Emphysema – Symptoms and Causes

Overview

Emphysema progressively harms the lungs over time. It specifically affects the air sacs (alveoli). When these tiny sacs lose their elasticity, breathing becomes difficult.

In healthy lungs, alveoli expand when you inhale and contract when you exhale. Emphysema disrupts this process, making it hard to push air out. This leaves little room for fresh, oxygen-rich air to enter.

Common symptoms include:

• Difficulty breathing (especially during activity)
• Wheezing when exhaling
• Varying degrees of severity

Cigarette smoking is the main factor leading to emphysema development.

Treatment can help manage symptoms and slow disease progression, but it cannot reverse existing lung damage. The condition requires ongoing management to maintain quality of life and prevent further deterioration of lung function.

Signs and Symptoms

People with emphysema may not notice any problems for many years. When symptoms do appear, they typically develop slowly and include:

• Breathing difficulty, particularly during physical activity
• Wheezing or whistling sounds when breathing out
• Persistent cough
• Feeling of tightness or heaviness in the chest
• Unusual fatigue
• Weight loss and swollen ankles as the condition progresses

Many people begin to avoid activities that make them short of breath. Because of this, symptoms might not become noticeable until they interfere with daily tasks. Eventually, emphysema can cause breathing problems even at rest.

Emphysema is one type of chronic obstructive pulmonary disease (COPD). It often occurs alongside chronic bronchitis, where the airways become inflamed and produce excess mucus. Both conditions restrict airflow in the lungs.

Flare-ups

Even with regular treatment, you may experience periods when symptoms suddenly get worse. These episodes, called acute flare-ups, can last for days or weeks. Without quick medical attention, they may lead to respiratory failure.

Flare-ups often result from:

• Respiratory infections
• Air pollution
• Other inflammatory triggers

When Medical Help Is Needed

If you have unexplained shortness of breath lasting for months, especially if it is worsening or impacting your daily activities, contact your healthcare provider. Don’t dismiss these symptoms as normal aging or poor physical fitness.

Seek emergency care immediately if:

• You struggle to catch your breath or speak
• Your lips or fingernails turn bluish or gray during activity
• Others notice changes in your mental alertness

These signs may indicate a serious oxygen shortage that requires immediate medical attention.

Causes

Emphysema primarily arises from prolonged exposure to airborne irritants. The most common trigger is cigarette smoking, which damages lung tissue over time.

People who work around chemical fumes face higher risks of developing this condition. Similarly, regular exposure to industrial dusts and vapors can lead to emphysema development.

In rare cases, emphysema stems from a genetic condition rather than environmental factors. This genetic variant results in alpha-1-antitrypsin (AAT) deficiency, where the body produces insufficient amounts of this protective protein.

AAT normally shields lung tissues from damage caused by irritants like smoke and chemicals.

Individuals with AAT deficiency typically show emphysema symptoms at younger ages than those with environmental causes. This genetic form often appears alongside liver problems and usually shows a pattern of emphysema cases within families.

Risk Factors

Several factors can increase the chance of developing emphysema. The condition usually appears after age 40, with lung damage to the lungs happening slowly over time.

Tobacco use stands as the main risk factor. People who smoke cigarettes face the highest risk, but cigar, pipe, and marijuana smokers are also at risk. The danger increases with both how long and how much a person smokes.

Secondhand smoke exposure also raises emphysema risk. Breathing smoke from someone else’s tobacco products can damage your lungs over time.

Work environments with chemical fumes, vapors, or dust create another risk. People who work around chemicals or dust from grain, cotton, wood, or mining face higher chances of developing emphysema.

This risk becomes even greater for those who also smoke. Indoor pollutants (like heating fumes) and outdoor pollutants (such as car exhaust and smog) can both cause emphysema.

Alpha-1 antitrypsin (AAT) deficiency, an uncommon genetic condition, significantly increases emphysema risk. Other genetic factors may make certain smokers more vulnerable to developing the condition than others.

Complications

People with emphysema face several serious health risks beyond their primary breathing difficulties.

Pulmonary Hypertension and Heart Issues

• High blood pressure in lung arteries (pulmonary hypertension)
• Right heart enlargement and weakness (cor pulmonale)
• Increased risk of heart disease and heart attacks

Emphysema patients often develop pulmonary hypertension as the disease progresses. This condition increases pressure in the blood vessels of the lungs, making the right side of the heart work harder.

Over time, this strain can lead to cor pulmonale, where the heart’s right side becomes enlarged and weakened.

Structural Lung Damage

Emphysema causes the formation of bullae—large air spaces that develop when alveoli walls break down.

Bullae can become very large, potentially taking up half a lung and limiting normal lung function and breathing. This structural damage increases vulnerability to other complications.

Emergency Situations

A collapsed lung (pneumothorax) represents a life-threatening emergency for emphysema patients. Their already compromised lung function makes this condition particularly dangerous.

Additional Health Risks

• Higher lung cancer risk, especially in smokers
• Anxiety and depression due to activity limitations
• Reduced quality of life from chronic breathing problems

Many emphysema patients develop mental health challenges as their physical capabilities decline. Struggling to breathe can prevent you from enjoying activities, causing feelings of isolation, anxiety, and depression.

Prevention

Stopping emphysema from developing or worsening requires several key actions.

Begin by completely eliminating smoking from your life. If you currently smoke, speak with your doctor about effective quitting strategies.

Stay clear of secondhand smoke whenever possible. This smoke contains many of the same harmful chemicals as directly inhaled smoke.

If your job involves chemical fumes, dust, or vapors, always wear appropriate protective equipment, like specialized masks.

Minimize exposure to air pollution and other lung irritants in your environment.