Emphysema

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Introduction

What is emphysema?

Emphysema is a form of chronic obstructive pulmonary disease (COPD) that causes destruction of the air sacs in the lungs, resulting in reduced lung capacity and difficulty breathing. Emphysema is a common respiratory disorder in the United States: about 3.7 million people in the United States have been diagnosed with it. It is the third most common cause of death in American adults. People over 45 years of age are most likely to develop emphysema (Source: ALA).

Smoking is the most common cause of emphysema, and the risk of emphysema increases the longer you smoke. Rarely, nonsmokers develop emphysema as the result of an inherited deficiency in alpha-1 antitrypsin, a protein made by the liver that helps protect lung tissue. Risk factors that can increase your risk of emphysema include exposure to secondhand smoke, chemical fumes, dust, and air pollution.

The characteristic symptom of emphysema is shortness of breath, which develops slowly over time and can become severe. Treatment for emphysema includes smoking cessation therapy, bronchodilators, anti-inflammatory drugs, and pulmonary rehabilitation to improve shortness of breath with coughing and breathing exercises. Healthy lifestyle practices, such as washing your hands well, exercising regularly, avoiding respiratory irritants and cold air, and refraining from smoking, can slow the progression of the disease and decrease the risk of complications.

In some cases, emphysema can be associated with serious or life-threatening symptoms. Seek immediate medical care (call 911) for severe difficulty breathing, bluish lips or fingernails, change in level of consciousness or alertness, and rapid heart rate.

Seek prompt medical care if you are being treated for emphysema but mild symptoms recur or are persistent.

Symptoms

What are the symptoms of emphysema?

The primary symptom of emphysema is shortness of breath, which may or may not be accompanied by other symptoms.

Common symptoms of emphysema

You may experience emphysema symptoms daily or just once in a while. Symptoms are usually worse during morning hours. At times, any of these emphysema symptoms can be severe:

  • Chest pain or pressure

  • Clubbing of the fingers and toes (thickening of the tissue beneath the nail beds)

  • Coughing up clear, yellow, light brown, or green mucus

  • Fatigue

  • Shortness of breath or rapid breathing (tachypnea)

  • Wheezing (whistling sound made with breathing)

Serious symptoms that might indicate a life-threatening condition

In some cases, emphysema can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Bluish coloration of the lips or fingernails

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness

  • Rapid heart rate (tachycardia)

  • Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking

Causes

What causes emphysema?

Emphysema is a form of chronic obstructive pulmonary disease (COPD) that causes destruction of the air sacs of the lungs, resulting in reduced lung capacity and difficulty breathing. The most common cause of emphysema is smoking. Rarely, nonsmokers develop emphysema as the result of an inherited deficiency in alpha-1 antitrypsin, a protein made in the liver that helps protect the lung tissue.

What are the risk factors for emphysema?

A number of factors increase the risk of developing emphysema. Not all people with risk factors will get emphysema. Risk factors for emphysema include:

  • Breathing in dust particles or chemical fumes
  • Exposure to air pollution
  • Family history of alpha-1 antitrypsin deficiency
  • Jobs working with livestock, grain, textiles or coal
  • Preexisting lung disease
  • Secondhand smoke
  • Smoking
Treatments

How is emphysema treated?

Treatment for emphysema begins with seeking medical care from your health care provider. The goal of treatment is to improve breathing. Severe cases not responding to therapy or accompanied by serious bleeding may require surgical resection, or, in rare cases, lung transplant.

Treatment options for emphysema

There are several treatment options for emphysema including:

  • Bronchodilators to open the airways, such as albuterol (ProAir, Proventil, Ventolin), levalbuterol (Xopenex), and pirbuterol (Maxair)

  • Chest physical therapy (CPT) to help you cough up sputum

  • Inhaled cholinergic agents to improve symptoms (tiotropium, ipratropium)

  • Inhaled corticosteroids, such as Budesonide (Pulmicort Flexhaler, Pulmicort Respules), flunisolide (Aerobid Aerosol), fluticasone propionate (Flovent HFA), and triamcinolone acetonide (Azmacort Inhalation Aerosol)

  • Lung transplantation (selected patients)

  • Medication to help with smoking cessation, such as varenicline (Chantix) or bupropion hydrochloride (Zyban)

  • Positive pressure ventilation (noninvasive)

  • Oxygen therapy if you have low blood oxygen levels

  • Pulmonary rehabilitation to improve shortness of breath with coughing and breathing exercises

  • Surgery to remove the most damaged portions of the lung (in selected patients)

What you can do to improve your emphysema

In addition to reducing your exposure to emphysema triggers, you can prevent or limit emphysema by:

  • Avoiding cold air

  • Drinking plenty of fluids

  • Getting plenty of rest

  • Removing irritants in your home, such as fireplace fumes and smoke

  • Taking all medications as prescribed

What are the potential complications of emphysema?

Complications of untreated or poorly controlled emphysema can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of emphysema include:

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 12
  1. Chronic obstructive pulmonary disease. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001153/.
  2. Emphysema. American Lung Association. http://www.lungusa.org/lung-disease/emphysema/
  3. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy.Philadelphia: Saunders, 2013.
  4. McDonough JE, Yuan R, Suzuki M, et al. Small-airway obstruction and emphysema in chronic obstructive pulmonary disease. N Engl J Med 2011; 365:1567.
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