What is pulmonary emphysema?
Emphysema is a chronic lung condition in which the air sacs (alveoli) may be:
Overinflation of the air sacs 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 fixed. It causes permanent breakdown in the lower lung tissue.
Pulmonary emphysema is part of a group of lung diseases called COPD (chronic obstructive pulmonary disease). COPD causes airflow blockage and breathing problems. The 2 most common conditions of COPD are chronic bronchitis and emphysema.
What causes pulmonary emphysema?
Pulmonary 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. The World Health Organization advises that all people with COPD be screened once for AATD.
What are the symptoms of pulmonary emphysema?
Symptoms may be slightly different for each person. These are the most common:
Early symptoms of pulmonary emphysema may include:
- Rapid breathing
- Shortness of breath, which gets worse with activity
- Sputum production
Other symptoms may include:
- Extreme tiredness (fatigue)
- Heart problems
- Overinflation 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 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:
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 (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.
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.
This test takes pictures of internal tissues, bones, and organs. A chest X-ray is not recommended to diagnosis COPD, but it can help identify other conditions.
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.
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.
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. 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 is 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 inhaler techniques for your medicine delivery systems
- Cope with other conditions you have and the medicines you use
Key points about pulmonary emphysema
- Pulmonary 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 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, including e-cigarettes.
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 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.
Cedars-Sinai has a range of comprehensive treatment options.