Emphysema is a long-term lung condition that causes shortness of breath.
Over time, the condition damages the thin walls of the air sacs in the
lungs called alveoli. In healthy lungs, these sacs stretch and fill with
air when you breathe in. The elastic sacs help the air leave when you
breathe out. But when the air sacs are damaged in emphysema, it's hard
to move air out of your lungs. This doesn't leave room for fresh,
oxygen-rich air to enter your lungs.
Symptoms of emphysema include trouble breathing, especially with
activity, and a wheezing sound when breathing out. How severe the
condition is can vary.
Smoking is the leading cause of emphysema. Treatment can help with
symptoms and may slow how fast the condition gets worse. But it can't
reverse the damage.
Symptoms
You can have emphysema for many years without noticing any symptoms.
They usually begin gradually and include:
Shortness of breath, especially with physical activity. This is the
main symptom of emphysema.
Wheezing, whistling or squeaking sound when you breathe out.
Coughing.
Chest tightness or heaviness.
Feeling very tired.
Weight loss and ankle swelling that may happen as the condition gets
worse over time.
You may start avoiding activities that cause you to be short of breath,
so the symptoms don't become a problem until they keep you from doing
daily tasks. Emphysema eventually causes trouble breathing even while
you're resting.
Emphysema is one of the two common types of
chronic obstructive
pulmonary disease (COPD). The other common type is
chronic bronchitis.
In chronic bronchitis, the lining of the tubes that carry air to your
lungs, called bronchial tubes, become irritated and swollen. This
inflammation limits the space for air to move in and out of the lungs
and makes extra mucus that blocks the airways. Emphysema and chronic
bronchitis often occur together, so the general term COPD may be used.
Exacerbations
Even with ongoing treatment, you may have times when symptoms become
worse for days or weeks. This is called an acute exacerbation (eg-zas-er-bay-shun).
It may lead to lung failure if you don't receive prompt treatment.
Exacerbations may be caused by a respiratory infection, air pollution or
other things that trigger inflammation. Whatever the cause, it's
important to get medical help promptly if you notice an ongoing
worsening cough or extra mucus, or if you have a harder time breathing.
When to see a doctor
See your healthcare professional if you've had shortness of breath you
can't explain for several months, especially if it's getting worse or if
it's keeping you from doing your daily activities. Don't ignore it or
tell yourself it's because you're aging or out of shape.
Go to the emergency department at a hospital if:
You're having a hard time catching your breath or talking.
Your lips or fingernails turn blue or gray with physical activity.
Others notice that you're not mentally alert.
Causes
Emphysema results from long-term exposure to airborne irritants,
including:
Smoking cigarettes, which is the most common cause.
Chemical fumes, especially in the workplace.
Vapors and dusts, especially in the workplace.
Rarely, emphysema results from a gene change passed down in families.
This gene change causes low levels of a protein called
alpha-1-antitrypsin (AAT). AAT is made in the liver and is passed into
the bloodstream to help protect the lungs from damage caused by smoke,
fumes and dust. Low levels of AAT, a condition called
alpha-1-antitrypsin deficiency, can cause liver damage, lung conditions
such as emphysema or both. With AAT deficiency, there is usually a
family history of emphysema, and symptoms begin at a younger age.
Risk factors
Lung damage in emphysema develops gradually. In most people with the
condition, symptoms start after age 40.
Factors that increase your risk of developing emphysema include:
Smoking. Smoking cigarettes or having smoked in the past is
the biggest risk factor for emphysema. But people who smoke cigars,
pipes or marijuana also are at risk. The risk for all types of
smokers increases with the number of years of smoking and the amount
of tobacco smoked.
Being around secondhand smoke. Secondhand smoke is smoke
that you breathe in from someone else's cigarette, pipe or cigar.
Being around secondhand smoke raises your risk of emphysema.
Job exposure to fumes, vapors or dust. If you breathe in
fumes or vapors from certain chemicals or dust from grain, cotton,
wood or mining products, you're more likely to develop emphysema.
This risk is even greater if you also smoke.
Exposure to indoor and outdoor pollution. Breathing indoor
pollutants, such as fumes from heating fuel, as well as outdoor
pollutants, such as smog or car exhaust, increases your risk of
emphysema.
Genetics. The uncommon condition called AAT deficiency
raises the risk of emphysema. Other genetic factors may make certain
smokers more likely to get emphysema.
Complications
People who have emphysema are more likely to develop:
High blood pressure in lung arteries. Emphysema may cause
high blood pressure in the arteries that bring blood to the lungs.
This serious condition is called pulmonary hypertension. Pulmonary
hypertension can cause the right side of the heart to expand and
weaken, a condition called cor pulmonale.
Other heart problems. For reasons that aren't fully
understood, emphysema can raise your risk of heart disease,
including heart attack.
Large air spaces in the lungs. Large air spaces called
bullae form in the lungs when the inner walls of the alveoli are
destroyed. This leaves one very large air sac instead of a cluster
of many smaller ones. These bullae can become very large, even as
large as half the lung. The bullae lessen the space available for
the lung to expand. Also, giant bullae can increase the risk of a
collapsed lung.
Collapsed lung. A collapsed lung called pneumothorax can be
life-threatening in people who have severe emphysema because their
lungs are already damaged. This is not common but it's serious when
it happens.
Lung cancer. People with emphysema have a higher risk of
getting lung cancer. Smoking raises this risk even more.
Anxiety and depression. Problems breathing can keep you
from doing activities that you enjoy. And having a serious medical
condition such as emphysema can sometimes cause anxiety and
depression.
Prevention
To prevent emphysema or to keep symptoms from getting worse:
Don't smoke. Talk to your healthcare professional about options for
quitting.
Stay away from secondhand smoke.
Wear a special mask or use other measures to protect your lungs if
you work with chemical fumes, vapors or dust.
Avoid exposure to secondhand smoke and air pollution when possible.
Diagnosis
To find out if you have emphysema, your doctor or other healthcare
professional asks about your medical and family history, smoking, and
whether you're often around other lung irritants. Your healthcare
professional does a physical exam that includes listening to your lungs.
You may have imaging tests, lung function tests and lab tests.
Imaging tests
Chest X-ray. This test may show some lung changes caused by
emphysema. It also can rule out other causes of your symptoms. But
the chest X-ray may not show changes even if you have emphysema.
Computerized tomography (CT) scan. A CT scan combines X-ray
images taken from many different angles to create images of
structures inside the body. A CT scan gives much greater detail of
changes in your lungs than a chest X-ray does. A CT scan of your
lungs can show emphysema. It also can help in deciding if you might
benefit from surgery. A CT scan can be used to check for lung cancer
too.
Lung function tests
Also called pulmonary function tests, lung function tests measure the
amount of air you can breathe in and breathe out, and whether your lungs
deliver enough oxygen to your blood.
Spirometry is the most common test to diagnose emphysema. During
spirometry you blow into a large tube connected to a small machine. This
measures how much air your lungs can hold and how fast you can blow the
air out of your lungs. Spirometry tells how much airflow is limited.
Other tests include measurement of lung volumes and diffusing capacity,
six-minute walk test, and pulse oximetry.
Lung function tests and imaging tests can show whether you have
emphysema. And they also can be used to check your condition over time
and see how well treatments are working.
Lab tests
Blood tests aren't used to diagnose emphysema, but they may give more
information about your condition, find the cause of your symptoms or
rule out other conditions.
Arterial blood gas analysis. This blood test measures how
well your lungs are bringing oxygen into your blood and removing
carbon dioxide.
Testing for AAT deficiency. Blood tests can tell if you
have the gene change passed down in families that causes the
condition alpha-1-antitrypsin deficiency.
Treatment
Treatment is based on how severe your symptoms are and how often you
have exacerbations. Effective therapy can control symptoms, slow how
fast the condition worsens, lower the risk of complications and
exacerbations, and help you lead a more active life.
Quitting smoking
The most important step in any treatment plan for emphysema is to quit
all smoking. Stopping smoking can keep emphysema from getting worse and
making it harder to breathe. Talk with your healthcare professional
about stop-smoking programs, nicotine replacement products and medicines
that might help.
Medicine
Several kinds of medicines are used to treat the symptoms and
complications of emphysema. You may take some medicines on a regular
basis and others as needed. Most medicines for emphysema are given using
an inhaler. This small, handheld device delivers the medicine straight
to your lungs when you breathe in the fine mist or powder. Talk with
your healthcare professional so that you know the right way to use the
inhaler prescribed.
Medicines may include:
Bronchodilators. Bronchodilators are medicines that usually
come in inhalers. Bronchodilators relax the muscles around your
airways. This can help relieve coughing and make breathing easier.
Depending on the severity of your emphysema, you may need a
short-acting bronchodilator before activities, a long-acting
bronchodilator that you use every day or both.
Inhaled steroids. Inhaled corticosteroids can lessen airway
inflammation and help keep exacerbations from happening. Side
effects may include bruising, mouth infections and hoarseness. These
medicines are useful if you often have exacerbations of emphysema.
Combination inhalers. Some inhalers combine bronchodilators
and inhaled steroids. There also are combination inhalers that
include more than one type of bronchodilator.
Antibiotics. If you have a bacterial infection, such as
acute bronchitis or pneumonia, antibiotics can help.
Oral steroids. For exacerbations, a short course, for
example, of five days of oral corticosteroids may keep symptoms from
getting worse. But long-term use of these medicines can have serious
side effects, such as weight gain, diabetes, osteoporosis, cataracts
and a higher risk of infection.
Lung therapies
Pulmonary rehabilitation. These programs generally combine
education, exercise training, nutrition advice and counseling. You
work with a variety of specialists who can tailor your
rehabilitation program to meet your needs. Pulmonary rehabilitation
may help lessen your breathlessness and allow you to be more active
and exercise.
Nutrition therapy. You may benefit from advice about
nutrition by working with a dietitian. In the early stages of
emphysema, many people need to lose weight, while people with
late-stage emphysema often need to gain weight.
Oxygen therapy. If you have severe emphysema with low blood
oxygen levels, you may need extra oxygen at home. You can get this
extra oxygen to your lungs through a mask or a plastic tubing with
tips that fit into your nose. These attach to an oxygen tank.
Lightweight, portable units can help some people get around more.
Supplemental oxygen can help your breathing during physical activity
and help you sleep better. Many people use oxygen 24 hours a day,
even when resting.
Managing exacerbations
When exacerbations occur, you may need added medicines, such as
antibiotics, oral steroids or both. You also may need supplemental
oxygen or treatment in the hospital. Once symptoms get better, your
healthcare professional can talk with you about what steps to take to
help stop future exacerbations.
Surgery
Depending on the severity of your emphysema, your healthcare
professional may suggest one or more different types of surgery,
including:
Lung volume reduction surgery. In this surgery, the surgeon
removes small wedges of damaged lung tissue from the upper lungs.
This creates extra space in the chest so that the remaining
healthier lung tissue can expand and the muscle that helps in
breathing can work better. In some people, this surgery can make
their quality of life better and help them live longer.
Endoscopic lung volume reduction. Also called endobronchial
valve surgery, this is a minimally invasive procedure to treat
people with emphysema. A tiny one-way endobronchial valve is placed
in the lung. Air can leave the damaged part of the lung through the
valve, but no new air gets in. This allows the most damaged lung
lobe to shrink so that the healthier part of the lung has more space
to expand and function.
Bullectomy. Large air spaces called bullae form in the
lungs when the inner walls of the alveoli are destroyed. This leaves
one large air sac instead of a cluster of many smaller ones. These
bullae can become very large and cause breathing problems. In a
bullectomy, the surgeon removes the bullae from the lungs to allow
more air flow.
Lung transplant. A lung transplant may be an option for
certain people who meet specific criteria. Getting a new lung can
make breathing easier and allow a more active lifestyle. But it's
major surgery that has serious risks, such as organ rejection. To
try to keep organ rejection from happening, it's necessary to take
lifelong medicine that weakens the immune system.
Alpha-1-antitrypsin deficiency
For adults with emphysema related to AAT deficiency, treatment options
include those used for people with more-common types of emphysema. Some
people can be treated by also replacing the missing AAT protein. This
may stop more damage to the lungs.
Lifestyle and home remedies
If you have emphysema, you can take steps to slow how fast it worsens
and to protect yourself from complications:
Stop smoking. This is the most important step you can take
for your overall health. Continuing to smoke can cause more damage
to your lungs and worsen emphysema. If you need help giving up
smoking, join a stop-smoking program or talk to your healthcare
professional about ways to quit. As much as possible, avoid
secondhand smoke. Secondhand smoke may add to lung damage.
Avoid triggers. These include fumes from paint and
automobile exhaust, some cooking odors, certain perfumes, and even
burning candles and incense. Change furnace and air conditioner
filters regularly to limit pollutants. Get your house checked for
radon.
Air pollution also can irritate your lungs, so check daily air
quality forecasts before going out. Figure out what may trigger
exacerbations for you and avoid them as much as possible.
Manage your breathing. Talk to your healthcare professional
or respiratory therapist about techniques to manage your breathing
so it's easier to breathe throughout the day. Also talk about
positions that make breathing easier, ways to save your energy such
as sitting for tasks when possible, and relaxation strategies to use
when you have trouble catching your breath.
Get regular physical activity. It may seem hard to be
physically active when you have trouble breathing. But regular
physical activity and exercise can help your overall strength, how
long you can be active, and the muscles you use to breathe. Ask your
healthcare professional which activities are best for you.
Eat healthy foods. Eating healthy foods can help you keep
your strength. If you're underweight, your healthcare professional
may recommend nutritional supplements. If you're overweight, losing
weight can greatly help your breathing, especially during
activities.
See your healthcare professional regularly. Stay with your
appointment schedule, even if you're feeling fine. It's important to
regularly monitor your lung function. Call your healthcare
professional if your symptoms get worse or you notice symptoms of
infection.
Avoid respiratory infections. Do your best to stay away
from people who have a cold or the flu. If you must be with large
groups of people during cold and flu season, wear a face mask. Also
wash your hands often and carry a small bottle of alcohol-based hand
sanitizer to use when needed.
And be sure to get your annual flu vaccine in the fall to help
prevent infections that can worsen your emphysema. Ask when you need
the pneumococcal vaccine, COVID-19 vaccines and other vaccines.
Protect yourself from cold air. Cold air can cause spasms
of the airways, making it even more difficult to breathe. During
cold weather, wear a soft scarf or a cold-air mask — available from
a pharmacy — over your mouth and nose before going outside. This can
warm the air entering your lungs.
Coping and support
Trouble breathing can limit your ability to do daily activities. You may
have to give up some activities you used to enjoy. Your family and
friends may find they need to adjust to some of these changes too.
Here
are some suggestions that may help:
Express your feelings. If you and your family can talk
openly about each other's needs, you'll be better able to meet the
differences living with emphysema can cause.
Consider a support group. Think about joining a support
group for people with emphysema. Support groups aren't for everyone,
but they can be a good source of information and coping strategies.
And it can be encouraging to spend time with other people who have
the same experiences. Talk with your healthcare professional or
check the American Lung Association's website for local and online
support groups.
Get help when needed. Be alert to changes in your mood and
your relationships with others, and don't be afraid to ask for help.
Talk with your healthcare professional or a mental health
professional, if needed. You may benefit from counseling or medicine
if you feel overwhelmed or depressed.
Preparing for your appointment
If your primary healthcare professional thinks that you may have
emphysema, you'll likely be referred to a doctor who specializes in lung
conditions called a pulmonologist.
What you can do
You might want to take a friend or family member with you to your
appointment. Someone who goes with you can help you remember
information. Take notes if this helps.
Before your appointment, make a list of the following information:
Symptoms and when they started. Include anything that makes
your symptoms worse or better.
All medicines, vitamins, herbs and supplements you take.
Include the doses.
Family history, such as whether anyone in your family has
emphysema or COPD.
Treatment you've had for emphysema, if any. Include what
the treatment was and if it helped.
Any other medical conditions you have and their treatments.
If you smoke or have ever smoked. Include whether you're
regularly around others who smoke.
Any jobs where you were around chemical fumes or vapors or
industrial dust.
Questions to ask your healthcare professional.
Questions to ask may include:
What is likely causing my symptoms?
What kinds of tests do I need?
What treatment do you recommend?
I have other health conditions. How will emphysema affect them?
Are there any restrictions that I need to follow?
Feel free to ask other questions.
What to expect from your doctor
Your healthcare professional may ask you questions, such as:
Do you get short of breath easily?
Does shortness of breath keep you from doing your daily tasks?
When did you first notice shortness of breath?
Do you cough every day? If so, when did that start?
If you smoke, have you tried to quit? Would you like help in
quitting?
Does anyone in your family have emphysema or COPD?
Have you ever noticed your fingernails or lips turning blue?
Have you recently gained or lost weight?
Be ready to answer questions so that you have time to talk about what's
most important to you.