Emphysema: How It Damages the Lungs, Who Gets It, and the Treatments That Help

Emphysema is a type of COPD (chronic obstructive pulmonary disease) — a group of lung diseases that make it hard to breathe and get worse over time. The other main type is chronic bronchitis, and most people with COPD have both, in different degrees.

What it does to the lungs

Emphysema affects the lungs' air sacs. Normally they are elastic: each one fills with air like a small balloon when you breathe in, and deflates when you breathe out.

In emphysema, the walls between many air sacs are damaged. The sacs lose their shape and become floppy, and some walls are destroyed, leaving fewer, larger sacs instead of many tiny ones. That makes it harder for the lungs to move oxygen in and carbon dioxide out.

Causes and risk

The usual cause is long-term exposure to irritants that damage the lungs and airways. In the United States, cigarette smoke is the main cause; pipe, cigar and other tobacco smoke can cause it too, especially if inhaled.

Symptoms

At first there may be none, or only mild ones. As the disease worsens:

• frequent coughing or wheezing, and a cough with a lot of mucus;
• shortness of breath, especially with activity;
• a whistling or squeaky sound when you breathe;
• chest tightness.

Some people get frequent colds and flu. In severe cases, emphysema can cause weight loss, weakness in the lower muscles, and swelling in the ankles, feet or legs.

Diagnosis

Your provider may use a medical history (including symptoms), a family history, and tests such as lung function tests, a chest x-ray or CT scan, and blood tests.

Treatment

There is no cure, but treatment can ease symptoms, slow the disease, help you stay active, and prevent or treat complications.

• Quit smoking — the most important step. Avoid secondhand smoke and other lung irritants. Ask your provider about an eating plan and how much physical activity is right; activity strengthens the breathing muscles.
• Bronchodilators relax the muscles around the airways to open them; most are inhaled, and in more severe cases the inhaler may also contain steroids to reduce inflammation.
• Vaccines for flu and pneumococcal pneumonia, which are more dangerous for people with emphysema.
• Antibiotics if you get a lung infection.
• Oxygen therapy for severe emphysema with low blood oxygen — all the time or only at certain times.
• Pulmonary rehabilitation: exercise, disease management training, nutritional counseling and psychological counseling for people with chronic breathing problems.
• Surgery, usually a last resort: removing damaged lung tissue, removing large air spaces (bullae) that form when air sacs are destroyed and get in the way of breathing, or a lung transplant for very severe disease.

Get emergency care for severe symptoms, such as trouble catching your breath or talking. Call your provider if symptoms are getting worse or you have signs of infection, such as fever.

Prevention

Since smoking causes most cases, the best prevention is not to smoke — and to avoid secondhand smoke, air pollution, chemical fumes and dusts.

Sources

Based on "Emphysema," MedlinePlus, U.S. National Library of Medicine, with information from NIH's National Heart, Lung, and Blood Institute; a work of the United States government in the public domain.