Emphysema belongs to a group of diseases called chronic obstructive pulmonary disease (COPD).
This long-term and progressive disease of the lungs causes shortness of breath. It destroys the tissues necessary to support the shape and function of the lungs.
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What Is Emphysema?
Emphysema belongs to a group of diseases called chronic obstructive pulmonary disease (COPD). Chronic bronchitis is the other member of the COPD family.
Emphysema is a long-term and progressive disease that damages lung tissue and alveoli — the tiny air sacs in the lungs. Over time, the alveoli break, creating one big air pocket instead of lots of tiny ones. The big air pockets trap stale air in the damaged tissue, preventing oxygen from moving easily into the bloodstream. This can make it hard to breathe.
Emphysema destroys the tissues necessary to support the shape and function of the lungs. When emphysema worsens, your air sacs — normally spherical in shape — contort into large, irregular pockets.
These pockets of destroyed air sacs:
- Diminish the amount of oxygen in your bloodstream.
- Leave gaping holes in their inner walls.
- Reduce the surface area of the lungs available for gas exchange.
Over time, emphysema destroys the elastic fibers that hold open the bronchioles — the tiny airways that lead to the air sacs.
When the bronchioles don’t close, the airways collapse when you exhale. Consequently, the lungs cannot expel carbon dioxide to make room for fresh air.
How common is emphysema?
According to the National Institutes of Health (NIH), roughly 14 million people have emphysema in the U.S. Among white male smokers, 14% have emphysema, compared to 3% of white male nonsmokers. White female smokers and African Americans of both sexes tend to have lower rates of emphysema but develop the disease after less exposure compared to other populations.
What causes emphysema?
The main causes of emphysema are:
- Smoking — Tobacco products can contribute to the destruction of alveoli. The more you smoke, the more likely you are to develop emphysema.
- Alpha-1 antitrypsin deficiency — Rarely, a deficiency of the substance known as alpha-1 antitrypsin can cause emphysema. Typically, people inherit this type of COPD.
Other rare causes of COPD include:
- Exposure to toxic gases and fumes in the workplace.
- Exposure to significant amounts of secondhand smoke.
- Frequent use of a fire for cooking or heat without proper ventilation.
- Living in a heavily polluted environment.
Emphysema risk factors
Risk factors for emphysema include:
- A genetic condition — If you inherit a condition known as alpha-1 antitrypsin (AAT) deficiency, you're more likely to get COPD. AAT makes you more vulnerable to smoke and chemical fumes. If you have AAT, you're also more likely to get COPD at a younger age.
- Age — Most people diagnosed with emphysema are over 40.
- Asthma — People who already have asthma are more likely to develop COPD. Asthma is a lung disease that causes swelling of the airways.
- Environmental irritants — Air pollution or chemical fumes from your workplace may damage your lungs. Second-hand cigarette smoke in the workplace can also be a factor.
- Lung disease as a child — If you had lung problems as a child, you're more likely to get COPD as an adult.
- Other health issues — If you have a condition such as HIV, pneumonia, or tuberculosis, you're more likely to develop COPD.
Complications of emphysema
Emphysema can lead to other physical, mental, and emotional complications.
If you have emphysema, you're more likely to:
- Develop memory loss.
- Get chronic diseases like arthritis, heart failure, diabetes, and stroke.
- Have depression or anxiety.
- Have physical limitations like trouble walking or going up a set of stairs.
- Lose weight and muscle.
- Miss out on social events with family and friends.
- Need an oxygen tank to help you breathe.
- Quit working before you want to.
How can I prevent emphysema?
The best way to prevent COPD is by not smoking. If you do smoke, try to quit as soon as possible.
Your PCP can talk to you about the best way to quit, including products, programs, and support groups to help.
You can also prevent complications from COPD by staying up to date on your vaccines. Getting routine flu and pneumonia shots helps prevent lung infections.
What Are the Signs and Symptoms of Emphysema?
The symptoms of emphysema and other chronic obstructive pulmonary diseases (COPD) develop slowly. Most people don't realize they have the condition until these symptoms worsen.
When symptoms do become apparent, they can include:
- Cough — with or without mucus.
- Fatigue.
- Frequent respiratory infections.
- Shortness of breath.
- Trouble catching your breath.
- Wheezing.
When should I see a doctor about my Emphysema symptoms?
If you have any of these symptoms, call your primary care provider to discuss them.
How Do You Diagnose Emphysema?
Doctors use a variety of tests to diagnose emphysema.
One of the best COPD diagnostic tools is a lung function test called spirometry.
Spirometry
For this test, the doctor will ask you to blow out as hard as you can into a device that measures lung capacity. They will tell you how long to keep blowing during the test. The results are available immediately.
Unlike some other diagnostic procedures, during spirometry, you don’t need to:
- Exercise.
- Have exposure to radiation.
- Wait for results.
Your doctor may also:
- Order an arterial blood gas test to measure the amount of oxygen and other gases in your bloodstream.
- Order x-rays or a CT scan of your lungs. While these can prove helpful, lungs may look normal even with emphysema present, especially with an x-ray image. That’s why doctors consider spirometry the most reliable tool for diagnosing COPD.
- Use a stethoscope to listen to your lungs as you breathe. But sometimes lungs sound normal even in people who have emphysema.
How Do You Treat Emphysema?
Chronic obstructive pulmonary disease (COPD) represents the fourth leading cause of death in the United States. However, effective treatment options do exist.
Although treatment cannot reverse damage from emphysema, it may slow the progression of the disease. If you smoke, the single most effective treatment involves quitting smoking.
Nonsurgical treatment for emphysema
The best way to treat emphysema without surgery is to stop smoking to slow disease progression.
Other therapies include:
Breathing assistance machine (BPAP)
Bilevel positive airway pressure (BPAP) machines use pressure to push air into your lungs, improving the level of oxygen in the blood.
Medication
Several different types of medications may be used to treat emphysema.
They include:
- Antibiotics for flare-ups to prevent infection.
- Anti-inflammatory medications, such as montelukast (Singulair) and roflumilast.
- Inhaled steroids to reduce inflammation.
- Inhaled bronchodilators to open airways (albuterol, Atrovent, Spiriva, Serevent).
- Oral or intravenous steroids.
- Oxygen therapy.
Surgical treatment for emphysema
The experts at UPMC also provide surgical options for people with emphysema.
Lung volume reduction surgery (LVRS) for emphysema
Some people with emphysema may have areas of the lung that are more affected than others. The LVRS procedure removes up to 35% of the poorly functioning lung tissue from each lung.
By removing this space-occupying tissue, the remaining relatively healthy lung tissue and surrounding muscles can work more efficiently. This allows for easier breathing and helps people with emphysema enjoy a better quality of life.
UPMC is one of the only hospitals in the United States approved to perform this life-enhancing procedure. In fact, we are a pioneer in both minimally invasive surgery techniques and LVRS specifically.
LVRS criteria and preliminary testing
You may want to consider LVRS if your emphysema greatly impacts your quality of life. It’s important to know the strict criteria necessary to qualify for LVRS.
Here are the best candidates for LVRS:
- If you have emphysema located mainly in the upper lobe of your lung(s) and a low exercise capacity, you may benefit most from LVRS surgery.
- If you have a high exercise capacity and upper lobe-predominant emphysema, you may qualify for LVRS but the impact on mortality is not as significant.
- If you have non-upper lobe-predominant emphysema and decreased exercise capacity, surgeons may — in select cases — agree to perform LVRS. It’s important to check with your doctors to see if you may qualify as a candidate in this case
You must have stopped smoking for a minimum of four months to undergo preliminary testing for LVRS. Before preliminary diagnostic tests, doctors will order tests that will show if you’ve used tobacco products in the past four months.
Medical risk assessment
A key factor in determining eligibility for LVRS involves undergoing careful medical risk assessment testing. These preliminary tests determine whether you are likely to survive the surgery and thrive after the operation.
Some of the preliminary tests include:
- CT scan — to look at the lungs carefully and determine if you have a clear-cut delineation of emphysema in the upper lobe region of the lung(s), or if the emphysema appears spread throughout the tissue.
- Routine pulmonary function testing — to establish baseline lung function.
- Ventilation/perfusion scan — uses scintigraphy, or medical isotopes, to evaluate the circulation of blood and air in a person’s lungs. This test will help doctors better establish upper lobe predominance of emphysema.
- Arterial blood gas test — to establish oxygen and carbon dioxide levels in the blood.
- Exercise test — may include a six-minute walk with standard protocols to measure how much work your body can perform.
- Cardiac testing — after the above preliminary tests, you’ll likely have an echocardiogram and a cardiac stress test.
What to expect during LVRS
Before surgery, once you’ve passed all the preliminary testing and qualified for the LVRS procedure:
- Your doctor will enroll you in a pulmonary rehabilitation program.
- The therapists working in the program will assign an exercise regimen to enhance cardiopulmonary status.
After minimally invasive LVRS, you will:
- Typically stay in the hospital between five and seven days.
- Should feel quite good by about two weeks after the operation.
- Return to your pulmonary rehabilitation program where therapists will work with you to greatly enhance your cardiopulmonary status through specialized exercise programs.
Lung transplant surgery for emphysema
A lung transplant may represent an option for those with very advanced (end-stage) disease or disabling emphysema symptoms.
UPMC's Lung Transplant Program is one of the most recognized and experienced centers in the world. This expertise allows us to accept many people as lung transplant candidates that other centers may decline.
