What Is Emphysema?

Emphysema is a chronic, progressive lung disease that affects over 3 million people in the United States alone. It is a form of chronic obstructive pulmonary disease (COPD) characterized by damage to the lungs' air sacs (alveoli). Long-term exposure to irritants like cigarette smoke and air pollution are the leading causes of emphysema, which causes symptoms like shortness of breath, wheezing, chronic cough, and fatigue.

Healthcare providers use a combination of diagnostic tools, including physical examination, lung function tests, and imaging tests. There is no cure for emphysema, but treatments such as medications, oxygen therapy, and pulmonary rehabilitation can help manage symptoms and slow the progression of the disease. Emphysema can be prevented by not smoking and avoiding exposure to irritants that damage the lungs. 

Types of Emphysema

Emphysema is classified into three types: centrilobular, panlobular, and paraseptal. The location of damaged alveoli in the lungs determines which type of emphysema is diagnosed.

Centrilobular Emphysema 

Centrilobular emphysema is the most common type and is usually caused by smoking. It affects the upper lobes of the lungs and damages the air sacs closest to the bronchioles. This type of emphysema usually starts in the center of the lungs and spreads outwards, causing the alveoli to become enlarged and eventually destroyed. 

Panlobular Emphysema

Panlobular emphysema affects the entire acinus—the gas-exchanging portion of the lung at the end of the respiratory bronchioles—including the alveoli, bronchioles, and blood vessels. It is more common in individuals with a genetic predisposition to alpha-1 antitrypsin (AAT) deficiency, a rare genetic condition that raises the risk of lung diseases.

Paraseptal Emphysema 

Paraseptal emphysema is a rare type that mainly affects the alveoli near the pleura (lining of the lung). This type of emphysema usually affects the upper area of the lungs, and many people with this type also have another form of emphysema. 

Symptoms

Symptoms of emphysema develop gradually over time. They may be unnoticeable or mild in the early stages of the disease, becoming more severe and interfering with daily activities as the disease progresses. Common emphysema symptoms include:

• Shortness of breath 
• Wheezing
• Persistent cough 
• Excess mucus (sputum) 
• Fatigue 
• Chest tightness
• Unintentional weight loss 
• Bluish discoloration of the lips and nails

What Causes Emphysema? 

Emphysema is a lung disease caused by damage to the alveoli (tiny air sacs) in the lungs. The alveoli become damaged and lose their elasticity by exposure to harmful chemicals and irritants, such as cigarette smoke. 

Over time, the damage causes the alveoli to rupture and form one large air pocket instead of many smaller ones. This makes it more difficult for the lungs to exchange oxygen and carbon dioxide when you breathe, causing breathing difficulties.

Cigarette smoke is the leading cause of emphysema, but other irritants are also linked to the disease, including:

• Pipe, cigar, and cannabis smoking 
• Exposure to secondhand smoke 
• Occupational exposure to chemical dust, fumes, and vapors 
• Environmental air pollution 
• Asthma 
• Alpha-1 antitrypsin deficiency

Risk Factors

Certain risk factors can increase the likelihood of developing emphysema. Emphysema risk factors include:

• Smoking: The risk of developing emphysema increases with the number of cigarettes smoked and the length of time smoking.
• Age: Emphysema is more common in peopled aged 50 and older because lung damage usually develops gradually over time. 
• Genetics and family history: Some people may have a genetic predisposition to emphysema, particularly if they have alpha-1 antitrypsin deficiency.
• Environment: Long-term exposure to air pollution, industrial chemicals, and dust can damage the lungs, leading to emphysema. 

Diagnosis

To diagnose emphysema, healthcare providers review medical history, perform a physical examination, and order diagnostic tests. 

If you have symptoms of emphysema, your healthcare provider will ask about when they started, how often you experience them, and what makes them worse (e.g., physical activity). They will carefully review your medical history and ask about risk factors, such as smoking, family history of emphysema, or occupational exposure to chemicals and other lung irritants.

During your physical exam, they will look for signs of emphysema, such as shortness of breath and coughing, and use a stethoscope to listen to your lungs to determine if they can hear sounds like wheezing or crackling as you breathe. 

If your healthcare provider suspects you have emphysema, they may order diagnostic tests to confirm the diagnosis and rule out other possible causes. These tests include:

• Pulmonary function tests: Lung function tests, such as spirometry, measure how much air you can breathe in and out and how quickly you can do so.
• Imaging tests: Imaging tests, such as chest X-ray and computed tomography (CT) scan, provide images of your lungs to help identify changes in the lungs, look for signs of damage, and determine the extent and severity of emphysema.
• Arterial blood gas test: This is a blood test that measures the amount of oxygen and carbon dioxide in the blood, which helps determine how well the lungs function.
• Alpha-1 antitrypsin deficiency test: This blood test determines if a person has a genetic condition that increases the risk of emphysema.

Stages of Emphysema

Once an emphysema diagnosis is made, staging is done based on lung function test results and the severity of symptoms and their impact on quality of life. The stages are:

• Stage 1: Mild with minimal symptoms, usually only noticeable during strenuous physical activity
• Stage 2: Moderate with increased shortness of breath, fatigue, and coughing
• Stage 3: Severe with significant limitation of physical activity due to shortness of breath and other symptoms 
• Stage 4: Very severe with a high risk of life-threatening complications, such as respiratory failure.

Treatments for Emphysema  

There is no cure for emphysema, so treatment focuses on managing symptoms and slowing disease progression. The specific treatment approach recommended depends on the stage of the disease. 

Common emphysema treatments include:

• Lifestyle interventions: Healthy lifestyle choices—not smoking, avoiding exposure to lung irritants, avoiding contact with people who are sick, and regular exercise—can help slow disease progression and prevent complications. 
• Bronchodilators: These are common medications delivered via inhaler or nebulizer to help relax the airways and make breathing easier. 
• Inhaled corticosteroids: These are medicines that help reduce inflammation in the airways and prevent symptom flare-ups. They are often used in combination with bronchodilators.
• Oxygen therapy: Supplemental oxygen is delivered through a nasal cannula (a thin tube that rests on your nostrils) to help increase the amount of oxygen in the blood and reduce shortness of breath.
• Pulmonary rehabilitation: A program that combines exercise training, breathing techniques, and education to help people with emphysema manage symptoms and improve lung function.
• Surgery: In some cases, surgery may be recommended to remove damaged lung tissue or air sacs to improve lung function.

Prevention

There are several ways to lower your risk of emphysema:

• Quit smoking and avoid exposure to secondhand smoke 
• Avoid exposure to air pollutants, workplace chemicals, and other lung irritants—an air purifier for mold, smoke, and other allergens can help.
• Exercise regularly to maintain optimal lung function
• Get regular check-ups with your healthcare provider, especially if you have a family history of lung disease or a history of smoking 
• Eat a balanced, healthy diet to support your overall health 

Comorbid Conditions   

While emphysema primarily affects the lungs, it can also impact other organs and bodily systems, such as the heart, brain, muscles, and circulatory system. People with emphysema have an increased risk of developing:

• Heart disease 
• Diabetes
• Osteoporosis 
• Lung cancer
• Depression 
• Sleep disorders
• Gastroesophageal reflux disease (GERD) 
• Pulmonary hypertension

Living With Emphysema  

Living with a chronic, progressive disease like emphysema can be taxing, especially when symptoms like shortness of breath and fatigue make it difficult to carry out your day-to-day activities.

While the outlook for emphysema depends on the severity of the disease and how well it is managed, following your treatment plan and making healthy lifestyle choices can help you maintain a good quality of life and participate in activities you enjoy. Turn to your family and friends for support when needed, and talk to your healthcare provider if your symptoms worsen or you need additional support.