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 one form of lung damage seen in COPD. COPD is common, particularly in middle-aged and older adults who have smoked, but it also affects people who have never smoked.
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 GP for persistent breathlessness or cough, whether or not you have smoked. Call your local emergency number for sudden severe breathing difficulty, blue or grey lips, collapse or new confusion. Seek urgent advice for a flare-up that is not responding to your agreed plan.
Diagnosis
COPD is assessed using symptoms, risk history and post-bronchodilator spirometry. An FEV1/FVC ratio below 0.7 supports persistent airflow obstruction in the appropriate clinical context. CT can show emphysema, and gas-transfer tests may provide further information.
Treatments
Smoking cessation
Stopping smoking is the most important way for a person who smokes to slow further lung damage. It is beneficial even when emphysema is advanced. Other treatments help manage symptoms, reduce flare-ups and support quality of life.
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.
Sources for targeted updates
Updated: 24 October 2026. Targeted corrections to treatment, diagnosis, key facts, urgent-care guidance, frequency. This update covers the named sections; a full review of the remaining guide is pending.