Pulmonary Emphysema

What is emphysema?

Emphysema is a progressive chronic lung condition in which the tiny air sacs (alveoli) are damaged or destroyed. When this happens, it causes the tiny air sacs to rupture and create one big air pocket instead of many tiny ones. Air becomes trapped in the damaged areas and doesn't move the oxygen correctly through the body.

Overinflation of the lungs 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 cured. It causes permanent breakdown in the lower lung tissue.

Emphysema is one form of COPD (chronic obstructive pulmonary disease). The other form of COPD is chronic bronchitis. When people who smoke have chronic breathing problems like being short of breath, they usually have some combination of both emphysema and chronic bronchitis.

What causes emphysema?

Emphysema occurs very slowly over time. It may be caused by:

• Smoking (the main cause)

• Exposure to air pollution, such as chemical fumes, dust, vapors, fumes, gases, and other chemicals or substances

• Exposure to indoor pollution. This includes irritating fumes, burning wood, smoke from home cooking, heating fuels, chemical fumes, environmental dust, and secondhand tobacco smoke.

• A rare, inherited form of the disease called alpha 1-antitrypsin (AAT) deficiency-related pulmonary emphysema or early onset pulmonary emphysema. You may be screened for AATD.

What are the symptoms of emphysema?

Symptoms may be slightly different for each person. These are the most common:

Early symptoms of emphysema may include:

• Cough

• Rapid breathing

• Shortness of breath, which gets worse with activity

• Mucus production

• Wheezing

Other symptoms may include:

• Anxiety

• Depression

• Extreme tiredness (fatigue)

• Heart problems

• Overinflation of the lungs

• Sleep problems

• Weight loss

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

How is emphysema diagnosed?

Along with a complete health history and physical exam, your healthcare provider may do 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 (less air will get into your lungs) or obstructive (less air will get out of your lungs)

• Look for lung disease

• Monitor 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. A blood test may be done to check eosinophil counts and vitamin D levels, and to monitor your hematocrit and hemoglobin levels for anemia.

Chest X-ray

This test takes pictures of internal tissues, bones, and organs. A chest X-ray is not recommended to diagnose COPD, but it can help identify other conditions.

CT scan

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

Mucus (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. It may also be done to check eosinophil levels. It generally takes 2 days to get the results.

How is emphysema treated?

The goal of treatment for people with 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. Community-based and home-based programs work as well as hospital-based programs as long as they are as often and of the same intensity. Standard home-based pulmonary rehab programs help with trouble breathing in people with COPD. Supervised, traditional pulmonary rehab remains the standard of care and best option for people with COPD. These programs help manage your disease, breathing methods, exercise, support, and counseling. To find one, ask your provider or call your local hospital. Also talk with your healthcare provider about which rehab or self-management program is best for you.

• 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

• Nutritional support since you may develop malnutrition and lose weight. It's important to stay at your ideal weight. Being overweight or underweight can affect your health.

• Other types of oral and inhaled medicines that are used to treat symptoms, such as coughing and wheezing

• Oxygen therapy from portable containers. Talk with your healthcare provider about long-term oxygen therapy.

• Quitting smoking. Smoking is the main cause of COPD. Quitting will help you be able to better manage your emphysema. Also don't use e-cigarettes or vaping products. Ask your healthcare provider about ways to help you quit smoking.

• Surgery to remove the damaged area of the lung

• An endobronchial valve system to treat breathing problems. This device is for people with severe emphysema. It's the first minimally invasive device to treat emphysema available in the U.S.

• Lung transplant for severe emphysema

During each appointment, your provider will assess your ability to:

• Cope in your usual environment (focusing on supportive, palliative, end-of-life care)

• Correctly use inhalers for your medicine delivery systems

• Cope with other conditions you have and the medicines you use

Key points about emphysema

• Emphysema is a chronic lung condition. It’s 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 emphysema is to live more comfortably, control symptoms, and prevent the disease from getting worse.

• A key part of treatment is to quit smoking, including e-cigarettes.

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 directions 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 don't 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, especially after office hours and on weekends and holidays.