Emphysema

Emphysema is a lung disease where there’s damage to the walls of the small air sacs in your lungs (alveoli). It’s a form of COPD (chronic obstructive pulmonary disease).

Your alveoli are stretchy sacs at the ends of your airways. They hold oxygen for your blood to pick up as it passes in nearby blood vessels. Long-term inflammation damages alveoli, causing them to lose their stretchiness and become floppy. Air doesn’t flow out of them like it should and gets trapped.

Also, the walls between individual air sacs are destroyed, creating larger areas filled with air. This leaves blood vessels with a smaller area of tissue to pick up oxygen from.

This means:

• It’s harder for your lungs to transfer oxygen to your blood.
• Trapped air containing carbon dioxide (a waste product) can’t escape, leaving less room for fresh air to come in.
• Your body has to work harder to breathe and get oxygen to your tissues.

Smoking is the most common cause of emphysema. But anything that causes long-term inflammation in your lungs can lead to it. Early symptoms include tiredness and worsening shortness of breath.

Symptoms of emphysema

Emphysema symptoms could include:

• Shortness of breath, especially during physical activity or exertion
• Fatigue
• Long-term cough
• Cough with a lot of mucus
• Wheezing (noises when you breathe)
• Constant feeling of not being able to get enough air
• Frequent respiratory infections or bronchitis
• Chest tightness

Complications

Complications of emphysema include:

• Frequent pneumonia
• High levels of carbon dioxide in your blood (hypercapnia)
• Low levels of oxygen in your blood (hypoxemia)
• High blood pressure in your lungs
• Collapsed lung
• Polycythemia vera, when your body makes too many red blood cells
• Respiratory failure
• Right-sided heart failure

Emphysema causes

Smoking is the main cause of emphysema. Cigarette smoke leads to long-term (chronic) inflammation that damages the lung tissue between your alveoli.

But anything that causes inflammation over a long period of time can lead to emphysema. People who smoke cigarettes are at the highest risk. Other risk factors include exposure to:

• Cigar and marijuana smoke
• Dirty air
• Dust or chemical fumes from your job or hobbies
• Secondhand smoke
• Smoke from campfires or wood-burning stoves

You’re also at a higher risk if you have long-term or recurrent lung infections or Alpha-1 antitrypsin deficiency (Alpha-1). Alpha-1 is a genetic condition that causes low levels of protective proteins in your lungs.

How doctors diagnose emphysema

Your healthcare provider will ask you about your symptoms and listen to your heart and lungs. They may tap on your chest to listen for hollow sounds, which can mean your lungs are trapping air.

To confirm a diagnosis, your provider may recommend:

• Imaging: Chest X-rays or CT scans can get images of the inside of your lungs.
• Pulmonary function testing: These tests measure how well your lungs are working.
• Arterial blood gas (ABG) test: This test measures oxygen and carbon dioxide levels in your blood.
• Blood tests: Your provider might do blood tests, including genetic testing, to diagnose Alpha-1 antitrypsin deficiency.

How is emphysema treated?

You can’t reverse damage from emphysema. Treatment focuses on slowing tissue damage and improving lung function. If you smoke, your provider will recommend quitting to help prevent further damage.

You should also take steps to avoid respiratory infections, which could lead to pneumonia. This includes getting recommended vaccinations, washing your hands frequently and wearing a mask when you’re around others who could be sick.

Other treatment options could include:

• Bronchodilators to open your airways
• Inhaled corticosteroids to reduce airway inflammation
• Oral corticosteroids to treat symptom flare-ups (exacerbations)
• Antibiotics to treat bacterial infections
• Oxygen therapy to get more oxygen to your lungs
• Lung volume reduction surgery (LVRS) to remove damaged parts of your lungs
• Bronchoscopic lung volume reduction to place valves in your lungs that release and prevent trapped air

If you have severe disease and other treatments don’t help, you might be eligible for a lung transplant.

When should I see my healthcare provider?

If you think you could have emphysema, don’t wait to see a healthcare provider. Early diagnosis and treatment can reduce the risk of your symptoms progressing.

Call 911 or your local emergency number if you have chest pain or severe shortness of breath.

Talk to your healthcare provider if you:

• Are short of breath often or find it harder than usual to breathe
• Have more mucus than usual
• Have yellow or green mucus (when you usually don’t)
• Have less energy
• Need to use your bronchodilator or inhaled corticosteroid medications more often
• Don’t feel like your medications are as effective
• Are coughing more
• Have breathing issues that keep you up at night or wake you in the middle of the night

What can I expect if I have emphysema?

What to expect depends on the severity of the disease when you’re diagnosed. People who are diagnosed earlier tend to have better outcomes.

If you quit smoking and avoid other lung irritants, you can slow down the progression of emphysema and reduce your risk of new damage. The existing damage is permanent and can get worse over time. But with treatment, many people manage their symptoms and improve their quality of life.

Life expectancy

Life expectancy depends on:

• Your age
• Your lung function and the severity of symptoms at diagnosis
• Whether or not you smoke or used to smoke
• Whether you have Alpha-1 antitrypsin deficiency

For example, if you have limited damage and it’s not progressing, you may have a normal life expectancy. If emphysema is in the later stages at diagnosis, it can shorten your life by six to nine years.

Can this be prevented?

The best way to reduce your risk of developing emphysema is to avoid smoking. If you currently smoke, ask a healthcare provider for resources to help you quit. You should also avoid secondhand smoke, chemical fumes, and dust and toxins in the air. Wear a respirator mask if you need to be around things that can irritate your lungs.