Emphysema

Overview

Emphysema is a long-term lung condition. It damages the tiny air sacs in the lungs, which are called alveoli. These sacs normally help move oxygen into your blood and carbon dioxide out. When they are damaged, the lungs lose some of their stretchiness, and small airways can collapse when you breathe out. This makes it harder to get air out of the lungs and can cause shortness of breath. Emphysema is one of the main patterns of chronic obstructive pulmonary disease, usually called COPD.

Emphysema is common, especially in adults with a history of smoking. It is one of the main types of COPD, and COPD affects millions of people worldwide.

It most often affects adults over 40 who smoke or have smoked. It can also affect people who have breathed in a lot of secondhand smoke, dust, fumes, or pollution at work or at home. A rare inherited form can affect younger adults. Children can get emphysema, but it is uncommon and needs specialist assessment.

Symptoms

Common symptoms

• Shortness of breath, especially with walking, climbing stairs, or other activity
• A cough that lasts a long time, sometimes with mucus
• Wheezing or a whistling sound when breathing
• Chest tightness
• Getting chest infections more often than usual
• Feeling tired or having less energy for daily activities
• Needing to stop and catch your breath during tasks

Symptoms in children

• Emphysema is uncommon in children. If a child has ongoing breathlessness, a long-lasting cough, or poor growth, they should be checked by a doctor.
• In children, doctors look for rare inherited conditions, birth-related lung problems, severe exposure to smoke or pollution, and other lung diseases.
• Children need specialist assessment rather than being treated as small adults.

Symptoms in older adults

• Older adults may blame breathlessness on getting older, but new or worsening breathlessness should be checked.
• Emphysema can occur alongside heart disease, frailty, and other long-term conditions, so a full review can help.
• Older adults may have more fatigue, muscle weakness, or difficulty with daily tasks and may benefit from extra support.

Causes

Main causes

• Smoking is the main cause of emphysema in most people.
• Long-term exposure to secondhand smoke, air pollution, or workplace dust and fumes can damage the lungs.
• A rare inherited condition called alpha-1 antitrypsin deficiency can cause emphysema, sometimes at a younger age. It affects a protein that normally helps protect the lungs.
• In rare cases, severe early-life lung injury or certain inherited conditions can lead to emphysema.

Risk factors

• Current or past smoking
• Living or working around smoke, dust, chemical fumes, or heavy air pollution
• A family history of early-onset emphysema or COPD
• Frequent chest infections or poorly controlled asthma
• Being exposed to tobacco smoke in childhood
• Premature birth or early-life lung problems, in some cases

When to see a doctor

See a doctor urgently if:

• Your breathing gets much worse suddenly, or you cannot do your usual activities
• You have chest pain, fever, confusion, or blue lips or fingertips
• You are coughing up blood
• Your ankles or legs swell suddenly, or you gain weight quickly
• You feel you need urgent help but are not sure what to do

Book a routine appointment if:

• You have ongoing breathlessness, a cough lasting more than 3 weeks, or wheezing
• You get chest infections often
• You have a family history of early lung disease or a known genetic risk
• You smoke or have smoked and want help to quit
• You have been exposed to dust, fumes, or asbestos at work

Diagnosis

A doctor will ask about your symptoms, smoking history, home and work exposures, and family history. They will examine you and likely arrange breathing tests. The main breathing test is spirometry, which measures how much air you can blow out and how fast. This helps show whether your airways are narrowed and how well your lungs are working.

Tests that may be done

• Spirometry: a breathing test where you blow hard into a tube
• Chest X-ray or CT scan to look at the lungs and rule out other problems
• Pulse oximetry: a small clip on your finger checks oxygen levels
• Blood tests, including a test for alpha-1 antitrypsin deficiency in some people
• Arterial blood gas test: a blood sample from the wrist to check oxygen and carbon dioxide levels in more severe cases
• Exercise tests or a walk test to see how breathing affects activity

What to expect at your appointment

Most tests are quick and painless. For spirometry, you may be asked to breathe in deeply and blow out as hard as you can into a tube. You may repeat this after breathing a medicine that opens the airways. The results help your care team understand your lung function and plan treatment. Ask questions if anything is unclear.

Treatment

Emphysema cannot usually be cured, but good treatment can ease symptoms, reduce flare-ups, and help you stay active. The main parts of care are stopping smoking, using medicines prescribed for you, joining a pulmonary rehabilitation programme, staying up to date with vaccines, and having a written action plan for when symptoms get worse.

Self-care at home

• Stop smoking, and ask for help if you need it. This is the most important step.
• Avoid smoke, dust, fumes, and heavy air pollution as much as possible.
• Stay active at a level that is safe for you. Ask your care team about pulmonary rehabilitation.
• Learn breathing techniques, such as relaxed breathing and pursed-lip breathing, from a healthcare professional.
• Pace yourself and plan rest breaks during tasks.
• Keep up with recommended vaccines and handwashing to lower infection risk.
• Follow your written action plan when symptoms change, and keep it somewhere easy to find.
• Eat a balanced diet and keep a healthy weight. Ask for advice if eating feels difficult because of breathlessness.

Medical treatments

Treatment is tailored to you. Your healthcare team may prescribe inhaled medicines that help open the airways or reduce inflammation, and they may use antibiotics when you have a chest infection. Some people need oxygen therapy at home after a specialist assessment. Pulmonary rehabilitation is a supervised exercise and education programme that can improve breathlessness, fitness, and confidence. Your team will review your medicines regularly and adjust them safely.

When is surgery considered?

Surgery is not suitable for most people with emphysema. In selected severe cases, specialist teams may consider procedures such as lung volume reduction or, rarely, lung transplant. These are major decisions and would be discussed carefully with you and your family.

Living with this condition

Emphysema can make daily tasks feel harder, so planning and pacing can help. Put often-used items within easy reach, sit down for tasks like dressing or cooking, and use breathing techniques before you get too short of breath. Keep your action plan close by, and tell family or carers how they can help if your symptoms worsen.

Lifestyle tips

• Stay smoke-free and avoid secondhand smoke.
• Keep physically active within your limits; walking and gentle strength work can help.
• Ask about pulmonary rehabilitation, which can make everyday breathing feel easier.
• Keep your home well ventilated and avoid strong fumes, dust, and smoke.
• In very cold weather, cover your nose and mouth with a scarf to warm the air.
• Get enough sleep and rest when needed.
• Keep up with vaccines recommended by your clinician.

Diet and exercise

A balanced diet with enough protein helps keep your muscles strong. If large meals make you breathless, try smaller meals more often. Limit salt only if your clinician advises it. Exercise should be gentle and steady at first. Walking, chair-based exercises, and light strength work can help. A pulmonary rehabilitation team can give you a safe plan. Stop and rest if you feel very breathless, dizzy, or unwell.

Mental health and emotional wellbeing

Long-term breathlessness can cause worry, panic, low mood, or poor sleep. These feelings are common and treatable. Tell your healthcare team if you feel anxious or depressed. Breathing techniques, counselling, peer support, and sometimes medicines can help. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis support service immediately.

Prevention

You cannot undo lung damage that has already happened, but you can greatly lower your risk and slow worsening. The best prevention is not smoking and avoiding smoke, dust, fumes, and pollution. If you smoke, stopping is the single most powerful step, and support is available. Wearing proper protective equipment at work and keeping homes well ventilated also help.

Vaccines

Ask your clinician which vaccines are recommended for you. People with lung conditions are often advised to have flu, COVID-19, and pneumococcal vaccines, and sometimes others. Vaccines lower the risk of serious chest infections.

Screening programmes

There is no national screening programme for emphysema. Breathing tests may be offered if you have symptoms or high risk, such as a smoking history or work exposure. A genetic test for alpha-1 antitrypsin deficiency may be suggested for some people, especially if emphysema occurs at a young age or runs in the family.

Complications

If left untreated

• More frequent flare-ups, where breathing suddenly gets worse
• Low oxygen levels, which can strain the heart and body
• Chest infections that are more serious
• Weight loss and muscle weakness from the effort of breathing
• Anxiety, low mood, and reduced social contact
• Rarely, a collapsed lung or heart strain from long-term low oxygen

Long-term outlook

Emphysema is a long-term condition, and the damage to the lungs is usually permanent. But many people live well for years with the right care. Stopping smoking, staying active, using treatment as prescribed, and getting support can slow worsening and improve quality of life. See your healthcare team regularly so your plan can be adjusted as your needs change.

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