Emphysema2

Overview

Emphysema is a long-term lung condition. Inside your lungs are millions of tiny air sacs called alveoli (say: al-VEE-oh-lie). They stretch open when you breathe in and spring back when you breathe out. In emphysema, the walls of these air sacs get damaged. They lose their stretch and become baggy and floppy. This means old air gets trapped in your lungs, and fresh air cannot get in easily. So you feel short of breath, especially when you move around. Emphysema is one of the main conditions that make up COPD (chronic obstructive pulmonary disease) — a term doctors use for a group of lung problems that make breathing harder over time.

Yes, it is common. Emphysema and other forms of COPD affect millions of people worldwide and are among the most frequent reasons people see a doctor about breathing problems. Rates are higher in places with lots of smoking and air pollution.

It mostly affects adults over 40 who have smoked for many years, or who have breathed in a lot of smoke, dust or chemical fumes at work or at home. A small number of people get it at a younger age because of an inherited condition called alpha-1 antitrypsin deficiency (say: AL-fa-one an-ti-TRIP-sin) — where the body lacks a protein that protects the lungs. It is rare in children.

Symptoms

Common symptoms

• Getting out of breath more easily than before, especially walking uphill, stairs or hurrying
• A cough that does not go away, often with mucus (phlegm)
• Wheezing or a whistling sound when you breathe
• A tight or heavy feeling in the chest
• Chest infections that keep coming back
• Feeling tired, or finding everyday tasks harder than they used to be
• Breathing through pursed lips (like blowing out a candle) to get more air
• In later stages: weight loss, swollen ankles, or a chest that looks more rounded

Symptoms in children

• Emphysema is very rare in children. When it does happen, it is usually linked to an inherited condition such as alpha-1 antitrypsin deficiency.
• Signs might include ongoing breathlessness, a long-lasting cough, poor weight gain, or getting puffed easily when playing.
• Any child with ongoing breathing problems should be checked by a doctor — there are many other, more common causes.

Symptoms in older adults

• Breathlessness may be put down to 'just getting older', so the condition can be missed for a while.
• Everyday activity may slowly reduce — for example, taking breaks on stairs or giving up hobbies.
• Chest infections may be more frequent and hit harder.
• Low mood, poor sleep and loss of appetite are common and worth mentioning to a doctor.
• Many older adults also have other conditions, such as heart problems, which need checking too.

Causes

Main causes

• Smoking — by far the most common cause. The longer and more you smoke, the higher the risk.
• Breathing in other people's smoke (secondhand smoke) over many years
• Long-term exposure to dust, fumes or chemicals at work — for example in mining, building, welding, farming or some factories
• Air pollution, especially in heavily polluted cities
• An inherited condition called alpha-1 antitrypsin deficiency, which affects a small number of people

Risk factors

• Current or past smoking, including vaping and other inhaled substances
• Growing up in a smoky home
• A job that exposes you to dust or fumes without good protection
• A family history of early lung disease, which can point to an inherited cause
• Asthma or repeated chest infections in childhood, which can affect lung growth
• Being born with a low birth weight or having lungs that did not grow fully
• Age — damage builds up over time

When to see a doctor

See a doctor urgently if:

• Breathlessness that is suddenly worse or new chest pain
• A fever with a change in your phlegm colour or amount
• Coughing up blood
• Feeling confused, very sleepy, or unusually unwell
• Swelling in your legs or ankles that is new or getting worse

Book a routine appointment if:

• A cough that lasts more than three weeks
• Breathlessness that is limiting your daily life or getting slowly worse
• Wheezing or a whistling chest
• Chest infections that keep coming back
• You smoke and would like help to stop
• A family member has had early lung disease, or you have worked with dust or fumes for years

Diagnosis

Your doctor will ask about your breathing, your cough, your smoking history and the jobs you have done. They will listen to your chest and may check your oxygen level with a small clip on your finger. The key test is a breathing test called spirometry (say: spy-ROM-uh-tree). You blow hard into a tube, and the machine measures how much air you can push out and how fast. This helps show whether your airways are narrowed. If results suggest emphysema, you may be referred for more tests or to a lung specialist.

Tests that may be done

• Spirometry — blowing into a machine to measure your lung function
• Chest X-ray to look at the lungs and rule out other problems
• CT scan — a more detailed scan of the lungs
• Pulse oximetry — a small clip on your finger that checks oxygen levels
• Blood tests, including a test for alpha-1 antitrypsin if the doctor thinks it may be inherited
• Blood gas test — a small sample of blood to check oxygen and carbon dioxide levels
• Heart tests, such as an ECG, because heart problems can cause similar symptoms
• A walk test to see how your breathing copes with activity

What to expect at your appointment

These tests are quick and do not hurt. Spirometry can feel a bit tiring because you blow out several times, and you may feel light-headed for a moment. You may be asked not to smoke or use your inhalers for a few hours beforehand. Results are usually discussed with you at the same visit or shortly after. Being diagnosed can feel worrying, but it gives you and your doctor a clear plan to work from.

Treatment

Emphysema cannot be cured, but it can be managed well. Treatment aims to slow the damage, ease breathlessness, keep you active and reduce flare-ups. The most important step is stopping smoking — this makes the biggest difference to how the condition progresses. Your doctor will build a plan with you that may include inhaled medicines, exercise and breathing programmes, vaccinations and help with flare-ups.

Self-care at home

• Stop smoking — ask your doctor or pharmacist for support; combining advice with nicotine replacement or other aids works best for many people
• Stay away from smoky places and strong fumes
• Learn breathing techniques, such as pursed-lip breathing and belly breathing, to help when you feel short of breath
• Pace yourself — take breaks and plan tiring activities
• Keep active with regular walking or other gentle exercise you enjoy
• Keep a flare-up action plan from your doctor so you know what to do when symptoms get worse
• Wash your hands often and avoid close contact with people who have colds or flu
• Keep your home warm and well ventilated, and avoid very cold air if it triggers your cough

Medical treatments

Doctors use several approaches. Inhaled medicines help open the airways or reduce swelling in the lungs, making breathing easier — some are used every day and some are used when you feel breathless. Pulmonary rehabilitation is a supervised exercise and education programme that is one of the most helpful treatments for breathlessness and confidence. Oxygen therapy at home can help some people with low oxygen levels. Antibiotics are used when there is a chest infection, and steroid tablets may be used for a short time during a flare-up. Your doctor will review your inhaler technique regularly, because using the device correctly matters a lot.

When is surgery considered?

Surgery is only suitable for a small number of people. Options include procedures to remove or shrink the most damaged parts of the lung (lung volume reduction), removing a large air pocket (bullectomy), or, very rarely, a lung transplant. These are decided with a specialist lung team after detailed tests. For most people, medicines, exercise and stopping smoking remain the main treatment.

Living with this condition

Life with emphysema usually means finding new ways to do the things you enjoy. Many people find that planning ahead helps — spreading heavy tasks across the day, keeping things you use often within easy reach, and sitting down for things like dressing or cooking. Breathing techniques can help you get through stairs, showers or shopping trips. Flare-ups are easier to handle when you have a written plan and know who to call.

Lifestyle tips

• Stay smoke-free — this is the single biggest thing you can do
• Keep up your vaccinations and hand hygiene to avoid infections
• Exercise within your limits and build up slowly
• Avoid very smoky, dusty or fume-filled places
• Keep your home warm and dry, and avoid damp or mould
• Get enough sleep and rest when you need to
• Ask about pulmonary rehabilitation — it helps many people feel stronger and less breathless

Diet and exercise

Eating well helps your muscles and immune system. Aim for a balanced diet with plenty of vegetables, fruit, wholegrains and protein. If you feel full quickly, try smaller meals more often. If you are losing weight without trying, tell your doctor — it can be a sign the body is working hard to breathe. Regular activity, such as walking or gentle cycling, keeps your muscles strong so your body uses oxygen better. Start slowly and build up. Ask your doctor or physiotherapist about a supervised exercise programme, which is often the safest and most effective way to start.

Mental health and emotional wellbeing

Feeling short of breath can be frightening, and it is very common to feel anxious or low at times. Anxiety can make breathlessness feel worse, which can become a difficult cycle. Depression is also common in people with long-term lung conditions. These feelings are understandable and treatable — talking therapies, breathing and relaxation techniques, and support groups can all help. If you ever have thoughts of harming yourself, please reach out right away to your local emergency services or a crisis support line in your area.

Prevention

Most cases can be prevented, because most are linked to smoking. Never starting to smoke — or stopping as early as possible — is the most effective protection. If you work with dust or fumes, use the protective equipment your employer provides and ask about workplace safety. Avoiding smoky environments and secondhand smoke also helps protect your lungs and those of your family.

Vaccines

Vaccines help prevent the chest infections that can make emphysema worse. Ask your doctor or pharmacist about yearly flu vaccination and about pneumonia and COVID-19 vaccination. Vaccination advice varies by country and by your personal health, so check what is recommended for you.

Screening programmes

There is no routine general screening for emphysema. However, if you have ongoing breathlessness or a persistent cough, or if you are a long-term smoker, a breathing test (spirometry) can be arranged. If you have a family history of early lung disease, ask your doctor whether testing for alpha-1 antitrypsin deficiency is right for you.

Complications

If left untreated

• Breathlessness that slowly gets worse and limits everyday life
• More frequent and more serious chest infections
• A collapsed lung (pneumothorax), which causes sudden sharp chest pain and breathlessness
• Strain on the heart, which can cause swollen ankles and fluid build-up
• Low oxygen levels, and in serious cases, breathing failure
• Weight loss and muscle weakness from the extra effort of breathing
• Anxiety and low mood, which can make symptoms feel harder to manage

Long-term outlook

Emphysema is a long-term condition and the damage already done cannot be reversed. But that does not mean a poor life. Stopping smoking, staying active, taking treatment as planned and getting vaccinated can slow the condition down and help you feel better for years. Many people with emphysema keep doing the things they love with some adjustments and good support. Seeing your doctor regularly means problems can be caught early and treated promptly.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.