What Is Emphysema?

Emphysema, a common form of chronic obstructive pulmonary disease (COPD), is a long-term disease of the lungs affecting an estimated 3.1 million Americans. A healthy lung is made up of tiny air sacs that stretch when air comes in and shrink when air moves out. In emphysema, these air sacs are destroyed, making it challenging to move air in and out of the lungs.

Causes of Emphysema

The damage to the air sacs in the lungs may be the result of a number of factors, including the following:

  • Smoking
  • Inhaling toxins or other irritants
  • Alpha1-antitrypsin deficiency (A1AD), a genetic defect that can cause emphysema at an early age

Risk Factors for Emphysema

Factors that may increase the risk of developing emphysema include the following:

  • Being age 40 or older
  • Smoking
  • Long-term exposure to secondhand or passive smoke
  • Family members with emphysema
  • Exposure to pollutants at work
  • History of frequent childhood lung infections

Symptoms of Emphysema

Early signs and symptoms include the following:

  • Coughing
  • Increased sputum production (mucus from deep in the lungs)
  • Wheezing
  • Shortness of breath with activity

As the disease progresses, additional signs and symptoms may include the following:

  • Increased shortness of breath
  • Rapid breathing
  • Choking sensation when lying flat, which may require propping with pillows or sleeping in a chair
  • Fatigue
  • Difficulty concentrating
  • An increase in chest size called “barrel chest”
  • Increased risk of serious lung infections
  • Heart problems
  • Coughing up thick and/or bloody mucus
  • Weight loss
  • Breathing through pursed lips
  • An impulse to lean forward to improve breathing
  • More frequent flare-ups of severe symptoms

Diagnosing Emphysema

In order to diagnose emphysema, a physician will ask about symptoms and medical history, and conduct a physical exam.

In order to determine how impaired a patient’s lungs may be, a physician may order tests such as the following:

  • Lung function tests: Called spirometry, this test measures the force of a patient’s breath.
  • Arterial blood gas test: This test measures oxygen and carbon dioxide levels in the blood.
  • Diagnostic imaging tests: Radiology tests such as chest x-rays and CT scans provide physicians with detailed pictures of a patient’s lungs.  

In addition, heavy smokers and especially those with COPD and emphysema are at high risk for developing lung cancer. Mount Sinai’s Lung Cancer Screening Program offers these high risk individuals low-radiation dose CT screenings a few times throughout the year.

Treatments for Emphysema

Because there is no cure for emphysema, treatments are focused on managing symptoms and improving each patient’s quality of life. Treatment options may include one or more of the following:

  • Smoking Cessation: Quitting smoking slows the progression of emphysema and is the most important part of treatment. There are many programs to help patients quit smoking, including behavior change programs and medications.

  • Environmental Management: Limiting the number of irritants in the air you breathe  may help to make breathing easier. Avoid smoke, dust, smog, extreme heat or cold, and high altitudes.

  • Medication: Medication for emphysema may help by opening the airways, relaxing the breathing passages, decreasing swelling, and treating lung infections with antibiotics. Medications may be taken as a pill, liquid, or inhalant.

  • Vaccines: Because the flu and pneumonia can make emphysema symptoms worse, it is recommended to get vaccinated against pneumonia and the flu. The flu vaccine may also reduce flare-ups.

  • Oxygen: If the oxygen levels in your blood are too low, oxygen therapy may help to relieve trouble breathing and improve energy. Oxygen may be given only for specific activities or throughout the day.

  • Exercise: Special exercises can strengthen chest muscles, making it easier to breathe. Regular physical activity, in accordance with your physician’s recommendations, can reduce the workload on your lungs by building endurance.

  • Breathing and Coughing Techniques: Special methods of breathing can help bring more air into the lungs and force trapped air out of the lungs. Effective coughing techniques can also help clear mucus from your lungs. Ask your doctor if these techniques—such as pursed lip breathing and the controlled coughing technique—can can help you.

  • Nutrition: Adopt a healthy diet low in saturated fat and rich in fruits, vegetables, and whole grains. Maintaining a normal weight is also helpful because excess weight causes the lungs and heart to work harder. If it’s difficult to eat because you feel full, try eating several smaller meals throughout the day instead of a few large meals. Slowing the pace of your eating will also make it easier to breathe.

  • Lifestyle Changes: Changes such as pacing activities, as well as learning relaxation techniques and other stress management techniques can be helpful. Seeking emotional support from professionals, family, and friends may also help because anxiety can increase your breathing rate.

  • Surgery: A very small number of people may benefit from surgery, such as a procedure to remove a part of the lung or a lung transplant.

Preventing Emphysema

To reduce your chance of getting emphysema, take these steps:

  • Quit smoking
  • Avoid secondhand smoke exposure
  • Avoid exposure to irritants or air pollution
  • Wear protective gear if exposed to toxins or irritants at work