What Is Emphysema?

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Emphysema is a chronic lung condition that affects over 3 million people in the United States. It is often caused by long-term smoking. It is part of a group of lung conditions known as chronic obstructive pulmonary disease (COPD).

Emphysema affects the alveoli, or air sacs, in the lungs. These air sacs are normally stretchy, which enables them to fill up with air every time we breathe. You can think of them as millions of tiny balloons in your lungs that inflate and deflate with each breath you take.

Emphysema damages the walls between the alveoli, causing the air sacs to become narrowed, stretched, collapsed, or entirely destroyed. This can lead to larger but fewer alveoli in the lungs, instead of several tiny ones. The reduced surface area makes it harder for the lungs to absorb oxygen and expel carbon dioxide.

The lung damage caused by emphysema cannot be fixed—it causes tissues in the lungs to break down permanently, leaving holes in the lungs. As a result, people with emphysema may experience breathlessness and other respiratory difficulties that get worse with time.

This article discusses the symptoms, causes, and diagnosis of emphysema, as well as some treatment strategies that may be helpful.

Symptoms of Emphysema

The early stages of emphysema may have mild symptoms, or no symptoms at all. Fatigue and breathlessness are often the first symptoms to appear, although they are often mistaken for symptoms of other health conditions.

The more severe symptoms of emphysema often become noticeable after the age of 40, after 50% of the lung tissue is already destroyed.

Symptoms of emphysema include:

  • Wheezing or coughing frequently 
  • Producing a lot of mucus while coughing
  • Breathing rapidly or emitting a whistling sound while breathing
  • Experiencing tightness in the chest
  • Having a consistent feeling of not being able to take in enough air
  • Feeling breathless, particularly while doing any type of physical activity such as walking, climbing stairs, or exercising lightly
  • Feeling tired and fatigued
  • Losing weight
  • Experiencing muscle weakness in the lower body
  • Developing swelling in the feet, ankles, or legs
  • Experiencing sleep difficulties
  • Developing depression or anxiety
  • Being prone to developing respiratory infections such as the cold, flu, bronchitis, or pneumonia

People with emphysema often develop a barrel-chested appearance. This happens because the damaged air sacs in their lungs may not be able to support their bronchial tubes, causing the tubes to collapse and block the lungs. As a result, air tends to get trapped inside the lungs.

Emphysema often occurs simultaneously with bronchitis, another type of COPD. Many people who have emphysema also have bronchitis; however, the severity of each condition can vary from person to person.

Causes of Emphysema

These are some of the causes of emphysema:

  • Smoking: Cigarette smoking is the leading cause of emphysema in the United States. Inhaling other types of smoke, such as cigar or pipe smoke can also cause emphysema. The particles and chemicals in the smoke irritate the lungs and damage the alveoli.
  • Exposure to other pollutants: Emphysema can also be caused by long-term exposure to other inhaled irritants such as secondhand smoke, air pollution, dust, chemical fumes, smoke from home cooking or burning wood, or other gasses and vapors.
  • Genetic factors: People who smoke may be more likely to develop emphysema if one of their biological relatives has COPD. Additionally, some rare cases of emphysema may be caused by a genetic condition known as alpha-1 antitrypsin deficiency.

Because emphysema is most commonly caused by smoking, it is considered to be one of the most preventable respiratory conditions.

Diagnosing Emphysema

A lung specialist, known as a pulmonologist, can diagnose emphysema. A primary care doctor can provide a referral if you need one.

Once you make an appointment and go and see the specialist, they will ask you about your symptoms and your medical history. They may need to perform a physical examination.

Emphysema cannot be diagnosed on the basis of your symptoms alone. Your healthcare provider may need to perform certain tests to check your lung function. The tests will help them determine how efficiently your lungs are able to exchange oxygen and carbon dioxide.

These are some of the tests that your healthcare provider may perform in order to diagnose emphysema:

  • Spirometry: You would have to take a deep breath and blow into a spirometer, which consists of a tube connected to a special machine. This is the simplest, most commonly used test to check for lung conditions. It helps healthcare providers determine whether you have a long condition, how severe it is, and whether your airways are blocked.
  • Peak flow monitoring: A special device measures how fast you can blow air out of your lungs. The coughing, mucus production, and inflammation caused by emphysema can cause the airways in your lungs to become narrower, which can reduce your ability to blow air out of your lungs.
  • Blood tests: An arterial blood gas (ABG) test can help measure the levels of oxygen and carbon dioxide in your blood. For this test, blood is drawn from an artery and analyzed in a lab. People with emphysema tend to have lower oxygen levels and higher carbon dioxide levels in their blood. This test is often used for patients who have severe emphysema, as it can help determine whether they need additional oxygen. 
  • X-rays: A chest x-ray or computer-aided tomography (CAT) scan can reveal the width and thickness of the airways in your lungs. CAT scans are considered the gold standard in diagnosing emphysema.
  • Sputum culture: This test involves examining sputum coughed up from the lungs to the mouth, to check for infection and inflammation.
  • Pulse oximetry: This is a simple test that involves clipping a device onto the end of your finger or earlobe, to check the level of oxygen saturation in your blood.
  • Electrocardiogram (ECG): An ECG test can help measure the electrical activity of the heart, detect heart damage, and check for abnormal heart rhythms. It can help rule out heart conditions as the cause of the breathlessness you’re experiencing.

Treating Emphysema

Emphysema cannot be cured; however, treatment can help manage the symptoms, slow the progression of the condition, and reduce the complications associated with the disease. The course of treatment can vary depending on how severe the condition is.

These are some of the treatment options for emphysema:

  • Lifestyle changes: If you smoke, the first and most important step in treating emphysema is to quit smoking. It’s also important to avoid secondhand smoke as well as other lung irritants.
  • Medication: Medications known as bronchodilators can help relax the muscles around the airways, making breathing easier. Bronchodilators are typically taken through an inhaler. 
  • Steroids: People with severe emphysema may also have to take steroid medications through an inhaler, to counter any inflammation in the lungs.
  • Vaccines: Getting flu shots regularly and taking the pneumococcal pneumonia vaccine can help prevent respiratory infections.
  • Antibiotics: Your healthcare provider may prescribe a course of antibiotics if you develop a lung infection.
  • Oxygen therapy: If you have severe emphysema that is causing your blood oxygen levels to drop, you may require oxygen therapy from an oxygen concentrator machine or portable oxygen containers. Your healthcare provider will determine whether you need additional oxygen all the time, or only at specific times.
  • Pulmonary rehabilitation: Pulmonary rehab programs are specially designed for people with chronic lung conditions. The program may include breathing exercises to strengthen your lungs, nutritional consultations to prevent weight loss and malnutrition, psychological counseling to help you cope with the condition, and other types of support.
  • Surgery: Surgery may be required if your condition isn’t responding to medication. Lung volume reduction surgery involves removing damaged lung tissue and joining the remaining lung tissue.
  • Lung transplant: For severe cases of emphysema, a lung transplant may be recommended.
  • Exercise: Staying physically active can strengthen your muscles, making it easier for you to breathe and improving your overall health. Talk to your healthcare provider about how much exercise you can do.

If you have emphysema, contact your healthcare provider if you have fever or an infection. If you are having difficulty breathing or speaking, seek emergency care immediately.

A Word From Verywell

The majority of cases of emphysema can be prevented by not smoking. Emphysema develops slowly over time and often becomes evident after a significant amount of lung damage has already occurred. While damaged lung tissue cannot be repaired, treatment can help manage the condition and prevent it from getting worse.

5 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  3. Cleveland Clinic. Emphysema.

  4. National Library of Medicine. Emphysema.

  5. Martini K, Frauenfelder T. Advances in imaging for lung emphysema. Ann Transl Med. 2020;8(21):1467. doi:10.21037/atm.2020.04.44

Additional Reading

By Sanjana Gupta
Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.