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Lung Center

Emphysema

Definition

Emphysema is a chronic lung disease in which air sacs and the surrounding lung tissues are destroyed. The air sacs may be collapsed or over inflated and stretched out. This is where gas exchange occurs in the lungs. This breakdown of the walls of the air sacs causes airflow limitation in the lungs that in most cases is not completely reversible. The most common cause of emphysema is cigarette smoking, although rare forms of emphysema may occur in non-smokers. Emphysema may be present with other lung diseases, such as chronic bronchitis and asthma. Like emphysema, these diseases are made worse by cigarette smoking. Emphysema and chronic bronchitis are often grouped together and commonly called chronic obstructive pulmonary disease (COPD). Exposure to air pollution and noxious particles or gases could also cause or worsen these conditions.

Symptoms

Symptoms associated with emphysema include:

  • Shortness of breath
  • Fatigue
  • Cough
  • Wheezing
  • Reduced exercise capacity
  • Frequent exacerbations and respiratory infections
  • Depression and anxiety
  • Weight loss

People with 'mild' emphysema have symptoms only with exertion, such as extended walks, exercise, etc. Those with moderate or severe emphysema maybe have symptoms with little exertion (such as getting around the house) or during activities of daily living or even at rest.

It is very important to understand that emphysema is a chronic condition, which may progress and ultimately result in death. Therefore, even people with 'mild' emphysema should make every effort to slow the progression of the disease and most importantly, quit smoking and seek medical attention.

It is very important to understand that emphysema is a chronic condition, which may progress and ultimately result in death.

Diagnosis

Symptoms of emphysema are usually determined by how well the lungs are able to get oxygen in, and carbon dioxide out, of the body. People with emphysema experience breathlessness and are usually diagnosed by history and physical examination, measures of lung function, and X-rays of the chest. Pulmonary Function Studies (PFTs) are good at revealing many lung problems, but they may not reflect the symptoms.

Risk Factors

The primary risk factor for the development of emphysema is tobacco abuse. In a few individuals, genetic factors such as a reduced level or activity of protective enzymes in the lung (such as occurs in alpha1-antiprotease deficiency) may result in emphysema even in the absence of smoking. It is not possible to predict in any individual smoker if they would ever develop emphysema, and how long or how many cigarettes it would take to develop emphysema. In fact, most smokers do not develop emphysema. However, because emphysema is essentially irreversible, and because tobacco abuse is associated with numerous other conditions including heart disease, lung cancer, stomach cancer, bladder cancer, and others, it is essential to emphasize that NO ONE should consider cigarette smoking a safe practice.

Prognosis

Unfortunately, there are few good predictors of outcome for patients with emphysema. Simply put, some individuals with emphysema show a rapid decline in lung function, while others show a more gradual decline. Symptoms are usually determined by how well the lungs are able to get oxygen in, and carbon dioxide out, of the body. When the lungs deteriorate to such a point that they cannot function well, symptoms become more obvious, and we commonly say the disease is approaching "end stage." Often, the heart attempts to compensate by increasing its workload, but over time this can lead to heart failure. While the heart failure is treatable to some degree, it is a sign that things are not going well. Usually, patients experience a progressive decline in exercise ability, and eventually become short of breath, even at rest. People with emphysema also have an increased chance of lung infection.

In many cases, careful management of emphysema by a skilled physician can not only slow down the progression of disease, but also reduce its effect.

Prevention

Once lung tissue is destroyed, it cannot be repaired. Prevention then is the key, and quitting smoking is the cornerstone. Patients who can stop smoking may be able to slow further lung deterioration back to the normal rate. Individuals with emphysema will almost always have progressive disease if they continue to smoke. Quitting smoking is strongly recommended, especially for those with lung disease, since it is linked with an increased risk of heart attacks and cancer.

Treatment

In many cases, careful management of emphysema by a skilled physician can not only slow down the progression of disease, but also reduce its effect. Quitting smoking is the single most important part of treatment for emphysema.  Other treatments include:

Sometimes inhaled corticosteroids in patients with emphysema who also suffer from an airway disease can be helpful. These drugs are similar to the steroids taken by mouth, but because they are delivered to the airways directly, they are most often not linked with any serious side effects.

Many centers offer pulmonary rehabilitation programs, which consist of patient education and exercises designed to improve functional capacity and quality of life in patients with lung disease. Your doctor should be able to help you decide if this is appropriate for you.

Treatment for end-stage emphysema is mostly supportive, including oxygen, medications to improve lung function, and early recognition and treatment of lung infections. In some patients with enzyme deficiency, replacement therapy with alpha1-antitrypsin may be helpful. Current surgical treatment includes resection of giant air collections (bulla) and lung transplantation in certain patients. Lung volume reduction surgery is also an option for certain types of patients with upper lobe predominant disease. This surgery reduces the size of the lungs by removing some of the most diseased parts of the lungs, which would then allow the remaining lung to function more normally.

Lung transplantation has also been shown to improve quality of life and functional capacity in some patients with emphysema.

For more information, visit the following websites:

National Heart, Lung, and Blood Institute

The National Institute of Health

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Go to the Lung Center health topic, where you can:

Last Reviewed: Oct 08, 2007

Mahasti   Rittinger, RRT Mahasti Rittinger, RRT
Clinical Program Manager of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University

Phillip T Diaz, MD Phillip T Diaz, MD
Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University

Stuart Green, MD
Assistant Professor of Medicine and Pathobiology
College of Medicine
University of Cincinnati

Mitchell C Rashkin, MD Mitchell C Rashkin, MD
Professor of Medicine
College of Medicine
University of Cincinnati