Pulmonary Emphysema

What is pulmonary emphysema?

Emphysema is a chronic lung condition in which the air sacs (alveoli) may be:

  • Destroyed
  • Narrowed
  • Collapsed
  • Stretched
  • Overinflated

Overinflation of the air sacs is a result of breakdown of the walls of the alveoli. It causes a decrease in respiratory function and breathlessness.

Damage to the air sacs is irreversible and results in permanent "holes" in the tissues of the lower lungs.

Pulmonary emphysema is part of a group of lung diseases called chronic obstructive pulmonary disease (COPD). COPD lung diseases cause airflow blockage and breathing problems. The two most common conditions of COPD are chronic bronchitis and emphysema.

What causes pulmonary emphysema?

Emphysema does not develop suddenly, but occurs very slowly over time. It’s caused by:

  • Smoking. This is the main cause.
  • Exposure to air pollution, such as chemical fumes, dust, and other substances
  • Irritating fumes and dusts at work
  • A rare, inherited form of the disease called alpha 1-antitrypsin (AAT) deficiency-related pulmonary emphysema, or early onset pulmonary emphysema. AAT is produced by the liver and is a "lung protector." Nearly all people without AAT develop emphysema.

What are the symptoms of pulmonary emphysema?

Symptoms may be slightly different for each person. The following are the most common symptoms for pulmonary emphysema.

Early symptoms of pulmonary emphysema may include:

  • Shortness of breath (most common symptom), which gets worse with activity
  • Cough
  • Rapid breathing
  • Sputum production
  • Wheezing

Other symptoms may include:

  • Fatigue (extreme tiredness)
  • Over-inflation of the lungs
  • Anxiety
  • Sleep problems
  • Heart problems
  • Weight loss
  • Depression

The symptoms of pulmonary emphysema may look like other lung conditions or health problems. See a healthcare provider for a diagnosis.

How is pulmonary emphysema diagnosed?

Along with a complete medical history and physical exam, your healthcare provider may request:

Pulmonary function tests (PFTs)

These tests help measure the lungs' ability to exchange oxygen and carbon dioxide. The tests are usually done with special machines into which you breathe. They may include:


A spirometer is a device used to assess lung function. Spirometry, the evaluation of lung function with a spirometer, is one of the simplest, most common PFTs and may be used to:

    Determine how well the lungs receive, hold, and move air
  • Look for lung disease
  • See how well treatment is working
  • Determine the severity of a lung disease
  • Find out whether the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow)

Peak flow monitoring (PFM)

This device measures how fast you can blow air out of your lungs. Cough, inflammation, and mucus buildup can cause the large airways in the lungs to slowly narrow. This slows the speed of air leaving the lungs and can be measured by a PFM. This measurement is very important in evaluating how well or how poorly the disease is being controlled.

Blood tests

These are done to check the amount of carbon dioxide and oxygen in the blood.

Chest X-ray

This test takes pictures of internal tissues, bones, and organs.

CT scan

This test uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. CT can show details like the width of airways in the lungs and the thickness of airway walls.

Sputum culture

This test is done on the material that is coughed up from the lungs and into the mouth. A sputum culture is often used to see if an infection is present.

Electrocardiogram (ECG)

This is a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias), and can help find heart muscle damage.

How is pulmonary emphysema treated?

The goal of treatment for people with pulmonary emphysema is to live more comfortably with the disease, control symptoms, and prevent the disease from getting worse, with minimal side effects. There is no way to repair or regrow the damaged lung tissue.

Treatment may include:

  • Quitting smoking. This is the single most important factor for lung health.
  • Avoiding the smoke of others and removing other air pollutants from your home and workplace
  • Antibiotics for bacterial infections
  • Bronchodilators. These are the mainstay of treatment and can be either oral or inhaled.
  • Other types of oral and inhaled medicines. These are used to treat symptoms like coughing and wheezing.
  • Vaccines. Infection can make emphysema symptoms worse, so both the pneumonia (pneumococcal) and flu (influenza) vaccines are recommended.
  • Exercise. A pulmonary rehabilitation program may include breathing exercises to strengthen the muscles you use for breathing, as well as exercises to condition the rest of your body.
  • Oxygen therapy, from portable containers
  • Nutritional support, since you may develop malnutrition and lose weight
  • Surgery to remove the damaged area of the lung
  • Lung transplant

Key points about pulmonary emphysema

  • Pulmonary emphysema is a chronic lung condition. It’s often part of chronic obstructive pulmonary disease (COPD), a group of lung diseases that cause airflow blockage and breathing problems.
  • Pulmonary emphysema does not develop suddenly, but occurs very slowly over time. It's most commonly caused by smoking.
  • Pulmonary emphysema causes shortness of breath that often gets worse with activity and many other symptoms, such as wheezing, cough, anxiety, and heart problems.
  • Tests that help measure the lungs' ability to exchange oxygen and carbon dioxide are used to diagnose pulmonary edema. Blood tests and imaging tests may also be used to see how severe the problem is and monitor it over time.
  • There is no way to repair or regrow the damaged lung tissue. The goal of treatment for people with pulmonary emphysema is to live more comfortably, control symptoms, and prevent the disease from getting worse.
  • A key part of treatment is to quit smoking.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.