Last Updated 05/07/2020
Author:Donald A. Mahler, MD, FCCP
- Emphysema destroys the air sacs and narrows the breathing tubes in your lungs.
- Cigarette smoking is the major cause of emphysema.
- The most common complaint is shortness of breath during daily activities.
To understand emphysema, you first have to understand chronic obstructive pulmonary disease (COPD).
COPD is a common, preventable lung disease. People with COPD have a hard time breathing and emptying the air from their lungs. There are 2 types of COPD: emphysema and chronic bronchitis.
In emphysema, the damage occurs to the two main parts of your lungs:
- Breathing tubes (called bronchioles). Emphysema destroys the attachments that hold your breathing tubes open, causing them to collapse when you breathe out.
- Air sacs (called alveoli). Emphysema destroys the walls of the air sacs, causing the sacs to enlarge.
In chronic bronchitis, the glands that line the breathing tubes produce too much mucus, which blocks the passage of air when you breathe out. People diagnosed with chronic bronchitis cough up mucus most days. It’s common for people to have both types of COPD—chronic bronchitis and emphysema.
About 1 out of 5 people who have smoked at least one pack of cigarettes each day for at least 10 years “gets” COPD. Unfortunately, there’s no way to identify those at risk for developing emphysema. Researchers have discovered one recognized inherited risk factor for emphysema, however, called alpha-1 antitrypsin deficiency (AAT). A blood test can show whether you have a low level of this protein.
How Emphysema affects your body
Collapse of the breathing tubes in your lungs when you breathe out can prevent you from emptying all the air in your lungs. This trapped air pushes down the main breathing muscle, called the diaphragm, preventing it from working well. The result is that you have too much air in your lungs—a process called hyperinflation—which makes it harder for you to breathe.
The damage to the air sacs in your lungs makes it harder for oxygen to pass into the blood vessels in your lungs, meaning less oxygen in your body. Your body tries to compensate for the low oxygen by breathing more. This process makes it difficult for those with emphysema to breathe.
The changes to the lungs that emphysema causes are permanent. The damage can vary from mild to severe. In mild cases, shortness of breath may occur only during exercise. In more advanced cases, people may have trouble breathing just walking from one room to another; they may even require the use of oxygen.
Unfortunately, there’s no treatment to reverse or repair the damage once it has occurred. Stopping smoking and avoiding breathing in “bad air” can prevent the damage from getting worse, though.
Symptoms of Emphysema
The damage to the lungs that emphysema causes happens slowly. Most of the time, people with emphysema may not even realize that they have the disease until their breathing difficulty starts to interfere with their daily activities.
Shortness of breath during physical activities is the major symptom of emphysema. As the disease gets worse, people may notice that it’s harder to breathe when their seated or lying down. A cough that is either dry or produces mucus, wheezing, and chest pain are not usually symptoms of emphysema.
What are the risk factors for Emphysema?
The main cause of emphysema is cigarette smoking. Inhaling “bad air,” such as second-hand smoke, dust, fumes, or smoke from indoor fires used for heating and cooking can also damage the lungs. People who have inherited the AAT deficiency may also be a greater risk for developing emphysema. The alpha-1 protein protects the lungs against damage, so when the level of this protein is low, smoking or inhaling “bad air” damages the lungs more easily. People who have AAT deficiency may develop emphysema at an earlier-than-usual age, such as in their 40s or 50s.
A lung specialist (called a pulmonologist) can diagnose emphysema in two ways:
- Lung function test. The most common way to diagnose emphysema is with a lung function test.
- Computed tomography (CT, or “cat” scan). The other way is with a CT scan of the chest. (CT scans are not usually used to diagnose emphysema, though.)
When should you see your health care provider?
You should see your health care provider if you experience shortness of breath with daily activities. Don’t assume that you’re short of breath because you are “getting old” or are “out of shape.” If you are currently a smoker or you used to smoke cigarettes and you find it hard to breathe during activities, be sure to tell your provider.
What to expect at your appointment
Expect your health care provider to ask you a lot of questions, such as whether you have breathing difficulty, cough up mucus, have chest pain, or hear wheezing. If you have shortness of breath, your provider will want to know which activities make you feel this way and whether you have breathing difficulty when you sleep. Expect questions about whether you have smoked and still smoke cigarettes and whether you inhale irritants in the air at work or at home. Your provider will also ask if any of your family members have lung problems such as COPD.
Your provider will exam you and listen to your lungs with a stethoscope when you breathe in and out. Your provider will also listen to your heart beating.
Most likely, your provider will order lung function tests either in the office or at the local hospital. During these tests, you’ll be asked to take a deep breath in, then exhale (blow out) fast and hard into a machine. Because of emphysema narrows the breathing tubes in your lungs, air comes out more slowly when you exhale. This is called airflow obstruction.
Another lung function test measures the damage to the air sacs in your lungs, or the diffusing capacity. After you blow out all the air in your lungs, you will be told to take a deep breath in and hold it for 10 seconds. A low diffusing capacity value suggests damage to the air sacs.
Based on your medical history, physical examination findings, and the results of the lung function tests, your provider will be able to determine whether you have emphysema.
There is no treatment to repair the damage to your lungs that emphysema causes. The most important thing you can do is to quick smoking and avoid breathing in “bad air.” If you can do these two things, you may be able to prevent your emphysema from getting worse.
There are treatments, however, that can improve shortness of breath and reduce the risk of an exacerbation (worsening of breathing symptoms usually because of a respiratory infection).
Inhaled Bronchodilator Medications
These medications are the cornerstone of emphysema treatment. These medications open the breathing tubes in your lungs to make it easier to get all the air out and thus easier to breathe. There are 2 types of inhaled bronchodilators, and they work in different ways to open your breathing tubes.
- Long-acting inhalers. You typically use these inhalers once or twice a day.
- Short-acting inhalers. You typically use these inhalers every 4 to 6 hours and as needed.
These inhaler types are frequently used together for greatest effect.
If the amount of oxygen in your blood falls below 88%, your provider may prescribe oxygen. (Your provider can measure the amount of oxygen in your blood by putting a clip called an oximeter on your finger.)
Starting a pulmonary rehabilitation program is the one of the best ways to improve shortness of breath, quality of life, and your ability to exercise.
Depending on your situation, your provider may consider surgical treatments. For example, parts of your lung that are damaged or destroyed can interfere with more normal parts of your lung. A surgical procedure can remove these damaged parts.
Another surgical procedure used for people with advanced emphysema is to insert little one-way valves—called endobronchial valves—into the breathing tubes in your lungs. The lung specialist or surgeon uses a long, flexible tube, called a bronchoscope, with a camera and tools on the end to place the valves. The valves allow air to exit the healthy parts of your lungs and collapse the areas of your lungs that are damaged. Your lungs deflate, which helps your diaphragm muscle work better so that you can breathe better.
Living with Emphysema
If you have emphysema, it’s important to focus on what you can do, not on what’s difficult to do. Make sure that you know as much as possible about your condition so that you can function at the highest possible level. Know the names of the medicines you take for emphysema and how long they’re supposed to work. Also, create an action plan in case your breathing gets worse.
You can expect your emphysema to get worse if you continue to smoke or inhale second-hand smoke and other irritants in the air. Many people with emphysema find that they reduce their activities to avoid breathing difficulty. Over time, however, lack of exercise can make shortness of breath worse because less activity leads to being “out of shape” and possible weight gain.
You can expect that using inhaled medications will open your airways and make it easier to breathe. You can also expect to be able to be more active if you exercise regularly, either on your own or by participating in a pulmonary rehabilitation program. If you follow recommended treatments, your breathing may remain stable for a long time.
Ideally, you should lead a healthy life style that includes not smoking, eating healthy foods, maintaining a normal body weight, exercising regularly, getting 7 to 8 hours of sleep each night, and avoiding too much stress. Get a yearly flu shot to reduce the chances of getting the flu. Also, you should get the two pneumonia shots to prevent the most common bacterial cause of pneumonia.
Be sure to use your inhaled medications correctly and as prescribed by your health care provider. Use your albuterol inhaler if you have difficulty breathing. This medicine opens the breathing tubes in your lungs quickly, but it lasts only 3 to 4 hours.
Finally, make sure that you get a written action plan from your health care provider. Keep it with you in case your breathing gets worse. Most action plans recommend using your rescue inhaler every 2 to 4 hours as needed and calling your health care provider if you have a chest cold or start to cough up yellow or green mucus. Call your provider if you experience any major change in your breathing, Regular appointments with your health care provider are important for monitoring your emphysema and discussing treatments.
There’s a lot of information out there about COPD and emphysema. Some local hospitals and clinics offer monthly support groups for COPD. Many websites for people with COPD and their families include basic information about emphysema and COPD, updates on what’s new, and the opportunity to submit questions to a health care expert. For more information about COPD and emphysema, visit the following websites:
- American Lung Association
- COPD Foundation
- National Heart, Lung, and Blood Institute
- WebMD’s COPD Health Center
- Living Well with COPD from McGill University Health Centre
- Donald A. Mahler, MD
Questions to ask your health care provider
- Is my COPD more emphysema or chronic bronchitis?
- Did I inherit emphysema from my parents?
- What treatments are available to help me breathe better?
- Will oxygen help me?
- Does the local hospital have a Better Breather support group?
- Does the local hospital have a pulmonary rehabilitation program?