Pulmonary [PULL-mon-air-ee] emphysema [em-fuh-SEE-muh] is when the small airways in the lungs become damaged, making it harder for you to push air out and breathe fresh air in. It is a type of COPD (chronic obstructive pulmonary disorder). With emphysema, the small airways (bronchioles [BRONG-kee-ohlz]) and air sacs (alveoli [al-VEE-oh-ly]) are damaged and lose their normal elasticity. Like worn-out balloons, the alveoli become over-expanded. They don’t contract to push air out as easily when you breathe out. Inhaled air tends to stay trapped inside, and fresh air has a hard time getting in. This limits the amount of oxygen going into your bloodstream, and keeps carbon dioxide from leaving. These problems are made worse because the blood vessels around the alveoli are also damaged.
People with emphysema often have chronic bronchitis. Chronic bronchitis is another type of COPD. The airways in your lungs become swollen and inflamed, and produce too much mucus. The swelling and mucus narrow the airways and make it hard to breathe.
The lung damage that happens with emphysema can’t be fixed, and the disease can’t be cured. But you can do a lot to reduce your symptoms and improve your life.
See a doctor anytime you have shortness of breath or any other symptoms similar to emphysema. It is important to confirm or rule out a diagnosis right away. If you have emphysema, the sooner you get treatment and avoid is the things that irritate your lungs, the less damage you will have.
Most people get emphysema after many years of breathing in a something that damages the lungs and airways:
- Cigarette smoking is the most common cause of COPD, including emphysema. Smoking a pipe, cigar, or anything else can also cause it. Even second-hand smoke — exposure from smokers you live or work with — can be a factor.
- Dust from a mine or quarry (like coal dust and sillica dust) or chemical fumes from a factory or paint shop can also cause lung damage over time.
- Fumes from the fuel used for daily cooking or heating can damage your lungs if your home is poorly ventilated.
- Heredity can also play a role. People with alpha-1 antitrypsin deficiency, for example, have an inherited form of emphysema.
Before diagnosing emphysema, your healthcare provider will assess your lungs and overall health by:
- Asking about your medical history. Your healthcare provider will ask about your symptoms ("How long have you had this problem?"), your family history ("Does anyone in your family have this problem?"), and your lifestyle ("Have you ever smoked?"). Your answers will help your healthcare provider understand more about what may be causing the breathing problem or making it worse.
- Doing a physical exam. Your healthcare provider will look at your skin color and listen to your chest as you breathe.
- Ordering imaging tests. Imaging tests (such as a chest x-ray) allow your healthcare provider to see what may be happening inside your chest and lungs. The images can't be used to diagnose emphysema, but they may reveal other problems such as a lung infection.
- Performing lung function tests (pulmonary function tests, or PFTs). Lung function tests are the only way to diagnose emphysema. They're also used to see your response to treatment and measure your condition over time. Common lung function tests are:
- Breathing tests to measure how well your lungs are working. The simplest breathing test is spirometry, which can be done in your doctor's office or in a hospital. Your doctor may also order more complex lung tests to get additional information about your lungs.
- Oxygen level tests to see how well your lungs get oxygen to your bloodstream. Pulse oximetry uses a special light clipped to your finger to measure oxygen in your blood. An arterial blood gas test measures the oxygen in a sample of blood from your artery.
- Exercise tests, which are sometimes combined with tests of your oxygen level, like the 6-minute walk test. These tests help your doctor know how your heart and lungs respond to the stress of physical activity. They can also help your doctor determine the severity of your condition.
Treatment for emphysema depends on the severity of your disease, your daily habits, and your overall health. Generally, treatment includes:
- Quitting smoking. This is the most important thing you can do to improve your overall health. Ask your healthcare provider for information on programs that can help you kick the habit.
- Other daily lifestyle changes, such as exercising, practicing breathing techniques, lowering stress, and eating well. Your healthcare team can give you a plan to help you care for yourself at home.
- Medicine. Nearly everyone with COPD can be helped by medicine. COPD medicines include:
- Quick-relief (“rescue”) medicines that you inhale to help you breathe better right away
- Maintenance medicines that help control symptoms and prevent them from getting worse
- Oxygen therapy. If your emphysema is mild, you may not need oxygen. Yet as it progresses, oxygen can be vital for helping you feel better and stay active. Studies have shown that oxygen therapy can extend your life, as well.
- Surgery. A small number of people with emphysema may be helped by lung volume reduction surgery. This surgery removes damaged lung tissue and creates more space for the diaphragm to move and help pull air into the lungs. Lung transplant may also be an option for treatment of severe COPD.
If you smoke or have regular contact with a lung irritant (such as airborne gases or dust, fumes, or smoke) then you’re at risk for COPD. To prevent COPD, you must:
- Stop smoking
- Avoid lung irritants, including second-hand smoke
Complete avoidance — quitting, not just cutting back — is the only way to prevent irreversible lung damage.
Emphysema takes many years to develop, and in its early stages you may not notice symptoms. These are the symptoms you will notice first:
- Coughing and shortness of breath, especially when you’re active
- Mucus with your cough
- Chronic wheezing (a faint whistling sound when you breathe)
As it worsens, you may also have these symptoms:
- Swollen ankles
- Poor concentration due to the low oxygen and high carbon dioxide levels in your body
COPD symptoms tend to sneak up on people. Without being aware of it, people with COPD gradually do less and less, limiting their daily activity so they can avoid becoming out of breath. Most people only seek medical help later in life, at age 50 or older, when their breathing problems are hard to ignore.