February 1, 2017

Emphysema, a type of Chronic Obstructive Pulmonary Disease (COPD), occurs when the walls of the alveoli (air sacs) in the lungs are damaged, becoming less elastic and, therefore, less able to exchange carbon dioxide for oxygen. The disease develops and worsens over time, and although it is not reversible, its progress can be slowed with therapy.

When a person breathes, air travels to the lungs through airways called bronchi. The bronchi divide into smaller airways, called bronchioles, which end in clusters of tiny air sacs, called alveoli. Emphysema, the fourth leading cause of death in the United States, affects the walls of the millions of tiny air sacs in the lungs, which become inflamed and loose elasticity, causing the bronchioles to collapse. As a result, air becomes trapped in the air sacks, which become overstretched and may rupture, greatly affecting a person’s ability to breathe normally.

When emphysema develops, the alveoli and lung tissue are destroyed. With this damage, the alveoli cannot support the bronchial tubes. The tubes collapse and cause an “obstruction” (a blockage), which traps air inside the lungs. Too much air trapped in the lungs can give some patients a barrel-chested appearance. Also, because there are fewer alveoli, less oxygen will be able to move into the bloodstream.

The leading cause of emphysema is cigarette smoking. Other risks factors include air pollution, occupational exposure to dust and chemicals, frequent lower respiratory infections and second hand smoke. In rare cases, the genetic disorder alpha-1 antitrypsin (AAT) deficiency causes emphysema.

Over 3 million people in the United States have been diagnosed with emphysema. Over 11 million Americans have COPD. Emphysema is most common in men between the ages of 50 and 70.


Cigarette smoking, air pollution, work hazards, and lung infections cause emphysema. Cigarette smoking is the most important of these factors. Cigarette smoking alters the structure and function of the lungs causing them to increase in size and lose their elasticity.

Cigarette smoking increases the number of inflammatory cells in the lungs. These cells release enzymes and other products that destroy the lung tissue. As a result, the lungs develop bullae (holes) and lose elasticity.

Alpha-1 antitrypsin deficiency is a disease caused by a genetic defect that leads to decreased levels of the protective protein, alpha-1 antitrypsin. Alpha-1 antitrypsin protects the lungs from the destructive effects of enzymes called elastates. Patients with alpha-1 antitrypsin deficiency may develop emphysema at an early age.

Risk Factors

  • Low body weight
  • Childhood respiratory disorders
  • Exposure to passive cigarette smoke
  • Air pollution
  • Occupational dust (mineral dust, cotton dust, for example)
  • Inhaled chemicals (coal, grains, isocyanates, cadmium, for example).


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.




  • Collapsed lung (pneumothorax) – A collapsed lung can be life-threatening in people who have severe emphysema, because the function of their lungs is already so compromised. This is uncommon but serious when it occurs.
  • Heart problems – Emphysema can increase the pressure in the arteries that connect the heart and lungs. This can cause a condition called cor pulmonale, in which a section of the heart expands and weakens.
  • Large holes in the lungs (giant bullae) – Some people with emphysema develop empty spaces in the lungs called bullae. Giant bullae can be as large as half the lung. In addition to reducing the amount of space available for the lung to expand, giant bullae can increase your risk of pneumothorax.


Anti-inflammatory medication – These medications reduce inflammation in the airways. However, long-term side effects of these drugs include osteoporosis, hypertension, high blood sugar, and fat redistribution.

Oxygen therapy – Oxygen therapy is prescribed for patients whose lungs are not getting enough oxygen to the blood (hypoxemia). These patients can’t absorb enough oxygen from the outside air and need to get more oxygen through a machine (a nasal catheter or a facemask).

Lung volume reduction surgery – Lung volume reduction surgery involves removing a portion of diseased lung tissue, then joining together the remaining tissue. Doing this may relieve pressure on the breathing muscles and help improve lung elasticity (or stretch). The results of the surgery have been very promising. Not all patients with emphysema are candidates for this surgery.

Bronchodilator medications – These medicines relax the muscles around the airways. They are often used to treat asthma. Bronchodilators, given through hand-held inhalants, produce more immediate results and have fewer side effects than oral medications.

Quitting smoking – If a person smokes, he should quit. This is the most important step that can be taken to protect the lungs. It is never too late to quit.

Avoidance of pollutants, lung irritants, and secondhand smoke.Try to avoid exposure to air pollution, which can worsen emphysema symptoms. Stay indoors when ozone levels are unhealthy and pollution levels are high. However, when indoors, avoid secondhand smoke, smoke from faulty wood-burning appliances and any other source of indoor air pollution.

Alternative Treatment

Bromelain – A supplement created from the enzymes found in a pineapple’s stem and juice, bromelain is said to reduce inflammation associated with emphysema. However, according to the National Institutes of Health, scientific evidence to support this claim is lacking.

Coenzyme Q10 – An antioxidant that is naturally produced by the body, coenzyme Q10 has been said to increase cell activity and ease inflammation in people with emphysema. Researchers have found that people living with emphysema have especially low levels of coenzyme Q10; however, studies have not proven that taking the supplement improves conditions.

L-Carnitine – Typically produced by the body, L-carnitineis used to burn fat and boost energy. In COPD patients, this supplement appears to help strengthen muscles and improve endurance when exercising. Further, research has proven that those people who take L-carnitine supplements do significantly better during walking exercise programs.

N-acetylcysteine – An antioxidant available as an over-the-counter dietary supplement, N-acetylcysteine has been researched for its role in breaking down the mucus that can clog the lungs of people living with emphysema. To date, research has showed mixed results on the supplement’s effectiveness.

Antioxidant vitamins – With properties of antioxidants, vitamins A, C and E have been said toimprove the lung function in people with emphysema. Studies have shown that people living with emphysema have low levels of these antioxidant-rich vitamins, and this deficiency can result in decreased pulmonary function. Further, studies have proven that emphysema patients whose diets are rich in fruits and vegetables—a good source of vitamins A, C and E—saw improved lung function.


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