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 breakdown of the walls of the alveoli. It causes a decrease in respiratory function and breathlessness. Damage to the air sacs is irreversible. It results in permanent holes in the tissues of the lower lungs.

Pulmonary emphysema is part of a group of lung diseases called COPD. COPD lung diseases cause airflow blockage and breathing problems. The two most common conditions of COPD are chronic bronchitis and emphysema.

What causes pulmonary emphysema?

Emphysema does not develop suddenly, but 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
• 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 medical 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 usually 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 whether 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 produce horizontal, or axial, images (often called slices) of the body. CT can show details like 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 may include breathing exercises to strengthen the muscles you use for breathing, as well as exercises to condition the rest of your body
• Antibiotics for bacterial infections
• Avoiding the smoke of others and removing other air pollutants from your home and workplace
• Bronchodilators, which can be either 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 used to treat symptoms like 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.
• Pulmonary emphysema does not develop suddenly, but very slowly over time. It’s most commonly caused by smoking.
• Pulmonary emphysema causes shortness of breath that often gets worse with activity and many other symptoms, such as wheezing, cough, anxiety, and heart problems.
• Tests that help measure the lungs’ ability to exchange oxygen and carbon dioxide are used to diagnose pulmonary edema. Blood tests and imaging tests may also be used to see how severe the problem is and monitor it over time.
• 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.