Emphysema

What is emphysema?

Emphysema is a lung disease that results from damage to the walls of the alveoli in your lungs. A blockage (obstruction) may develop, which traps air inside your lungs. If you have too much air trapped in your lungs, your chest may appear fuller or have a barrel-chested appearance. With fewer alveoli, less oxygen moves into your bloodstream.

Alveoli are small, thin-walled, fragile air sacs arranged in clusters at the end of the bronchial tubes (airways) deep inside your lungs. In a typical set of lungs, there are about 300 million alveoli. As you breathe in air (inhale), the air travels through the bronchial tubes until it reaches the alveoli. Once the air gets there, the alveoli stretch, draw in oxygen and transport oxygen to your blood. As you breathe out air (exhale), your alveoli shrink and force carbon dioxide out of your body.

Think of your lungs as bubble wrap. The alveoli are like individual bubbles in bubble wrap. If you have emphysema, your alveoli eventually break. Instead of many tiny bubble wrap bubbles, you develop a large air pocket, like a big shipping air pillow. This damage causes your lungs’ overall surface area to shrink, and it makes it hard to get fresh air in and out of your lungs. This makes your breathing difficult and makes you short of breath.

Emphysema usually develops after many years of smoking. However, emphysema has other causes. These include:

• Air pollutants in your home or workplace.
• Genetic (inherited) factors such as alpha-1 antitrypsin deficiency.
• Respiratory infections.

What is the difference between emphysema and COPD?

Chronic obstructive pulmonary disease (COPD) is an umbrella term that includes a range of progressive lung diseases. These diseases include emphysema and chronic bronchitis. Sometimes people with COPD also have asthma.

What is the difference between emphysema and chronic bronchitis?

Emphysema and chronic bronchitis are both types of COPD. Many people have them both at the same time.

Emphysema is a lung disease that damages the alveoli in your lungs. The primary symptom of emphysema is shortness of breath.

Chronic bronchitis is a lung condition that destroys the cilia in your airways. Cilia are hair-like parts (organelles) of cells that move germs and other debris out of your airways. The primary symptom of chronic bronchitis is mucus production, including a wet cough that produces thick, discolored (yellow, green or yellow-grey) mucus from your lungs (productive cough). Emphysema has more symptoms, including shortness of breath and cough.

What are the stages of emphysema?

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) categorizes COPD in four stages. Emphysema is a cause of COPD, but not all patients with emphysema have COPD. Healthcare providers use the COPD stages to help describe emphysema. The stages are:

• Stage 1. This is the mildest stage of emphysema. Your lungs operate at least 80% as well as the healthy lungs of someone who’s the same age, height and sex.
• Stage 2. This is moderate emphysema. Your lungs operate between 50% and 79% as well as the healthy lungs of someone who’s the same age, height and sex.
• Stage 3. This is severe emphysema. Your lungs operate between 30% and 49% as well as the healthy lungs of someone who’s the same age, height and sex.
• Stage 4. This is very severe emphysema. Your lungs operate less than 30% as well as the healthy lungs of someone who’s the same age, height and sex.

Who does emphysema affect?

Emphysema most commonly affects men and people assigned male at birth (AMAB) between the ages of 50 and 70. However, it also affects women and people assigned female at birth (AFAB) and may be diagnosed in people as young as 40.

How common is emphysema?

Over 3 million people in the United States have emphysema.

What is the life expectancy of a person with emphysema?

Life expectancy varies according to your age and stage of emphysema. Whether you smoked, used to smoke or never smoked also factors into your life expectancy. Smoking reduces your life expectancy by 3.5 years. Genetic factors also play a role in one’s life expectancy.

Men and people AMAB between 50 and 70 are the most likely group to have emphysema. Medical studies on how emphysema and smoking reduce the life expectancy of 65-year-old men and people AMAB show:

What are the first signs of emphysema?

Many people don’t notice emphysema symptoms until the disease has destroyed 50% or more of their lung tissue. Until then, the first signs include gradual shortness of breath and tiredness (fatigue).

Other emphysema symptoms include:

• Long-term coughing (smoker’s cough).
• Wheezing.
• Shortness of breath, especially during light exercise like climbing steps.
• Constant feeling of not being able to get enough air.
• Tightness in your chest.
• Increased mucus production.
• Abnormal mucus color (yellow or green).
• Ongoing fatigue.
• Heart problems.
• Trouble sleeping.
• Anxiety.
• Depression.
• Weight loss.

If you have emphysema, you also have an increased risk of pneumonia, bronchitis and other lung infections.

What is the main cause of emphysema?

Smoking is the main cause of emphysema.

Cigarette smoke destroys your lung tissue, and it also irritates your airways. Cigarette smoke causes inflammation and damages your cilia. Irritation and damaged cilia cause swollen airways, mucus production and difficulty clearing your airways. All of these changes can cause shortness of breath.

Though smoking is the main cause of emphysema, there are other causes. These include:

• Marijuana
• Vaping and e-cigarettes.
• Cigar smoke.
• Air pollution.
• Dust.
• Chemical fumes.

Is emphysema contagious?

No, emphysema isn’t contagious. If you have emphysema, you can’t give it to another person.

How is emphysema diagnosed?

Your healthcare provider can diagnose emphysema. However, they can’t diagnose emphysema solely from your symptoms.

Your healthcare provider will perform a physical examination. During the physical exam, they’ll listen to your lung sounds with a stethoscope (auscultation). A stethoscope is a medical device that features a small, metal disc (diaphragm) that connects to earpieces with rubber tubing.

With their stethoscope pressed against your chest, your healthcare provider will tap on your chest and listen for a hollow sound. If they hear a hollow sound, that means your lungs are trapping air. They’ll then order tests to confirm emphysema.

What tests will be done to diagnose emphysema?

Your healthcare provider may order the following tests to diagnose emphysema:

• Chest X-ray. Your healthcare provider will take X-rays of your chest to look at your lungs. They’ll compare your lungs to X-rays of healthy lungs. X-rays are usually not helpful in detecting the early stages of emphysema. They’re more useful in diagnosing moderate or severe emphysema.
• CT scan. A CT scan creates a 3D image of your lungs. It provides more detailed images than an X-ray.
• Pulmonary function testing. Pulmonary function tests measure how well your lungs inhale and exhale air. Testing may include spirometry. Spirometry uses a spirometer machine to measure the flow of air through your lungs. It also estimates the amount of air in your lungs.
• Arterial blood gas (ABG). An ABG measures the amount of oxygen and carbon dioxide in the blood from an artery (arterial blood). An artery is a tube that carries blood away from your heart. Your healthcare provider may order an ABG if your emphysema gets worse. It can help determine if you need extra oxygen.
• Electrocardiogram (EKG). An EKG checks your heart function. Your healthcare provider may order an EKG to rule out heart disease as a cause of shortness of breath.
• Blood tests and genetic tests. Your healthcare provider may order blood tests and genetic tests to confirm alpha-1 antitrypsin deficiency as a cause of emphysema.

Can your lungs heal from emphysema?

No, your lungs can’t heal from emphysema. However, treatments can help reduce your symptoms and improve your quality of life. Other interventions can help prevent further damage from occurring.

How is emphysema treated?

Emphysema can worsen over time, so treatment focuses on slowing emphysema down and maximizing the function of your remaining healthy lung. The type of treatment depends on the severity of your emphysema.

Treatment options may include:

• Quitting smoking. If you smoke, the best way to slow down emphysema is to quit. It’s the most important step you can take to protect your lungs. You and your healthcare provider can work together to find the best, most effective methods to quit smoking.
• Bronchodilators. These medicines relax the muscles around your airways. When these muscles relax, more air comes in and out of your lungs. They’re faster and more effective than oral medications. Bronchodilators also help treat asthma and other lung conditions.
• Inhaled corticosteroids. Inhaled corticosteroids reduce swelling in your airways and mucus production. You may have to take inhaled corticosteroids every day to help prevent emphysema symptoms.
• Oral corticosteroids. A provider often prescribes short courses of oral corticosteroids when you’re having an exacerbation or “flare” of your emphysema.
• Antibiotics. Antibiotics help treat bacterial infections, including pneumonia, bronchitis and other lung infections.
• Anti-inflammatory medications. Anti-inflammatories reduce inflammation in your airways.
• Oxygen therapy. If your lungs aren’t getting enough oxygen to your blood (hypoxemia), oxygen therapy can help. A machine will deliver more oxygen to you through a nasal catheter or a facemask. A nasal catheter (nasal cannula) is a flexible tube that your healthcare provider will clip to your nose.
• Lung volume reduction surgery (LVRS). During LVRS, your healthcare provider removes a portion of your diseased lung tissue and joins the remaining tissue together. Removing the damaged tissue may relieve pressure on your breathing muscles and help improve your lungs’ ability to stretch. LVRS results are usually promising. However, not all people with emphysema are candidates for this surgery.
• Bronchoscopic lung volume reduction. During bronchoscopic lung volume reduction, a provider places a one-way valve into your airways. The valve allows air to leave those sections of your lungs, but not enter. This helps decrease the amount of “trapped” air that’s in your lungs and makes it easier to breathe. Not all people with emphysema are candidates for this procedure.
• Lung transplant. If you have severe emphysema and your lungs don’t respond to other treatment options, a lung transplant replaces your damaged lungs with a donor’s healthy lungs.

How can I reduce my risk of developing emphysema?

The best way to reduce your risk of developing emphysema is to avoid smoking.

Quitting smoking is difficult to do. It may take several attempts to quit successfully. When you’re ready to quit smoking, talk to your healthcare provider. They can help you develop a plan to quit smoking. It’s also a good idea to join support groups. Support groups allow you to share your feelings and experiences with those who understand what you’re experiencing.

Other ways to help reduce your risk of developing emphysema include:

• Avoid secondhand smoke, air pollution, chemical fumes, dust, pollen and pet dander.
• Test your home for radon.
• Wear a mask when you’re working with chemicals or in highly polluted areas.

What can I expect if I have emphysema?

Your expectations depend on the severity of your emphysema.

If you have mild emphysema, your outlook is better. However, even mild emphysema can still affect some of your abilities, especially if you’re 65 or older. Activities such as walking, climbing stairs or getting dressed may cause symptoms to appear.

If you have severe emphysema, breathing is extremely difficult and you may require regular medical help.

There isn’t a cure for emphysema. Even if you quit smoking, your lungs won’t be able to heal the existing damage. However, you can slow emphysema down with treatment. Your quality of life will be better the earlier you start emphysema treatment.

How do I take care of myself?

If you have emphysema, the best way to prevent or reduce further problems is to quit smoking and avoid respiratory infections. The following tips can help prevent a respiratory infection:

• Wash your hands.
• Brush your teeth and floss every day. Use an antibacterial mouth rinse after you eat.
• Keep your breathing equipment clean.
• Keep your house clean and dust regularly.
• Stay up to date on your vaccinations, including a flu shot, pneumococcal vaccine and COVID-19.
• Get an exercise program from your healthcare provider and follow it.
• Avoid irritants, including smoke, car exhaust fumes, strong perfumes, cleaning products, paint/varnish, dust, pollen and pet dander.

When should I see my healthcare provider?

If you have severe shortness of breath, call 911 immediately.

Talk to your healthcare provider if you experience the following:

• You lose your breath easier or find it harder to breathe than usual.
• You produce more mucous than normal.
• Your mucus becomes yellow or green when it normally isn’t.
• You need to use your bronchodilator or inhaled corticosteroid medications more often.
• You don’t feel like your medications are as effective.
• You’re coughing more.
• Breathing problems keep you up at night or wake you up in the middle of the night.
• You have less energy.

What questions should I ask my healthcare provider?

• How do you know that I have emphysema?
• If I don’t have emphysema, what other condition do I have?
• What’ll make my emphysema worse?
• How can I tell that my breathing is getting worse?
• What treatment options do you recommend?
• What exercises do you recommend?
• What can I do to prevent a respiratory infection?
• What can I do to quit smoking?
• Are there any support groups you can recommend to help me quit smoking?
• Do I need an evaluation for lung volume reduction procedures or a lung transplant?

Does COVID-19 cause emphysema?

If you don’t already have diseased or damaged lungs, COVID-19 can cause giant emphysema. However, it’s rare for this to happen, and there are very few cases that link COVID-19 and giant emphysema.

Giant emphysema is a bullous disease. If you have emphysema, the air pockets may grow and affect up to one-third of one or both of your lungs. Providers call these giant air pockets bullae (singular bulla).

Other names for giant emphysema include giant bullous emphysema and vanishing lung syndrome.

A note from Cleveland Clinic

Emphysema is a chronic obstructive pulmonary disease that damages the air sacs in your lungs and makes it hard to breathe. You can’t reverse emphysema damage, and it’ll gradually get worse. However, you can manage the symptoms with treatment and slow down the effects of emphysema. In addition to treatment, you’ll breathe easier if you follow tips that prevent respiratory infections. An early diagnosis will help you maintain your quality of life for a longer period. If you have breathing problems, talk to your healthcare provider, especially if you smoke. They can diagnose emphysema and work with you to develop a healthcare plan so you can continue doing the activities you enjoy for as long as possible.