Pulmonary Emphysema: What It Is, Symptoms, and Causes

The word "emphysema" often appears suddenly — in a report after an examination or in a conversation with a doctor. Behind it lies damage to the air sacs of the lungs that makes breathing harder. Let's explain in simple terms how this works and by what signs it manifests.

What pulmonary emphysema is in simple terms

Emphysema is one of the types of COPD, chronic obstructive pulmonary disease. COPD brings together lung diseases that make breathing difficult and that worsen over time; its second main type is chronic bronchitis. Most people with COPD have both emphysema and chronic bronchitis, but the severity of each varies. Emphysema is pathological enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of the alveolar walls. Without the terms: the sacs where gas exchange occurs stretch out and lose their shape, and the lungs can no longer return to their previous function — the damage is irreversible, although treatment helps slow progression.

What happens to the lungs in emphysema

Normally the alveoli are elastic, like small balloons: they fill on inhalation, collapse on exhalation, and air flows out. In emphysema, the walls between many alveoli are damaged, the sacs lose their shape and become flabby. Destruction of the walls means that instead of many small alveoli there are fewer but larger ones, and it is harder for the lungs to transfer oxygen into the body and remove carbon dioxide. Loss of elasticity creates another problem: on exhalation the small bronchi, lacking their cartilaginous framework, collapse, air is trapped in the alveoli and overstretches them. This leads to a barrel-shaped chest, widened intercostal spaces, and a low position of the diaphragm.

Symptoms of pulmonary emphysema

At first there may be no symptoms at all or they may be barely noticeable, and as the disease progresses they become more pronounced. The most common are:

• shortness of breath, especially during physical activity;
• a cough with sputum that does not go away;
• wheezing or creaking breathing;
• a feeling of tightness in the chest;
• frequent respiratory infections, colds, and flu.

Without treatment, symptoms usually gradually worsen, and sometimes there are periods of sharp deterioration — exacerbations. In severe cases, weight loss, weakness of the lower limb muscles, and swelling in the feet, ankles, or lower legs appear. Primary emphysema is characterized by severe shortness of breath, with which the disease begins even before cough; such people often cover their mouth on exhalation and puff out their cheeks to make air escape more easily.

Why emphysema develops

The cause is usually prolonged exposure to irritants that damage the lungs and airways. The main risk factor is smoking: up to 75% of people with emphysema smoke or have smoked previously. Pipes, cigars, and other forms of tobacco smoke can also lead to it, especially if the smoke is inhaled. Secondhand smoke, air pollution, chemical vapors, dust, as well as cadmium compounds and nitrogen oxides in the workplace also play a role. Less often the cause is hereditary — alpha-1 antitrypsin deficiency; in smokers with a family history of COPD the risk is higher. Most people with emphysema are at least 40 years old when symptoms appear. There is also secondary emphysema: against the background of chronic obstructive bronchitis, pressure in the respiratory part of the lungs rises, and the alveoli become overstretched.

How emphysema is detected and when to see a doctor

The doctor asks about symptoms, about smoking now and in the past, and about family history. Then examinations are ordered: lung function tests, chest X-ray or CT, blood tests, including screening for alpha-1 antitrypsin deficiency. Such an examination helps confirm the diagnosis and rule out other lung diseases, such as asthma.

You should see a doctor if symptoms persist — especially if you are over 35 and smoke or have smoked previously. Do not delay: if the cause is COPD, treatment is best started as early as possible, before the lungs are significantly damaged. Worsening symptoms and signs of infection, such as fever, are also reasons to contact a doctor.

Emphysema itself is not a reason to call an ambulance. Call 103 or 112 if severe shortness of breath appears and there is so little air that it is difficult to speak.

This material is for reference: it helps you understand what is being discussed but does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer