What is Emphysema: Causes, Treatment, and Prevention

• Emphysema is a chronic lung condition, specifically a form of chronic obstructive pulmonary disease, that makes it difficult to breathe in one or both lungs.
• While there isn’t a cure for emphysema, multiple options exist to treat emphysema symptoms, including exercises for chronic breathing problems, steps to stop cigarette smoking, and medications. In severe cases, a lung transplant or surgery to remove diseased lung tissue may be required.
• To prevent chronic respiratory conditions, including emphysema, it’s best to never smoke or quit smoking of any kind, including cigarettes, vapes, hookah, and marijuana, and make lifestyle choices that promote healthy lungs.

14 million Americans have emphysema, a type of chronic obstructive pulmonary disease (COPD) that causes chest pain and difficulty breathing. While there is no known cure, there are treatment options to manage symptoms and prevention methods to lower the risk of developing emphysema. 

Continue reading to learn more about treatment and prevention, as well as emphysema’s symptoms, risk factors, causes, and more. 

Emphysema, sometimes referred to as pulmonary emphysema, is a chronic, progressive lung disease most often caused by cigarette smoking. It falls under the chronic obstructive lung disease (COPD) umbrella, alongside chronic bronchitis (long-term inflammation of the lung’s airways) and asthma-COPD overlap syndrome (when asthma, a disease that narrows and inflames the airways, is experienced alongside a form of COPD). 

All COPD lung diseases block the airways to the lungs, making it hard to breathe. What differentiates different COPD types is the cause of the airway blockage, the severity of symptoms, and the best treatment options for managing symptoms. 

In emphysema, the airway blockage is caused by damage to the wall between tiny air sacs in the bronchial tubes. Air sacs in the lungs should be stretchy, filling up when someone breathes in and emptying when they breathe out. Damaged air sacs in emphysema mean the alveoli cannot expand and retract as they should, making it harder for the breathing out function to happen. 

There are three main types of emphysema:

• Centriacinar: occurs in the top half of the lungs and is often linked to smoking. This is the most common type.
• Panacinar: also known as panlobular emphysema, this type occurs in the lower half of the lungs and is most often associated with genetic diseases, such as alpha‑1 antitrypsin deficiency. 
• Paraseptal: also known as distal acinar emphysema, this type affects the outermost parts of the lungs and is often seen alongside one of the other two types.

It’s also possible to have a mix of emphysema and another type of COPD, usually chronic bronchitis. Emphysema severity differs from individual to individual, though it can be life-threatening, and severe cases cause chronic respiratory failure, an inability to breathe, or acute decompensated heart failure, a gradual decline in your heart’s function.

In most cases, a person is usually at least 40 years old before symptoms begin. Symptoms may be mild in the early stages of the condition, making mild cases of emphysema difficult to diagnose in advance.

Emphysema’s primary symptom is difficulty breathing, but it’s not the only one. Other emphysema symptoms include:

• Persistent cough
• Chest pain
• Wheezing, a high-pitched whistling caused by blocked airways
• A productive cough (one that produces discolored mucus or phlegm)
• A squeaky sound when breathing
• Chest tightness
• Bluish fingers and lips

Symptoms (especially difficulty breathing) tend to get worse with physical activity. Associated symptoms of chronic emphysema include: 

• Increased risk of chronic, frequent respiratory infections, like the common cold, flu, and pneumococcal pneumonia.
• Unintentional weight loss, muscle weakness, and swelling in the legs or ankles.
• Difficulty sleeping or feeling fatigued
• Decreased energy levels (fatigue)
• Inability to concentrate

Emphysema can be categorized in four stages, determined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Those stages include:

• Stage 1: a mild stage where the lungs operate at least 80% of the functionality of healthy lungs for someone their age, weight, height, and gender. 
• Stage 2: moderate emphysema where the lungs operate at 50–79% of the functionality of healthy lungs for someone their age, weight, height, and gender. 
• Stage 3: a severe stage where the lungs operate at 30–49% of the functionality of healthy lungs for someone their age, weight, height, and gender. 
• Stage 4: the most severe stage where the lungs operate at 30% of the functionality of healthy lungs for someone their age, weight, height, and gender. 

Emphysema occurs when exposure to noxious particles or gasses damages lung cells. These dangerous gasses come from multiple sources, with the most common being cigarette smoke. Emphysema develops from persistent exposure meaning walking past someone smoking every once in a while won’t cause emphysema. Being a smoker or living with someone who smokes, however, does increase the chance of developing emphysema. In fact, over 75% of those with emphysema identify as smokers or used to smoke. Being around persistent secondhand smoke every day increases emphysema risk too.

While smoking is the most common source of noxious gasses in the United States, exposure to air pollution, dust, carbon dioxide, and chemical fumes can also increase your risk. Those who work in industries such as housekeeping, mining, manufacturing, car repair, and farming are particularly vulnerable.

Risk Factors for Emphysema

The most common risk factors for emphysema are: 

• Workplaces with exposure to dangerous chemicals and air pollutants 
• Being a smoker or consistently being exposed to secondhand smoke 

But not everyone in these groups develops emphysema—and they aren’t the only risk factors. Certain demographics are more likely to develop this condition, including:

• Gender: Men are more likely than women to develop emphysema.
• Race: White individuals get it the most often.
• Age: Emphysema is most common in populations over the age of 40.
• Genetic factors: A family history of COPD makes someone more likely to develop this condition. 
• Alpha‑1 antitrypsin deficiency: A diagnosis of alpha‑1 antitrypsin deficiency, a rare genetic condition, increases one’s risk. 

If left untreated, emphysema can lead to several complications, including:

• Higher risk of lung cancer
• Collapsed lung
• Pulmonary hypertension, or high blood pressure specifically in the lung arteries
• Possible heart conditions, such as a heart attack or heart disease

Regular visits to a healthcare provider can help manage emphysema and allow prompt modifications to treatment when necessary.

If you experience one or more of the following symptoms you may want to make an extra medical appointment, outside of your regular visit:

• Experiencing labored breathing (harder to breathe than usual)
• Producing more mucus than usual
• Observing mucus that is yellow or green in color
• Using a corticosteroid medication frequently 
• Feeling less energetic than usual
• Coughing more than usual

During a check-up or appointment to discuss health concerns, patients can talk to their healthcare provider about potential causes of their symptoms, such as emphysema, and explore treatment options and lifestyle modifications to slow disease progression.

If you experience severe symptoms, mainly shortness of breath, call 911 immediately. 

Emphysema cannot be diagnosed at home, even if someone has all the symptoms listed above. Instead, a qualified healthcare provider needs to make a diagnosis. Before diagnosing emphysema, a healthcare provider will consider:

• Family and medical history, particularly pertaining to COPD
• Current symptoms
• Any other current medical conditions

They will also perform a physical exam and pulmonary function tests, sometimes referred to as a ​“lung function test,” to confirm an emphysema diagnosis. These tests include CT scans or X‑rays of the chest. Lung function tests are covered by Medicare Part B and many private insurance plans. They may also be covered by Medicaid, depending on a state’s coverage.

Additionally, blood tests, such as arterial blood gas tests, may be performed to measure the levels of oxygen and carbon dioxide in your blood.

Emphysema isn’t like the flu – it won’t go away with time and it’s incurable. Instead, treatment focuses on managing symptoms, improving an individual’s quality of life, and slowing disease progression. Preventative measures against other lung infections or respiratory infections may be recommended too. Fortunately, there are many treatments for emphysema symptoms that range from simple lifestyle changes to various medication regimens and more.

Lifestyle Changes

Severe emphysema symptoms and their progression are often triggered by specific lifestyle choices, such as eating unhealthily or smoking. To help manage symptoms, consider:

• Eating a balanced diet
• Quitting smoking, if currently a smoker
• Avoiding places with secondhand smoke
• Participating in aerobic activity (i.e. biking, walking, jumping rope) to strengthen the lungs
• Trying breathing exercises that strengthen the lungs

Some evidence suggests that structured pulmonary rehabilitation programs may work best. These programs, overseen by healthcare professionals, include exercises to strengthen the lungs, dietary changes to promote overall health, and mental health counseling for accountability when implementing these lifestyle changes.

Medications

Bronchodilators, a class of medication that relaxes the airways, may make it easier to breathe with emphysema. These medications are typically taken through an inhaler. When emphysema is severe, a doctor may also prescribe long-term use of steroids.

During a symptom flare-up, short-term use of certain medications may also be prescribed, including antibiotics, anti-inflammatory medications like corticosteroids, and mucolytics (medications that make it easier to get rid of excess mucus). 

On top of these emphysema drugs, it’s important to stay up-to-date on routine vaccinations, such as flu and COVID-19 shots. Immunizations boost the immune system, ensuring one’s body can better manage emphysema symptoms. 

Oxygen Therapy

In severe cases, oxygen levels in the blood may drop to critically low levels due to an imbalance of oxygen and carbon dioxide levels. When this happens, oxygen therapy (supplemental oxygen administered through a machine) may be prescribed. The most common machines for oxygen therapy include portable and at-home oxygen concentrators. This machine will provide oxygen to you through a facemask or a nose catheter (nasal cannula).

Typically, these machines are (partially or fully) covered by Medicare or private health insurance. Since there are many concentrators to choose from, get a recommendation from a healthcare provider and double-check that insurance covers a specific concentrator before purchasing. 

Surgery

For very severe emphysema cases, surgery may be prescribed. The most common surgeries include: 

• Bronchoscopic lung volume reduction
• Surgical removal of damaged lung tissue or destroyed air sacs
• Lung transplant
• Surgeries to get rid of large air pockets
• Lung volume reduction procedures/​lung volume reduction surgery

Surgery may also be a route to insert a Zephyr endobronchial valve, an FDA-approved device, into the airways. This device helps improve breathing in patients with severe emphysema. 

Emphysema is a common disease, and while it’s tricky to manage, you don’t have to face it alone. There are actions you can take to either prevent emphysema or better manage it, plus a healthcare provider can provide additional support and guidance as needed. 

Preventing or Managing Emphysema

While there isn’t a cure for emphysema, there are steps to reduce the chance of developing this condition–or to slow emphysema’s progression. The first, and most important, is to not start smoking or to quit smoking. 

The CDC provides a free information hub on how to quit smoking, which includes a tool to create a personalized quitting plan. A healthcare provider can also provide medical advice and accountability during someone’s quitting journey. 

When possible, avoid secondhand smoke, air pollution, and other harmful chemicals linked to emphysema. Someone can, for example, reduce their time outside if air pollution levels are high in their area due to forest fires or other external factors. Those who work in environments with exposure to harmful chemicals can ask their employer to provide respirator masks during shifts.

Life Expectancy of an Individual with Emphysema

Emphysema typically shortens someone’s life expectancy, but by how much can differ. Someone’s life expectancy depends on their age, overall health, and the stage of emphysema. One study suggests those with emphysema live shorter lives by about 7–8 years compared to those without emphysema. Life expectancy is shorter for those with severe emphysema and longer for those with mild cases.