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Emphysema

Pronounced: em-fiss-SEE-mah
by Cynthia M. Johnson, MA

Definition

Emphysema is a problem with the tiny air sacs of the lungs. These sacs should stretch to fill with air and get smaller as air moves out of the lungs. Emphysema is when the air sacs are damaged. It makes it hard to breathe.

Emphysema is a type of chronic obstructive pulmonary disease (COPD).

Normal Lung versus Emphysemic Lung

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Causes

Damage to the air sacs may be caused by:

  • Smoking
  • Breathing toxins or other irritants
  • Alpha1-antitrypsin deficiency (A1AD)—a genetic problem that can cause emphysema at an early age

Risk Factors

Emphysema is more common in people over 40 years old. Other things that may raise your risk are:

  • Smoking
  • Being around smoke
  • Exposure to irritants at work
  • Having alpha-1 antitrypsin deficiency
  • Indoor air pollution

Symptoms

Early symptoms include:

  • Problems breathing
  • Coughing
  • Coughing up mucus

Later symptoms may be:

  • Breathing that worsens
  • A choking feeling when you are lying flat
  • Fatigue
  • Problems concentrating
  • An enlarged chest
  • Coughing up bloody mucus
  • Weight loss

Diagnosis

You will be asked about your symptoms and health history. A physical exam will be done.

Your doctor will need to test how how well your lungs are working. This may be done with:

  • Pulmonary function tests, called spirometry—to test the force of your breath
  • Arterial blood gas test—to test oxygen and carbon dioxide levels in the blood

Your doctor may also need to look at pictures of your lungs. This may be done with:

Treatment

There is no cure. Your doctor will focus on helping you manage symptoms and improve your quality of life.

Treatment may be:

Stop Smoking

Quitting smoking slows the disease. It is a critical part of treatment. There are many things that can help:

  • Behavior change programs
  • Medicines
  • Both behavior programs and medicines

Breathe Clean Air

Limit the number of irritants in the air you breathe. Avoid smoke, dust, smog, extreme heat or cold, and high altitudes.

Medication

These medicines may be used:

  • Bronchodilators to open and relax airways
  • Corticosteroids to ease swelling
  • Antibiotics to treat lung infections

Some medicines may be taken as pills or liquids. Others are inhaled medicines that are delivered directly to the lungs.

Vaccines

The flu and pneumonia can make your symptoms worse. Get vaccinated against pneumonia and the flu. The flu vaccine may also reduce flare-ups.

Oxygen

Oxygen therapy may be helpful if the oxygen levels in your blood are too low. It can help you breathe and improve your level of energy. You may only need it for specific activities or it may be given throughout the day.

Exercise

Special exercises can strengthen chest muscles. This can make it easier to breathe.

Regular physical activity can improve how your body uses oxygen. It can reduce workload on your lungs.

Breathing and Coughing Methods

Special methods of breathing can help bring more air into the lungs. They can also help force trapped air out of the lungs. Coughing methods can also help clear mucus. Ask your doctor if these methods can help you. Some examples include:

  • Pursed lip breathing
  • Controlled coughing

Weight Management

Excess weight causes the lungs and heart to work harder, which they are already doing because of emphysema. For some people, the extra work of breathing can make eating enough food difficult. This can result in weight loss. A dietitian may be needed to help with weight management.

Stress Management

Emphysema can be stressful. Therapists, support groups, and family members and friends can provide support. Relaxation methods can also help.

Surgery

A small number of people may benefit from surgery. Part of the lung may be removed. This will let healthier areas open.

A lung transplant may be an option. A healthy, donor lung will be placed. It will require lifelong medicine.

Prevention

To prevent emphysema:

  • If you smoke, talk to your doctor about how to quit
  • Avoid exposure to secondhand smoke
  • Avoid exposure to air pollution or irritants
  • Wear protective gear if you are around irritants or toxins on the job

RESOURCES:

American College of Chest Physicians
http://www.chestnet.org
American Lung Association
http://www.lung.org

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca
The Lung Association
http://www.lung.ca

References:

COPD. American Lung Association website. Available at:
...(Click grey area to select URL)
Accessed May 10, 2020.
COPD. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T115557/COPD . Accessed May 10, 2020.
COPD. National Heart, Lung, and Blood Institute website. Available at:
...(Click grey area to select URL)
Accessed May 10, 2020.
COPD and asthma. National Lung Health Education Program website. Available at:
...(Click grey area to select URL)
Accessed May 10, 2020.
Emphysema. American Lung Association website. Available at:
...(Click grey area to select URL)
Accessed May 10, 2020.
Petrache I, Diab K, Knox KS, et al. HIV associated pulmonary emphysema: A review of the literature and inquiry into its mechanism. Thorax. 2008;63(5):463-469.
Last reviewed May 2020 by EBSCO Medical Review Board Daniel A. Ostrovsky, MD
Last Updated: 05/10/2020