What Is Emphysema?

Emphysema—a type of chronic obstructive pulmonary disease (COPD)—is a progressive chronic lung disease caused by damage to the alveoli. These are the tiny air sacs in the lung where the exchange of oxygen and carbon dioxide takes place. The result is air becoming trapped, oxygen levels in the blood decreasing (hypoxemia), and carbon dioxide levels in the blood increasing (hypercapnia). Emphysema is associated with severe disability and a loss of as many as six life-years.

Roughly three million Americans are living with emphysema. COPD is today the third leading cause of death in the United States.

Emphysema Symptoms

Emphysema primarily affects the lungs but can also affect other organs and systems, including the heart, muscles, and circulatory system, as the disease progresses.

Depending on the stage of the disease and other factors, the symptoms of emphysema may include:

• Shortness of breath (dyspnea)
• Persistent cough 
• The production of sputum or phlegm
• Wheezing
• Frequent respiratory infections (including pneumonia)
• Chest pain
• Cyanosis (bluish fingers and lips due to low oxygen in the blood)

In addition to respiratory symptoms, emphysema can also lead to exercise intolerance and muscle atrophy. The combination of decreased physical activity and chronic respiratory stress can promote lean muscle loss, especially in the core muscles—a situation that only increases the severity of respiratory symptoms.

Finally, emphysema is characterized by what is known as COPD exacerbations. These are periods when symptoms become worse and require hospitalization. Exacerbations may be precipitated by infections or exposure to air pollution, wood smoke, or even perfume.

People with emphysema are also at an increased risk of developing lung cancer. According to research from Northwestern University Feinberg School of Medicine, COPD increases the risk of lung cancer by anywhere from 200% to 500% when compared to smokers without COPD.

If your COPD symptoms are worsening, speak with your doctor about the possibility of lung cancer. Lung cancer is far more curable when diagnosed in the early stages of the disease.

Causes

Smoking is the most common cause of emphysema, thought to be responsible for 85% to 90% of cases. But there are many other causes that can act alone or in conjunction with smoking to cause emphysema.

While researchers can't be entirely sure why some people get COPD and others don't, several risk factors have been identified, including:

• Secondhand smoke
• Occupational exposures to fumes, dust, and vapors
• Air pollution
• Asthma

Diagnosis

The diagnosis of emphysema or another type of COPD is often suspected through a careful history and physical examination, and then confirmed by pulmonary function tests (PFTs).

Medical History

Various factors may alert a doctor to a potential diagnosis of COPD. These factors include a patient feeling short of breath at rest or with exercising, and/or a patient experiencing a chronic cough with or without phlegm production.

A history of significant smoking, especially more than 30 to 40 pack-years, or a history of significant exposure to various air pollutants or occupational dust are additional factors that may raise suspicion for a diagnosis of COPD.

Physical Examination

Physical exam findings in emphysema will vary depending on the severity of the disease. While one's physical exam is often normal in the early stages of the disease, over time, the following findings may appear:

• Decreased breath sounds
• Wheezing and crackles at the lung bases
• Distant heart sounds
• Use of accessory muscles of respiration and exhaling through pursed lips (in advanced emphysema)

Pulmonary Function Tests

Pulmonary function tests, specifically a test called spirometry, are needed to confirm the diagnosis of COPD.

Spirometry entails taking a very deep breath in and then breathing out as hard as you can into a tube that is connected to a machine. The machine (called a spirometer) measures the amount and speed of air going in and out of your lungs.

Two key measurements obtained from spirometry are FVC (forced vital capacity) and FEV₁ (forced expiratory volume).

• FVC is the amount of air forcefully breathed out after taking a deep breath in and inhaling as much air as possible.
• FEV₁ is the amount of air breathed out during the first second of the FVC test.

Traditionally, an FEV₁/FVC ratio of less than 70% is used to diagnose COPD. However, some doctors use a ratio defined by the American Thoracic Society (ATS), especially for diagnosing young adults or adults who do not smoke. The ATS criteria define COPD as an FEV₁/FVC ratio that is less than the fifth percentile of a healthy, non-smoking reference group.

Treatment

At the current time, emphysema remains an irreversible disease and treatment is aimed at slowing the progression and complications related to the disease. Research in lung regeneration therapy is ongoing and may help develop new treatments for COPD in the future.

Today, treatment involves a combination of approaches, and the course of treatment is largely directed by the disease stage:

• Mild: Short-acting bronchodilator and an annual flu vaccine
• Moderate: Long-acting bronchodilator and pulmonary rehabilitation
• Severe: Adding inhaled corticosteroids to treat exacerbations
• Very severe: Oxygen therapy and lung surgery if needed

Lifestyle Changes

Quitting smoking is critical for individuals living with this condition and can help to slow the progression of the disease. Speak with your doctor about ways to support your effort.

Engaging in regular physical activity is also important, as it is what will help prevent muscle atrophy and resulting disease progression. But there's no doubt that emphysema itself can make exercise difficult.

The best exercises for COPD include a combination of endurance, flexibility, and strength training. Your doctor can help you determine what regimen is best for you.

Medications

There are no drug treatments that have proven successful in slowing the rate of decline of lung function with emphysema. Instead, medications are used to help increase exercise tolerance, reduce COPD exacerbations, and improve overall health status.

Medications used for stable COPD include:

• Bronchodilators
• Inhaled corticosteroids
• Antibiotics for infections

Oxygen Therapy

This can be given continuously, during activity, or for the relief of sudden episodes of shortness of breath. Long-term oxygen therapy of over 15 hours per day is given when a patient has low oxygen saturation levels during advanced (stage IV) COPD.

Pulmonary Rehabilitation

There are many benefits of pulmonary rehabilitation, an interdisciplinary program that should last at least six weeks. Pulmonary therapy can make a big difference for people living with emphysema by improving exercise tolerance, reducing symptoms, and decreasing hospitalizations/lengths of stay.

Lung Surgery

Lung volume reduction surgery to remove severely damaged tissue may be useful for some people with severe emphysema, especially for those who have disease predominantly involving the upper lobes. Bullectomy may be done in patients who have giant bullae. Lung transplant is another consideration.

A Word From Verywell

Emphysema can be a frustrating disease in many ways. Not only do you have to cope with the physical effects of symptoms and treatments, but the impact they can have on your mental wellness and everyday life as well. Unfortunately, many people with COPD receive inadequate support. If that applies to you, lean on your healthcare team, consider seeing a therapist, and tap into support groups (the American Lung Association is a good place to start). You are not alone.