The Symptoms of Emphysema

The lung disease emphysema often starts without any symptoms, but as the illness progresses, people with emphysema experience shortness of breath with activities, which can worsen to chronic cough with phlegm and frequent bouts of bronchitis or pneumonia.

Part of a group of lung diseases known as a chronic obstructive pulmonary disease (COPD), it occurs when the alveoli of the lungs — where oxygen and carbon dioxide are exchanged — become damaged, causing them to enlarge and burst. This makes it difficult to expel air, causing a build-up of carbon dioxide in the body.

Commonly caused by cigarette smoking and exposure to other lung irritants and pollutants, emphysema is a progressive illness without any cure. However, several treatments are available to manage symptoms.

Frequent Symptoms

In the beginning, symptoms of emphysema are often silent. In fact, research suggests emphysema can present with no symptoms until alveoli damage occurs in more than 50% of the lungs. Over time, however, the condition progresses making it harder and harder to breathe. The most common symptoms of emphysema are:

Shortness of Breath

Shortness of breath, also known as dyspnea, is the hallmark symptom of emphysema and often the first one to appear. It can also be the most anxiety-producing symptom of emphysema.

At first, dyspnea occurs only upon exertion and people with emphysema report feeling winded or like they are gasping for air. Over time, it can occur while resting and takes the form of labored breathing that can be described as "air hunger." 

Rapid Breathing

Tachypnea, the medical term for rapid breathing, is another common symptom of emphysema. The normal respiratory rate for a healthy adult ranges from 12 to 18 breaths per minute. If you take more than 20 breaths per minute for at least a few minutes, you would be described as having tachypnea.

Tachypnea commonly occurs during emphysema exacerbations and can also include:

  • Rapid breathing
  • Shallow breaths
  • Shortness of breath
  • Inability to walk
  • A feeling that you want to lean over, sit down, or lie down
  • A sense that you are running out of oxygen
  • A strong feeling of anxiety
  • Nausea and/or vomiting

Chronic Cough

A chronic cough is a long-term, persistent cough that does not seem to go away in spite of treatment. Most doctors consider a cough chronic if it's been going on for eight weeks or more.

In emphysema, the long-term cough can be described as productive (with sputum) or non-productive (without sputum).

Wheezing

Wheezing, a high-pitched whistle sound that occurs as you breathe through your mouth or nose is a common symptom of emphysema. The sound is due to the narrowing of airways from inflammation and constriction, which makes it more difficult for air to flow through the lungs.

Though wheezing can occur as you take air in, in emphysema, it more commonly takes place on the exhale.

Reduced Exercise Tolerance

Many people with emphysema have decreased exercise tolerance, which often gets worse as emphysema progresses. At first, you may be unable to tolerate moderately strenuous activities like climbing the stairs in your house but as the disease progresses, walking from one room to another may become difficult.

During exercise, people generally need to breathe faster and deeper while exercising to get enough oxygen and energy. With emphysema, the air becomes trapped inside the lungs, a condition described as hyperinflation of the lungs, making it difficult to absorb enough oxygen to get the energy needed for physical exertion and you will notice that you have to sit down and rest.

Out of breath woman
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Rare Symptoms

There are four stages of emphysema. The following symptoms are rare and occur later in the disease stage:

Loss of Appetite and Weight Loss

As emphysema progresses, it is common to experience a decreased appetite and weight loss. This is typically due to shortness of breath during mealtimes, which can make it difficult to eat.

Many pulmonologists recommend nutritional counseling for patients with emphysema. When not addressed, difficulty eating can lead to malnutrition, a serious condition that can also be life-threatening.

Both appetite loss and unintentional weight loss are symptoms that warrant further investigation, as they may also indicate that other diseases are present, such as lung cancer or pulmonary tuberculosis.

Barrel Chest

A barrel chest is a rounded, bulging, barrel-like appearance of the chest that is common in the later stages of emphysema. This occurs when the lungs become chronically overinflated (hyperinflated) with air, forcing the rib cage to stay expanded for long periods of time.

Over time, the distention of the rib cage affects both the anterior (forward-facing) and the posterior (back-facing) chest wall. Muscle wasting, which develops in later-stage emphysema, further promotes this deformity.

Cyanosis

Blue-tinged lips, fingernails, and toenails, a condition that is known as cyanosis, can occur in people with emphysema. Caused by a lack of red blood cells that carry oxygen throughout the body, cyanosis can range in color from a light gray to a darker purple hue. Cyanosis is a sign that prompt medical attention is needed.

Poor Sleep

Getting enough quality sleep is especially important for people with chronic respiratory illnesses like emphysema because a well-rested body gives you the energy you need to complete activities of daily living and to breathe more efficiently.

However, many symptoms of emphysema, such as a chronic cough and wheezing, can make it difficult to sleep. If breathing difficulties are keeping you awake at night, speak to your doctor about ways to better manage your symptoms at night. Many people with chronic lung disease find nighttime oxygen therapy can help them to sleep better.

Decreased Sexual Function

The shortness of breath, coughing, and fatigue that are part of emphysema can interfere with intimacy. In men, the restriction of air to the lungs can impact the ability to achieve or maintain an erection and impact the speed by which climax is achieved. Both sexes can also experience decreased desire due to fatigue and illness.

While emphysema can complicate a sex life, it doesn't have to stop it. With preparation, communication, and insight, many couples are able to find new and exciting ways to enjoy intimacy while moving past the frustrations that can place undue pressure on sex life. If you are struggling to maintain a satisfying sex life, talk to your doctor about ways to safely engage in sexual activity.

Complications

Many complications can occur as a result of emphysema. Being aware of them can help you stay on top of your symptoms and get treatment as soon as possible if they occur.

Respiratory Infections

While most healthy immune systems can bounce back quickly from the common cold, people with emphysema are at increased risk for respiratory infections, including bronchitis and pneumonia.

It's important to get your flu shot every year and to talk with your doctor about getting the pneumococcal vaccine to help decrease the number of infections you pick up. In addition, avoid crowded areas during cold and flu outbreaks, wash your hands frequently, and consider wearing gloves indoors to avoid touching doorknobs, railings, and other common surfaces.

Anxiety and Depression

The emotional effects of emphysema and COPD are often overlooked. Anxiety and depression can affect your quality of life and may also increase the risk of exacerbation and contribute to a poorer health status overall.

Panic attacks are also very common among people with emphysema and can lead to a vicious cycle when combined with shortness of breath. Medications and other non-pharmacological treatments can help manage these concerns. Talk with your healthcare provider about treatment options.

Heart Disease

In addition to seeing a pulmonologist for your lungs, many emphysema patients are also under the care of a cardiologist. Emphysema and COPD come with an increased risk for cardiovascular disease, including heart attacks and heart failure. What's more, people with chronic lung diseases are less likely to fully recover after a heart attack.

This is because emphysema can weaken the arteries that connect the heart and lungs, putting additional strain on the heart. In addition, many people with emphysema have a history of smoking, which contributes to heart disease.

Pulmonary Hypertension

High blood pressure in the arteries in your lungs, called pulmonary hypertension, is a common complication of emphysema, especially in the advanced stages of the disease.

Symptoms of pulmonary hypertension can be similar to emphysema and include shortness of breath, tiredness, chest pain, a racing heartbeat, pain on the upper right side of the abdomen, and decreased appetite. The condition is usually diagnosed via imaging and/or lab tests.

Respiratory Failure

Respiratory failure occurs when your lungs fail to do their job passing oxygen into your bloodstream and removing carbon dioxide. In emphysema, your lungs don't efficiently transfer oxygen and carbon dioxide and cells in your body start to suffer from a lack of oxygen (hypoxemia), too much carbon dioxide (hypercapnia), or both.

Signs of respiratory failure include shortness of breath, rapid breathing, feeling tired or fatigued, lethargy, sleepiness, and confusion. As emphysema progresses, the efficiency of gas exchange in the lungs generally declines, leading to worsening symptoms, disability, and severe illness.

When to See a Doctor or Go to the Hospital

People with undiagnosed emphysema typically have a history of bronchitis and upper respiratory infections. If you have completed your course of treatment, but still have lingering symptoms talk to your doctor.

You should also see your doctor if you experience unexplained shortness of breath for several months, especially if it interferes with your daily activities. Some people mistakenly think they are out of breath because they are getting older or out of shape and delay getting a proper diagnosis, so be sure to discuss with your doctor.

When To Call 911

You should seek medical attention right away if:

  • You are too short of breath to climb stairs.
  • Your fingernails or lips lose color or turn blue or gray with exertion.
  • The person is not mentally alert.

A Word From Verywell

Living with emphysema can present unique challenges and there will be good days along with the bad. Work closely with your doctor to manage your symptoms and have a plan in place to deal with exacerbations when they flare-up. Preparing in advance can help to decrease the impact of emphysema on your lifestyle and help you continue to enjoy daily activities.

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Article Sources
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Additional Reading
  • Bare, Brenda G. & Smeltzer, Suzanne C. Brunner and Suddarth's Textbook of Medical-Surgical Nursing (8th Edition). Philidelphia, PA: Lippincott-Raven Publishers.