Emphysema

Overview

Emphysema is a lung disease that is characterized by shortness of breath. Generally, emphysema develops after smoking for many years. Emphysema is one of a few lung diseases, including asthma and chronic bronchitis, known as chronic obstructive pulmonary disease (COPD).

Over time, the air sacs in the lungs become damaged from cigarette smoke, which causes the inner walls to weaken and eventually rupture. This will reduce the surface area in the lungs and limit the amount of oxygen that can reach your bloodstream. When the air sacs do not work properly, oxygen-rich air is not able to enter the lungs.

Most patients develop chronic bronchitis and emphysema together. 

Emphysema causes

Emphysema develops after long-term exposure to irritants in the air, such as:

• Smoke from tobacco.
• Smoke from marijuana.
• Air pollution.
• Fumes or dust from chemicals.

In rare cases, emphysema is caused by alpha-1-antitrypsin deficiency emphysema. This is a genetic deficiency.

Emphysema risk factors

People who smoke are at much higher risk than nonsmokers to develop emphysema. The risk increases with the amount of tobacco a person smokes and the number of years he or she has smoked.

Other factors that can increase your risk of developing emphysema include:

• Exposure to secondhand smoke.
• Exposure to fumes or dust, such as from grain mining products.
• Exposure to pollution (indoor and outdoor) such as car exhaust or heating fuel.
• Gender. Emphysema is most common in men.
• Age. Most people who develop emphysema are between 40 and 70 years old.

Emphysema symptoms

The most common symptoms of emphysema are chronic cough and shortness of breath. Typically, these symptoms will develop in the early stages of the disease. 

In the early stages, these symptoms develop during physical exertion, but as the disease gets worse, it will happen during rest.

As the disease progresses, you may develop any of the following symptoms:

• Frequent lung infections.
• Excessive mucus production.
• Wheezing.
• Weight loss and loss of appetite.
• Fatigue.
• Depression and anxiety.
• Headaches in the morning due to lack of oxygen.
• Sleep issues.
• Other lung conditions have similar symptoms. Contact your doctor if you suspect you have emphysema.

Emphysema complications

If left untreated, emphysema can cause severe complications, including:

• Holes may develop in the lungs, which makes it harder to breathe.
• Collapsed lung. 
• Heart conditions. Emphysema increases the pressure in the arteries between the lungs and heart. When this occurs, the affected area of the heart can expand and weaken.

Emphysema diagnosis

During a clinic visit, your doctor will take a full medical history, perform a physical exam, and order a variety of diagnostic tests such as:

• Chest X-ray.
• CT scan.
• Blood tests.
• Lung function tests, such as a spirometer. A spirometer can measure how well your lungs move oxygen to your bloodstream. 

Emphysema treatment

While there is no cure for emphysema, treatment can slow the progression of the disease and help relieve your symptoms. Your doctor will develop a treatment plan based on your condition's severity and stage.

Quitting smoking is the first-line treatment for emphysema. Other treatments for emphysema include:

• Bronchodilators. A bronchodilator can help open the airways to increase airflow to the lungs.
• Corticosteroids. Corticosteroids can reduce lung inflammation to help improve breathing. 
• Antibiotics. Antibiotics may be used to treat infections such as bacterial pneumonia or bronchitis.
• Pulmonary rehabilitation. During pulmonary rehabilitation, you will learn a variety of breathing exercises to help you breathe easier.
• Oxygen therapy. For patients who need additional oxygen, oxygen therapy may be necessary.
• Nutrition therapy. Nutrition therapy customized to each patient will help patients eat correctly during each stage of the disease.

In severe cases, surgery may be necessary. Your doctor will evaluate the severity of your case to determine which surgery is most appropriate for you. Surgical options include:

• Lung volume reduction surgery. Your surgeon will remove a section of damaged lung tissue. After removing the damaged tissue, your lung can expand and work efficiently to help improve breathing.
• Lung transplant. Lung transplant is only an option if you have severe lung damage, and all other treatments have failed.

When to Seek Care

Schedule an appointment with your doctor if you have experienced unexplained shortness of breath for several months. Some patients ignore shortness of breath thinking it is a normal part of aging. If your shortness of breath is progressively worsening or interfering with your day to day activities, you should seek care.

Seek immediate medical attention if you have any of the following symptoms:

• You are not able to climb stairs from severe shortness of breath.
• Your fingernails or lips are blue or gray during or after physical exertion.
• You are losing mental alertness.