What Is Emphysema?

Emphysema is a lung disease that limits the movement of air in and out of your lungs. This makes breathing harder. It's most often caused by heavy, long-term cigarette smoking. Emphysema is one of a group of conditions called chronic obstructive pulmonary disease (COPD).

Healthy lungs

  • Inside the lungs are branching airways made of stretchy tissue. Each airway is wrapped with bands of muscle that help keep it open. Air travels in and out of the lungs through these airways.

  • The tubes branch into smaller passages called bronchioles. These end in clusters of balloon-like sacs called alveoli.

  • Blood vessels surrounding the alveoli move oxygen into the blood. At the same time, the alveoli remove carbon dioxide from the blood. The carbon dioxide is then exhaled.

When you have emphysema

  • Airways become damaged. When the lung tissue loses its stretchiness, the surrounding airways collapse more easily and trap air in the lungs. 

  • Damaged airways collapse when you exhale, causing air to get trapped in the alveoli. This trapped air makes breathing harder.

  • Over time, the air sacs lose their clustered shape and don't work well. And less oxygen enters the blood.

  • The air sacs get larger. This makes it even harder for the lungs to move air in and out.

What is pulmonary emphysema?

Emphysema is a chronic lung condition in which the air sacs (alveoli) may be:

  • Collapsed
  • Destroyed
  • Narrowed
  • Overinflated
  • Stretched

Overinflation of the air sacs is a result of a breakdown of the alveoli walls. It causes a decrease in respiratory function and breathlessness. Damage to the air sacs can't be fixed. It causes permanent holes in the lower lung tissue.

Pulmonary emphysema is part of a group of lung diseases called COPD (chronic obstructive pulmonary disease). COPD lung diseases cause airflow blockage and breathing problems. The 2 most common conditions of COPD are chronic bronchitis and emphysema.

What causes pulmonary emphysema?

Pulmonary emphysema occurs very slowly over time. It’s caused by:

  • Smoking (the main cause)
  • Exposure to air pollution, such as chemical fumes, dust, and other substances
  • Irritating fumes and dusts at work
  • A rare, inherited form of the disease called alpha 1-antitrypsin (AAT) deficiency-related pulmonary emphysema or early onset pulmonary emphysema

What are the symptoms of pulmonary emphysema?

Symptoms may be slightly different for each person. The following are the most common symptoms for pulmonary emphysema.

Early symptoms of pulmonary emphysema may include:

  • Cough
  • Rapid breathing
  • Shortness of breath, which gets worse with activity
  • Sputum production
  • Wheezing

Other symptoms may include:

  • Anxiety
  • Depression
  • Extreme tiredness (fatigue)
  • Heart problems
  • Over-inflation of the lungs
  • Sleep problems
  • Weight loss

The symptoms of pulmonary emphysema may look like other lung conditions or health problems. See a healthcare provider for a diagnosis.

How is pulmonary emphysema diagnosed?

Along with a complete health history and physical exam, your healthcare provider may request pulmonary function tests. These tests help measure the lungs’ ability to exchange oxygen and carbon dioxide. The tests are often done with special machines into which you breathe. They may include:

Spirometry

A spirometer is a device used to check lung function. Spirometry is one of the simplest, most common tests. It may be used to:

  • Determine the severity of a lung disease
  • Find out if the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow)
  • Look for lung disease
  • See how well treatment is working

Peak flow monitoring

This device measures how fast you can blow air out of your lungs. Cough, inflammation, and mucus buildup can cause the large airways in the lungs to slowly narrow. This slows the speed of air leaving the lungs. This measurement is very important in seeing how well or how poorly the disease is being controlled.

Blood tests

These are done to check the amount of carbon dioxide and oxygen in the blood.

Chest X-ray

This test takes pictures of internal tissues, bones, and organs.

CT scan

This test uses a combination of X-rays and computer technology to make images of the body. CT can show details such as the width of airways in the lungs and the thickness of airway walls.

Sputum culture

This test is done on the material that is coughed up from the lungs and into the mouth. A sputum culture is often used to see if an infection is present.

ECG

This is a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias), and can help find heart muscle damage.

How is pulmonary emphysema treated?

The goal of treatment for people with pulmonary emphysema is to live more comfortably with the disease, control symptoms, and prevent the disease from getting worse, with minimal side effects. There is no way to repair or regrow the damaged lung tissue.

Treatment may include:

  • A pulmonary rehab program. This may include breathing exercises to strengthen the muscles you use for breathing, and exercises for the rest of your body.
  • Antibiotics for bacterial infections
  • Staying away from the smoke of others and removing other air pollutants from your home and workplace
  • Medicines (bronchodilators) that widen the airways of the lungs, and can be either taken by mouth (oral) or inhaled
  • Getting the flu and pneumococcal vaccines
  • Lung transplant
  • Nutritional support since you may develop malnutrition and lose weight
  • Other types of oral and inhaled medicines that are used to treat symptoms such as coughing and wheezing
  • Oxygen therapy from portable containers
  • Quitting smoking
  • Surgery to remove the damaged area of the lung

Key points about pulmonary emphysema

  • Pulmonary emphysema is a chronic lung condition. It’s often part of COPD, a group of lung diseases that cause airflow blockage and breathing problems.
  • It develops very slowly over time. It’s most often caused by smoking.
  • It causes shortness of breath that often gets worse with activity and many other symptoms, such as wheezing, cough, anxiety, and heart problems.
  • There is no way to repair or regrow the damaged lung tissue. The goal of treatment for people with pulmonary emphysema is to live more comfortably, control symptoms, and prevent the disease from getting worse.
  • A key part of treatment is to quit smoking.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your healthcare provider if you have questions.

Saint Luke’s Pulmonary Specialists

From chronic cough and asthma to pulmonary hypertension and sleep apnea, Saint Luke’s Pulmonary Specialists provides a full spectrum of treatment options to help patients suffering from pulmonary issues breathe easy again.

Our multidisciplinary approach to care provides every patient access to a team of highly experienced specialty physicians. Our pulmonary team also works with three dedicated chest radiologists, who specialize in interpreting chest images including X-rays and CT scans.