At a glance:
- Emphysema is a chronic lung condition that leads to shortness of breath
- Damage to the alveoli (air sacs) in the lungs leaves the lungs with reduced capacity and a reduced ability to transfer oxygen to the bloodstream
- Smoking is the most common cause of emphysema
What is Emphysema?
Emphysema is a chronic (long term) lung condition that leads to shortness of breath due to damage to the alveoli. These small air sacs in the lungs are responsible for gas exchange - oxygen moving from the lungs to the bloodstream and carbon dioxide from the bloodstream to the lungs.
Damage to the alveoli leaves them less elastic than they should be. Over time this lack of elasticity may lead to the alveoli bursting, creating larger air chambers in the lungs. These larger chambers reduce the surface area of the lung in contact with capillaries, making the gas exchange less effective, so less oxygen can get into the blood. They may also trap some of the deoxygenated air in them, reducing the capacity of the lung to draw in good air.
Tobacco smoking is the main cause of emphysema and as such is quite common. People with emphysema frequently also suffer from chronic bronchitis , a condition caused by the inflammation of the lining of the bronchial passages. These two diseases are classified under the umbrella of chronic obstructive pulmonary disease (COPD) . According to Lung Foundation Australia, around one in seven Australians over the age of 40 have some form of COPD.
Depending on how the emphysema presents, it may be classified in one of three ways:
- Subcutaneous Emphysema - gas or air is trapped under the skin placing pressure on the lungs. This is typically due to some form of trauma to the lungs
- Bullous Emphysema - a bulla is an air pocket in the chest cavity that may limit lung function. Bullous emphysema is sometimes known as “vanishing lung syndrome
- Paraseptal Emphysema - describes when the bronchioles and alveoli are inflamed and damaged
The classification may be further refined to describe which part of the lung is most affected. Emphysema is diagnosed via lung function tests that measure lung capacity as well as blood gasses, to show if the blood contains enough oxygen.
Even with an early diagnosis, there is no cure for emphysema, as the damaged tissues of the lungs don’t regenerate. Through medication and lifestyle change, symptoms of emphysema may be managed.
If you need help quitting smoking or have started to experience shortness of breath, schedule an appointment with a doctor and take care of your lungs.
Symptoms of Emphysema
Far and away the most common symptom of emphysema is shortness of breath or breathlessness. As emphysema is a progressive disease (meaning it gets worse over time), the initial shortness of breath may only present after physical exertion so may be ignored.
As the disease progresses, the periods of breathlessness become more regular and common. What may have resulted from strenuous activity in the beginning stages may progress to being triggered by even light physical activity. People with severe emphysema may even experience shortness of breath when they are at rest, leading to extreme restriction on what they are capable of doing.
During the later stages of emphysema, people may also exhibit an expanded “barrel” chest. This is due to the fact that the lungs are always partially inflated due to air trapped by the damaged alveoli, so the ribcage stays partially expanded, like you’ve just taken a breath, all the time.
In addition to shortness of breath, most people that have emphysema also have chronic bronchitis. As a result they may have a chronic productive cough and wheeze when they breathe.
Aside from the shortness of breath and coughing, emphysema may lead to a number of possible complications, including:
- Collapsed Lung - a coughing fit from chronic bronchitis can rupture one of the large air pockets in the lungs causing the trapped air to flood into the chest cavity and the lung to deflate. Also referred to as pneumothorax
- Pneumonia - people with emphysema are more prone to infections of the alveoli and bronchioles
- Pulmonary Hypertension - high blood pressure in the lungs. If left untreated, pulmonary hypertension may lead to heart failure
If you’ve developed a cough and shortness of breath and either can’t or don’t want to leave the comfort of home, the Virtual Respiratory Clinic is here for you.
What Causes Emphysema?
The leading preventable cause of emphysema is tobacco smoking. A very high percentage of people presenting with emphysema are current or ex smokers. Exposure to passive, second hand smoke may also increase the risk of developing emphysema.
While smoking is the major cause of emphysema, the condition may also be caused by prolonged exposure to dust or industrial fumes/chemicals as well as air pollution. While we don’t currently have to worry overmuch about air pollution causing emphysema in Australia, in other countries such as China, studies have linked increased prevalence and mortality rate of pulmonary diseases with fine particulate air pollution.
A rare protein disorder known as alpha-1-antitrypsin deficiency (AATD) may be the root cause of emphysema in some people. AATD leaves people with a deficiency in a protein that helps protect the lungs. The lack of this protein and the protection it provides lung tissue may lead to the development of a form of emphysema, even if none of the other usual triggers for the development of the condition are present.
Living With and Treatment For Emphysema
Emphysema is an incurable, lifelong condition, but with medication, lifestyle change and therapy the symptoms may be reduced allowing people to have an improved quality of life.
If a smoker is diagnosed with emphysema, the single most important thing they can do to protect their health and improve their chances of living a normal life is immediately quit smoking. For long time smokers, giving up the habit may be extremely difficult, but services such as Quitline , QuitCoach , or iCanQuit can help people form a quitting plan and stay on track. A visit with a doctor may also help as they can recommend techniques or even prescribe medication to help a person quit.
In addition to quitting smoking, other treatments include:
- Medications - people with emphysema may be prescribed a number of medications to help control symptoms or possible complications. Bronchodilators may be used to open up the airways to relieve coughing and shortness of breath. Inhaled corticosteroids may be used to reduce inflammation in lung tissue. Antibiotics may also be prescribed to fight lung infections, a common complication of emphysema.
- Pulmonary Rehabilitation - a tailored and supervised exercise program designed to help strengthen the lungs. Pulmonary rehabilitation programs typically last for around eight weeks. At the end of the program the patient's lungs will be reassessed and they will be given an ongoing exercise program to help maintain the health of their lungs.
In addition to exercise, the pulmonary rehabilitation program may include lifestyle changes intended to reduce the risk of flare ups and improve quality of life.
- Oxygen Therapy - people living with severe emphysema with low blood oxygen levels may require constant, or near constant oxygen therapy. Take home oxygen canisters typically deliver oxygen via nasal cannulae (prongs). A person who takes home oxygen will typically have to use it for all activities, even sleep in some cases.
- Surgery - in some cases of bullous emphysema, lung volume reduction surgery may help reduce symptoms by removing damaged tissue from the lung allowing the healthy tissue to better expand and contract. In some rare cases, lung transplant surgery may also be used to treat the condition.
- Lifestyle Changes/Homecare - getting plenty of rest, regular exercise, eating healthily and avoiding irritants such as smoke and air pollution are all recommended to aid in reducing flare ups or complications from emphysema.
- Vaccinations - due to the lungs being in a weakened and susceptible state, it is recommended that anyone with emphysema be up to date with vaccinations for the season's influenza strains, pneumococcal disease and COVID-19.