacco products using a pipe, cigar, or other means.

In rare cases, the cause is an inherited deficiency in an important protein that protects the alveoli. This is called alpha-1 antitrypsin deficiency emphysema.

Risk factors

A risk factor is anything that increases your chance of developing a condition. Risk factors for emphysema include:

  • Smoking. Smoking is the main cause of emphysema, and most emphysema patients have a history of smoking. Your risk increases with each additional year of smoking.
  • Exposure to secondhand smoke. Secondhand smoke is smoke that you accidentally inhale from someone else’s cigarette or tobacco smoke. If you live with someone who smokes, you are at greater risk for emphysema
  • Exposure to fumes at work. Working with chemicals, fumes, or you work with cotton, wood, or mining products can expose you to lung irritants.
  • Living with air pollution. Constantly breathing in polluted air can increase your risk for emphysema. Air pollution can be caused by indoor sources, like heating fuel, or outdoor pollutants like car exhaust and smog.
  • Being older. Most emphysema patients begin developing symptoms later in life, usually between ages 40 and 60.

Complications of emphysema

Emphysema damages your lung tissue and makes it hard to breathe. It is a chronic lung condition, which means it gets worse with time. If left untreated, this can lead to serious medical problems, including:

Pulmonary bleb. A pulmonary bled is a small pocket of air located between the lung and the lung’s outer surface. If they rupture, trapped air is released into the chest cavity, which can cause other problems like a collapsed lung.

Bullae. A bullous is a large space that forms in the lungs. This reduces your lung’s ability to expand, further disrupting lung function. Bullae can take up as much as half of your lung space. Like blebs, bullae can rupture and cause a collapsed lung.

Collapsed lung (pneumothorax). This is a serious but rare complication. It happens when air gets into your chest cavity and puts pressure on the lung, causing it to collapse. A collapsed lung can be life-threatening and requires immediate medical attention. If you have a collapsed lung, you may experience sharp chest pain and very sudden shortness of breath.

Diagnosing emphysema

If you have symptoms of emphysema, you should talk to your doctor. They can provide you with a diagnosis and help you find a treatment that works for you. Your doctor will start by asking you about:

  • Your family history.
  • Your medical history.
  • Whether or not you smoke, and how often.
  • Any other work-related exposures that may be causing your symptoms.

From there, your doctor will perform a physical exam, look for signs of emphysema, and listen to your breathing. The way that your lung sounds can provide a clue about the underlying cause of your symptoms.

Provider and patient having a discussion

Diagnostic tests

If your doctor suspects emphysema, they may also recommend the following tests:

  • Blood tests. Your doctor takes a small blood sample to determine the levels of oxygen and carbon dioxide.
  • Imaging exams. These tests allow your doctor to see inside your body for proper diagnosis.
    • Chest X-ray: An x-ray uses high-energy beams to create a picture of your body. Unless you have advanced emphysema, a chest x-ray alone can’t be used to diagnose you. But it can rule out other conditions, such as lung cancer.
    • CT scan: A CT scanner takes multiple X-ray images to create a cross-sectional view of the body. This can help your doctor see lung damage and diagnose emphysema.
  • Lung function test. This test measures how much air your lungs can hold and how well you can inhale and exhale. Generally, this involves breathing into and out of a machine while following a doctor’s instructions.

Treatments for emphysema

There is no cure for emphysema, and there is no way to reverse the lung damage that causes it. However, there are a variety of treatments and lifestyle changes you can make to manage your symptoms:

These lifestyle changes will not necessarily resolve your symptoms, but they will prevent further damage.

  • Quit smoking. If you smoke and are diagnosed with emphysema, your first step to treatment is to quit smoking. This will prevent further lung damage and make it easier to breathe.
  • Avoid secondhand smoke. Like smoking, continuous exposure to secondhand smoke means continuous damage to your alveoli. Avoid places where there may be lots of smoke or other lung irritants.
  • Wear the appropriate protective equipment, such as face masks or respirators, while at work.

Medications for treating emphysema include:

  • Anti-inflammatory medications. Airway inflammation is common with emphysema, and it can make symptoms like shortness of breath worse. Your doctor may prescribe you an inhaler containing corticosteroids, strong anti-inflammatory medications, to ease symptoms.
  • Bronchodilators. Bronchodilators are medications that relax the muscles in your airways and make it easier for you to breathe. This reduces coughing and shortness of breath. You will use an inhaler to get the medication directly to your lungs. Depending on the severity of your emphysema, your doctor may recommend you use the inhaler only as needed or on a regular schedule.
  • Mucolytics. These drugs thin out the mucus in your lungs and make it easier to cough up. Your doctor may prescribe this if you have a chronic cough with lots of mucus.

In addition to the above medications, your doctor may recommend that you get the annual flu vaccine. If you have emphysema and get the flu, you are more likely to have severe complications. Additionally, if you get pneumonia or another infection, you will need to take antibiotics.

Oxygen therapy

If you have severe emphysema, you may need additional oxygen because your body is not getting enough.

You may only need to use oxygen when you perform physical activities, but you may need it all the time.

Pulmonary rehabilitation

This involves learning different breathing techniques and exercises to improve your ability to exercise and carry out daily activities. You may also get nutrition and psychological advice so that you can better take care of yourself and your condition.

If you have severe emphysema and other treatments aren’t working, your doctor may suggest surgery. The main types of surgery for emphysema include:

Removal of blebs or bullae. Your surgeon will remove the empty air sacs to prevent them from rupturing and to give your lungs more space to expand.

Lung volume reduction surgery. Your surgeon removes a wedge of damaged lung tissue. This gives the rest of your lungs more space to expand and work more efficiently.

Lung transplant. A lung transplant is considered a last resort for emphysema treatment. In this procedure, your damaged lung will be removed and replaced by a lung from a donor. There are many risks associated with a lung transplant, such as rejection. Additionally, the wait times for a lung transplant are usually long, as donors are few and far between.