Emphysema

Emphysema is a lung disease. The main cause of emphysema is smoking, but other causes include air pollution and chemical fumes. Symptoms include shortness of breath, coughing and fatigue. Your healthcare provider can diagnose emphysema through imaging and breathing tests. Treatment includes quitting smoking and taking medications.

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.

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.