Learn about Emphysema
Emphysema is one type of chronic obstructive pulmonary disease (COPD). It means destruction of the lung. In emphysema, the breathing tubes are narrowed and the air sacs are damaged. These changes lead to shortness of breath with daily activities. The major cause of emphysema is smoking cigarettes.
- The breathing tubes are narrowed and air sacs are destroyed in emphysema.
- Cigarette smoking is the major cause of emphysema
- Shortness of breath with activities is the most common complaint.
What is emphysema?
To understand emphysema, it is important to consider briefly, “What is COPD?” COPD is a common lung condition that includes two conditions – emphysema and chronic bronchitis. In emphysema, the damage occurs to the breathing tubes and to the air sacs.
- Breathing tubes – attachments that hold the breathing tubes open are destroyed and result in collapse of the breathing tubes when breathing out.
- Air sacs – the walls of the air sacs are destroyed causing enlargement
In contrast, with chronic bronchitis the glands that line the breathing tubes produce too much mucus which blocks the passage of air when breathing out. Those diagnosed with chronic bronchitis cough up mucus most days. It is common to have both chronic bronchitis and emphysema.
About 1 out of 5 people who smoke at least a pack or more of cigarettes each day for at least 10 years “gets” COPD. It would be great if doctors could take a blood sample and identify those at risk for developing emphysema. There is one recognized inherited risk factor for emphysema called alpha-1 antitrypsin deficiency. A blood test can show whether someone has a low level of this protein.
How emphysema affects your body?
Collapse of the breathing tubes when breathing out can prevent emptying all of the air out of the lungs. This trapped air pushes down the main breathing muscle called the diaphragm and makes it less effective. This process is called hyperinflation – too much air in the lungs – and makes it harder to breathe.
The damage to the air sacs makes it harder for oxygen to pass into the blood vessels of the lungs. As a result, the oxygen level in the body is frequently reduced. The body tries to compensate for the low oxygen by breathing more. This process also makes those with emphysema feel like breathing is difficult.
Many of those diagnosed with emphysema gradually lose weight and are thin.
How serious is emphysema?
Changes to the lungs with emphysema are permanent, and the damage can vary from mild to very severe. In mild cases, shortness of breath may only occur with exercise. In more advanced cases, the individual may have breathing difficulty walking from one room to another and may require the use of oxygen.
Unfortunately, there is no treatment to reverse or repair the damage once it has occurred. However, stopping smoking and avoiding breathing in “bad air” can prevent the damage from getting worse.
Emphysema Symptoms, Causes and Risk Factors
The damage to the lungs with emphysema usually occurs as a slow pace. It is common that the individual may not realize that emphysema has developed until breathing difficulty interferes or limits the ability to perform daily activities.
What are the symptoms of emphysema?
Shortness of breath with physical activities is the major symptom. In those with advanced emphysema, breathing difficulty may occur when seated or when lying down. A cough that is either dry or produces mucus, wheezing, and chest pain are not usual symptoms of emphysema.
What causes emphysema?
The main cause of emphysema is cigarette smoking. Inhaling “bad air” such as second-hand smoke, dust, and fumes can also damage the lungs. Another cause of emphysema in some countries is inhaling smoke from indoor fires used for heating and cooking. There is one inherited cause of emphysema called alpha-1 antitrypsin deficiency. The alpha-1 protein protects the lung from damage. With a deficient or low level of the protein, the effects of smoking or inhaling “bad air” damage the lungs more readily. This process may occur at an early age, such as someone in their 40s or 50s.
What are the risk factors?
The major risk factor is smoking cigarettes. Having a parent or grandparent with emphysema also increases the risk if you smoke. Inhaling irritants in the air such as smoke and fumes may also contribute to emphysema. A low level of a protein in the blood – alpha-1 antitrypsin – is a hereditary risk factor for emphysema.
When to see your doctor
You should see your healthcare provider if you experience shortness of breath with daily activities. You should not assume that this is because you are “getting old” or are “out of shape.” If you are currently a smoker, or you used to smoke cigarettes, and find that it is hard to breathe with activities, make sure to tell your healthcare provider.
Diagnosing and Treating Emphysema
Emphysema can be diagnosed in two different ways. The most common approach is a breathing test. Another approach is a CT scan of the chest. However, a CT scan is not done routinely to diagnose emphysema.
What to expect
You can expect that your healthcare provider will ask you a lot of questions about whether you have breathing difficulty, cough up mucus, or experience chest pain and wheezing. If you have shortness of breath, the healthcare provider will want to know what activities cause you to feel this way, and whether you have breathing difficulty when you sleep. You can expect questions about past and current smoking cigarettes and inhaling irritants in the air at work or at home.
Your healthcare provider will want to know if you have any family members who have a lung problem such as emphysema/COPD.
You can expect your healthcare provider to exam you and listen to your chest with a stethoscope when you breathe in and out and also listen to your heart beating.
Most likely, your healthcare provider will order breathing tests either in the office or at the local hospital. Breathing tests provide information about how your lungs are working.
Diagnosis and Treatment
How It’s Diagnosed
Breathing tests are used to diagnose emphysema. After you take a deep breath in, you will be told to exhale, or blow out, fast and hard into a machine. Because of collapse or narrowing of the breathing tubes in emphysema, there is slowing of air when breathing out. This is called airflow obstruction.
You may also be asked to do another breathing test which measures whether there has been damage to the air sacs. This test is called diffusing capacity. After you blow all of the air out from your lungs, you will be told to take a deep breath in and hold it for 10 seconds. A reduced value suggests damage to the air sacs.
Based on your medical history, physical examination findings, and the results of the breathing tests, your healthcare provider will decide whether you have emphysema.
Your healthcare provider may also diagnose emphysema if you have a CT scan of the chest for some reason, like to evaluate a “spot” or nodule in the lung that was seen on a chest x-ray. The CT scan can show the damage to the lungs that has occurred in emphysema. However, CT scans of the chest are not routinely done to diagnose emphysema.
How It’s Treated
There is no treatment to repair damage to the lungs in emphysema. The most important thing that you can do is not smoke and not breathe in “bad air.” By doing these, you can prevent the emphysema from getting worse. If you are a current smoker, you need to quit today.
Treatment is intended to improve shortness of breath and to reduce the risk of an exacerbation (worsening of breathing symptoms usually due to a chest infection). Inhaled bronchodilator medications are the cornerstone of treating emphysema. These medications open the breathing tubes to make it easier to get all of the air out and thus make it is easier to breathe. There are two different types of inhaled bronchodilators which work in different ways to open the breathing tubes. They are frequently used together for greatest effect.
Regular use of long-acting inhalers (once or twice a day) is generally recommended because they last longer than short-acting inhalers (used every 4 – 6 hours and as needed). Oxygen may be prescribed if your saturation value is 88% or less. This is measured by putting a device on your finger called an oximeter. Starting a pulmonary rehabilitation program is the one of the best ways to improve shortness of breath, quality of life, and ability to exercise. In some cases, surgical treatments may be considered depending on your situation. An operation may remove parts of your lung that are very damaged or destroyed and that interfere with more normal parts of your lung.
Living with Emphysema
Even though you or a loved one may have emphysema, it is important to focus on what you, or your loved one, can do and not on what is difficult or hard to do. Make sure that you know as much as possible about your condition in order to function at the highest possible level. You should know the names of the medicines that you are taking for emphysema and how long they are supposed to work. Also, you should have an action plan in case your breathing gets worse.
What to Expect
You can expect that emphysema will get worse if you continue to smoke and continue to inhale second hand smoke and other irritants in the air. Stopping smoking will slow down the emphysema from getting worse. Many individuals find that they reduce activities to avoid breathing difficulty. Over time, this 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 the airways and make it easier to breathe. And 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. For many individuals who follow recommended treatments, your breathing may remain stable for a long time.
Managing the Disease
Ideally, you should lead a healthy life style that includes not smoking, eating healthy foods, having normal body weight, exercising regularly, getting 7 – 8 hours of sleep each night, and avoiding too much stress. A yearly flu shot is recommended to reduce the chances of getting the flu. There are two different pneumonia shots which are recommended to prevent to the most common bacterial cause of pneumonia. It is important to use your inhaled medications correctly and as prescribed by your healthcare provider on a regular schedule.
You should have an albuterol inhaler to use if you experience an increase in difficulty with your breathing. This medicine opens the breathing tubes quickly, but only lasts 3 – 4 hours.
You should make sure that you get a written action plan from your healthcare provider and have it available in case your breathing gets worse. Most action plans recommend using your rescue inhaler every 2 – 4 hours as needed and calling your healthcare provider if you have a chest cold or start to cough up yellow or green mucus. You should call your healthcare provider if you experience any major change in your breathing, Regular appointments with your healthcare provider are important to monitor your emphysema and to consider any new treatments..
Various types of information are available about COPD and emphysema. Some local hospitals and clinics offer monthly support groups for COPD. The internet includes numerous websites for those with COPD and their families that include basic information about emphysema/COPD, updates on what is new, and the opportunity to submit questions to a health- care expert. Here are some places to get more information about COPD and emphysema.
Questions to Ask your Doctor About Emphysema
- Is my COPD more emphysema or chronic bronchitis?
- Did I inherit emphysema from my parents?
- What treatments are available to help me breathe easier?
- Will oxygen help me?
- Does the local hospital have a Better Breather support group?
- Does the local hospital have a pulmonary rehabilitation program?
Donald A. Mahler, MD, FCCP
Date Last Reviewed