Overview
Emphysema is a type of chronic obstructive pulmonary disease (COPD) in which the tiny air sacs (alveoli) in the lungs are progressively destroyed. This reduces the surface area available for oxygen exchange, causing breathlessness that worsens over years. It is largely caused by smoking.
How common is it?
Emphysema is a component of COPD, which affects about 1.2 million diagnosed people in the UK, with a further million estimated undiagnosed. Smoking is the cause in over 80% of cases.
Causes and risk factors
Tobacco smoke and other inhaled irritants trigger a chronic inflammatory process in the lungs. Enzymes released during this inflammation destroy the alveolar walls, which cannot regenerate.
Common risk factors
- Cigarette smoking (principal cause)
- Long-term exposure to air pollution, dust, or chemical fumes
- Alpha-1 antitrypsin deficiency (a rare inherited cause affecting young non-smokers)
- Cannabis smoking
- Passive smoking over many years
Symptoms
- Progressive breathlessness on exertion, eventually at rest
- Reduced exercise tolerance
- Chronic cough
- Barrel-shaped chest in advanced disease
- Weight loss in severe disease
- Using accessory muscles of breathing
- Low oxygen levels causing bluish lips or fingertips (cyanosis)
When to see a doctor
See a doctor if you are a smoker with increasing breathlessness or a persistent cough. Seek emergency care for sudden severe worsening of breathlessness, which may indicate an exacerbation or pneumothorax.
Diagnosis
Spirometry confirms airflow obstruction. The ratio of FEV1 to FVC below 0.7 confirms COPD. CT chest shows emphysematous changes. DLCO (diffusion capacity) is reduced in emphysema.
Treatments
Smoking cessation
The only intervention proven to slow emphysema progression. Even after significant disease is established, stopping smoking significantly reduces the rate of decline.
Bronchodilator inhalers
Long-acting beta-agonists (LABA) and long-acting muscarinic antagonists (LAMA) dilate airways and significantly reduce breathlessness and exacerbation frequency.
Pulmonary rehabilitation
A supervised exercise and education programme that is the most effective intervention for improving quality of life, exercise tolerance, and reducing hospital admissions.
Self-care and lifestyle
- Stop smoking immediately and seek help with nicotine replacement or varenicline
- Pace activities and use energy conservation techniques
- Take up pulmonary rehabilitation if offered
- Annual flu vaccine and pneumococcal vaccine are essential to reduce exacerbation risk
Prevention
Not smoking prevents the vast majority of emphysema. Reducing occupational exposure to dusts and fumes is also important.