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Emphysema — An Overview

Updated on April 28, 2021
Medically reviewed by
Allen J. Blaivas, D.O.
Article written by
Jessica Wolpert

The term emphysema is often used interchangeably with chronic obstructive pulmonary disease (COPD). However, emphysema actually is one of the two main types of COPD. The other main type of COPD is chronic bronchitis, which involves inflammation of the small airways in the lungs. Most people who have emphysema also experience chronic bronchitis, but emphysema is still a distinct condition.

Emphysema affects the tiny air sacs — or alveoli — in your lungs. In healthy lungs, these air sacs easily expand when you inhale. The walls of these air sacs absorb oxygen from the air you inhale and transfer that oxygen to your blood, while at the same time releasing carbon dioxide into your lung tissue. When you exhale, the air sacs compress, pushing carbon dioxide out of the body.

In people with emphysema, the alveolar walls grow weak or even break down, creating larger air spaces in the lungs. These breakdowns reduce the amount of lung surface that can be used for air exchange. With less usable surface area, the lungs are less able to absorb oxygen and get rid of carbon dioxide (a process called gas exchange). In addition, when the air sacs lose elasticity, it’s harder to breathe out old air and get fresh, oxygen-rich air into the lungs. Destroyed air sacs can even trap air inside the lungs. In severe cases, these breakdowns can lead to a pneumothorax — more commonly known as a collapsed lung.

Causes of Emphysema

Cigarette smoke is the most common cause of emphysema. Up to 75 percent of people who develop emphysema smoke or used to smoke. The components of tobacco cigarettes irritate the lungs and destroy their tissues. Other types of smoking also can cause emphysema. Using electronic cigarettes, or vaping, is linked to emphysema, although a 2019 analysis found that combining e-cigarettes with traditional cigarette smoking was the riskiest habit of all. Some research suggests marijuana smoking can raise emphysema risk, although it is unclear whether it is as harmful as tobacco smoke.

Other causes of emphysema include long-term exposure to air pollution — such as car exhaust — and secondhand smoke. Pollutant exposure in the workplace can also cause emphysema. Mining, farming, construction, welding, and working with textiles, flour, or petroleum can raise your risk of emphysema.

Up to 5 percent of people with emphysema don’t develop it because of outside risk factors. Instead, they have a mutation in a gene responsible for the production of a protective protein called alpha-1 antitrypsin. People with this gene mutation have an alpha-1 antitrypsin deficiency — a condition often called AATD or just alpha-1. This deficiency allows enzymes to attack the lung tissues. This lack of lung protection means people with AATD develop lung conditions, including emphysema. People with AATD are also more likely to develop liver disease.

People with AATD are likely to develop emphysema at a younger age. Their symptoms tend to develop at ages 40 to 50, while most people who develop emphysema start seeing symptoms between the ages of 40 and 60.

Symptoms of Emphysema

Emphysema can develop so slowly that you may have it for years without knowing it. Unsurprisingly, the first emphysema symptoms that most people notice involve the lungs. Shortness of breath is the main symptom of emphysema, especially during physical activity. Some people with emphysema may experience shortness of breath even while sitting or lying down. This shortness of breath can lead to exhaustion and a lack of energy.

Other lung-related symptoms of emphysema include wheezing, coughing, tightness in the chest, and distention of the chest. You might also develop respiratory infections, such as colds and flu, more easily.

Not every emphysema symptom is directly related to symptoms involving the chest and lungs. Emphysema can actually change the color of your skin. If you have lighter skin, you might notice that your lips and fingernails turn blue with physical exertion. If your skin has a yellow undertone, you might notice a grayish-green skin tone, and if you have darker skin, your skin might turn gray or whitish.

These skin symptoms appear because emphysema is keeping your blood from getting enough oxygen, which keeps your blood a healthy bright red. The hemoglobin in the blood carries the oxygen around to all the tissues and organs in the body. When the level of oxygen in the hemoglobin is low, the blood turns a dark bluish-red color — which causes the changes in skin appearance.

Your appetite can be affected by emphysema as well. Shortness of breath can make it difficult to eat. In addition, emphysema makes physical activity difficult, and a lack of physical activity can cause a corresponding lack of appetite. Many people with emphysema lose weight despite this lack of physical activity because they’re losing useful muscle mass.

A lack of appetite can also be part of another symptom of emphysema — depression. Depression and anxiety are incredibly common among people with emphysema. In one study, 40 percent of people attending respiratory clinics had depression. The symptoms of depression and emphysema — exhaustion and energy loss — are similar. Researchers have found that treating the symptoms of emphysema to improve quality of life can also help reduce the symptoms of depression.

Diagnosing Emphysema

Health care providers use several types of tests to diagnose emphysema. Your doctor may order any of the following tests.

Lung Function Tests

Lung function tests (also called pulmonary function tests) measure how well your lungs are working. Spirometry is the most common type of this test. During spirometry, you breathe into a tube as hard as you can. Your ability to breathe is then measured against the normal ability of people of your age, height, and weight.

Peak flow meter tests allow measurements of lung airflow similar to spirometry, except they involve handheld devices instead of in-clinic testing.

Imaging

CT scans — which combine X-rays and computer technology to produce enhanced images — can detect lung damage. Regular chest X-rays can be useful for diagnosing advanced emphysema, but they are not sensitive enough to diagnose milder cases.

Other Tests

Blood tests can measure the amounts of carbon dioxide and oxygen in the blood. If you are coughing up mucus, a sputum culture can be done to see if you have a lung infection. An electrocardiogram can detect whether emphysema has damaged your heart muscle.

If you have a family history of emphysema without smoking or if you have emphysema symptoms at a younger age with few risk factors, consider genetic testing for AATD.

Stages of Emphysema

The progression of the disease is measured in four stages. These stages are determined by your score on the spirometry test, which measures your breathing ability.

  • Mild emphysema — Your breathing ability is 80 percent or more of the normal ability for your age, weight, and height.
  • Moderate emphysema — Your breathing ability is 50 percent to 80 percent of the normal ability for your age, weight, and height.
  • Severe emphysema — Your breathing ability is 30 percent to 50 percent of the normal ability for your age, weight, and height.
  • Very severe emphysema — Your breathing ability is less than 30 percent of the normal ability for your age, weight, and height.

Treatment Options

At this time, emphysema cannot be cured or reversed. However, there are several treatments that can slow its progress and ease symptoms.

If you smoke, the most important step you can take against emphysema is quitting. Quitting smoking is especially helpful in the early stages of emphysema, but it can improve your quality of life at any stage.

Medications

Bronchodilators are medications that relax the bronchial tubes in the lungs, making it easier to breathe. Bronchodilators are usually taken through an inhaler or nebulizer. Short-acting bronchodilators work immediately, but their effects do not last long. Long-acting bronchodilators are used daily to prevent emphysema exacerbations and assist your breathing and activities throughout the day.

Corticosteroids decrease swelling and inflammation in the lungs, making it easier to breathe. Corticosteroids can be taken daily through inhalers or nebulizers to reduce inflammation over time. Corticosteroid pills and injections are useful against flare-ups. Many inhalers combine a long-acting bronchodilator and a corticosteroid to provide the benefits of both in one dose.

Phosphodiesterase-4 (PDE4) inhibitors are a newer class of drugs that can help relieve swelling and inflammation in the lungs that make it difficult to breathe. Daliresp (roflumilast) is the only PDE4 inhibitor currently approved for treating COPD. The main use of Daliresp is to decrease the number of flares you may experience.

People with AADT can replace the missing alpha-1 antitrypsin proteins through medications called alpha1-proteinase inhibitors.

Antidepressants can treat depression linked to emphysema.

Other Treatments

Oxygen therapy, breathed through your nose, increases the amount of oxygen available for your blood. Depending on the severity of your emphysema, you may need oxygen during airline flights, while doing certain physical activities, while sleeping, or 24 hours a day.

A type of physical therapy called pulmonary rehabilitation can improve your quality of life. People undergoing pulmonary rehabilitation do physical exercises and learn special breathing techniques.

Surgical Treatments

Several types of thoracic surgery can treat late-stage emphysema. A surgical process called bullectomy removes bullae — large air pockets — that form in emphysema-damaged lungs. This improves lung function.

During lung volume reduction surgery, damaged portions of the lung are removed. The remaining parts of the lung can now function more efficiently. However, some lung reduction procedures can now be done without surgery.

A lung transplant is usually only considered for people with end-stage emphysema. Lung transplant candidates must be healthy enough to undergo a transplant.

Finding Support for Emphysema

On MyCOPDTeam, members talk about a range of personal experiences living with COPD. More than 110,000 members, including more than 44,000 with emphysema, are available to offer support and share tips for life with COPD.

Have you been diagnosed with emphysema? What has your experience been? Which treatments or lifestyle changes have helped you? Comment below or post on MyCOPDTeam.

Allen J. Blaivas, D.O. is certified by the American Board of Internal Medicine in Critical Care Medicine, Pulmonary Disease, and Sleep Medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Jessica Wolpert works to empower patients through the creation of content that illuminates treatments' effects on the everyday lives of people with chronic conditions. Learn more about her here.

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