Emphysema

What is emphysema?

Emphysema is a chronic (ongoing) condition in which the walls of the alveoli in the lungs become gradually damaged, resulting in irreversible destruction of the tissues of the lower lungs.

The alveoli are the air sacs at the end of the smallest branches of the airways of the lungs. When you breathe in, air is sucked down through the branches of the lungs (the bronchi and bronchioles), eventually reaching the alveoli, where oxygen is transferred to the bloodstream and carbon dioxide is removed from the bloodstream.

What happens to the lungs in emphysema?

In emphysema, the walls of the alveoli are damaged. This makes it harder for them to prop open the tiny microscopic branches of the lungs called bronchioles, so when air is breathed out of the lungs the bronchioles collapse. As the damage to the alveoli progresses over time, the lungs become less elastic and less able to transfer oxygen to the bloodstream. This results in the affected person experiencing breathlessness and breathing difficulties, especially on exertion, but even at rest in severe disease.

Emphysema and chronic bronchitis, particularly if these 2 conditions occur together, cause long-term obstruction of the airways, and are often called chronic obstructive pulmonary disease (COPD).

What causes emphysema?

Emphysema doesn’t come on suddenly, but gradually, often developing over many years. The single most preventable cause of emphysema is cigarette smoking, with a very high percentage of people with the condition being smokers.

Exposure to industrial pollutants in the air may also be a contributing factor.

A1AD-related emphysema

There is also a rare type of emphysema known as A1AD-related emphysema, a genetic condition in which a person’s body lacks a protein called alpha1-antitrypsin (AAT). AAT protects the lungs from excessive exposure to an enzyme known as neutrophil elastase, which helps fight bacteria but which can damage the lungs if not neutralised by AAT. Smoking hastens the speed at which emphysema develops in people with alpha1-antitrypsin deficiency.

Symptoms

The most common symptom of emphysema is shortness of breath, which often occurs after only mild exertion. Cough is another symptom. In the severe stages the chest may become ‘barrel-shaped’ and the shortness of breath may be disabling and lead to a drastic restriction of daily activities.

Treatment

Once emphysema has been diagnosed, the lung damage has been done and it is not possible to reverse it. Treatment is aimed at relieving symptoms and preventing the disease from progressing even further.

Quit smoking

If you have been diagnosed with emphysema and are a smoker, your doctor will advise you to stop smoking immediately. Stopping smoking is the most important thing you can do to maintain the health of your lungs and prevent further damage. There are many methods available to help you – talk to your doctor now.

Medications

Medications called bronchodilators may be prescribed to help you breathe – they relax and open up the airways in the lungs. Corticosteroids can also help relieve symptoms in some people. If you develop a bacterial chest infection and you have emphysema this can be dangerous, so antibiotics will be prescribed.

Self-care tips

You should strive to maintain good health habits by ensuring you eat a balanced diet and get adequate rest. Your doctor will also probably advise you take up a regular exercise programme that may include exercises to improve your breathing. These are called pulmonary rehabilitation exercises and may improve your exercise capacity and quality of life.

Try to avoid air pollution, which may make your symptoms worse.

Make sure you see your doctor at the start of the winter season for a vaccination against flu. It may also be worthwhile being vaccinated against pneumococcal pneumonia, as this infection would also aggravate emphysema.

Surgery

Some people with emphysema may be suitable for surgery called lung volume reduction surgery, which gives some patients improvement, at least in the short term. Lung transplantation can also provide symptom relief for some people.

Oxygen

Portable oxygen cylinders are used by some people for short walking trips of an hour or so. Other people have such low oxygen content of their blood that they have to have an oxygen supply at home.

Last Reviewed: 29 July 2009
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References

1. The Australian Lung Foundation. COPD-X Guidelines.
2. American Lung Foundation. Alpha-1 Antitrypsin deficiency emphysema. Nov 2006
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