Emphysema Symptoms, Causes and Treatment

Emphysema is a form of chronic obstructive pulmonary disease (COPD). Doctors estimate that more than 24 million people in the United States have emphysema or another form of COPD. It gradually damages the delicate air sacs in your lungs, known as alveoli, which are vital for oxygen exchange. In healthy lungs, these tiny air sacs are elastic and work like small balloons, expanding to take in oxygen and deflating to push out carbon dioxide.

With emphysema, the walls of these air sacs weaken and eventually rupture, creating larger, less efficient air spaces. This damage leads to areas of the lung becoming hyperinflated, trapping old, stale air and making it incredibly difficult to inhale fresh air and effectively remove carbon dioxide.

This progressive, debilitating disease is characterized by irreversible destruction of air sacs (alveoli) in the lungs, which decreases air flow. Progressive destruction makes it difficult to breathe, making even simple daily activities a challenge.

Primary Causes of Emphysema 

The most common cause of emphysema is tobacco smoking. Pipe, cigar and secondhand smoke also pose significant risks. Quitting smoking can help prevent you from getting the disease. If you already have emphysema, quitting smoking will prevent your lung function from declining as rapidly. 

Other causes include long-term exposure to lung irritants like outdoor pollution, indoor allergens, chemical fumes, workplace dust and vapors that can contribute to lung damage.

Symptoms of Emphysema

The most common symptom of emphysema is shortness of breath (dyspnea). Additional symptoms can include:

• Wheezing, or a whistling sound during exhalation
• Increased mucus production and frequent lung infections
• Persistent cough that is often dry but sometimes productive
• Reduced appetite and weight loss
• Chronic fatigue

Diagnosing Emphysema 

• Medical history: The history focuses on symptoms like persistent cough, shortness of breath, smoking history and exposure to lung irritants 
• Physical exam: A stethoscope detects decreased breath sounds. 
• Spirometry: The cornerstone of diagnosis is spirometry, a lung function test. It measures the forced expiratory volume in one second (FEV₁) and the forced vital capacity (FVC). A post-bronchodilator FEV₁/FVC ratio below 0.70 confirms persistent airflow obstruction, a characteristic of emphysema. 
• Imaging: A chest X-ray or especially a CT scan shows emphysematous changes, such as enlarged air spaces, decreased lung markings and flattened diaphragms. 
• Plethysmography: Measures lung volumes 
• Diffusing capacity: Assesses gas exchange efficiency 
• Six-minute walk tests 
• Pulse oximetry 
• Blood tests: Arterial blood gases for oxygen and carbon dioxide levels 
• Genetic testing: Looks for alpha-1 antitrypsin deficiency

This comprehensive evaluation ensures accurate diagnosis, severity assessment and tailored treatment planning.

Emphysema Treatment Options

Traditional emphysema treatment options often focus on symptom management through medications like bronchodilators, inhaled corticosteroids and oxygen therapy. Pulmonary rehabilitation programs are also crucial, helping patients learn breathing techniques and exercise strategies to maximize their remaining lung function. However, for individuals with severe emphysema where medical management alone is insufficient, the persistent hyperinflation of the lungs continues to limit daily activities.

While emphysema is not curable, there are treatments that can help you manage the disease. Treatment for emphysema varies based on your symptoms. Mild emphysema can be managed with prescription inhalers, oxygen and pulmonary rehabilitation. Once medical therapy achieves maximum benefit, the remaining options for treatment have been limited to surgical lung volume reduction or lung transplantation, until recently.

Bronchoscopic Lung Volume Reduction (BLVR)  

BLVR, which uses small endobronchial valves, is a new, minimally invasive treatment option that has been shown to greatly improve shortness of breath and quality of life for patients with severe emphysema. Patients with emphysema who are still short of breath despite using their inhalers should be evaluated for valves. 

Learn More About BLVR

Lung Volume Reduction Surgery (LVRS)

Originally developed as a bridge to a lung transplant, lung volume reduction surgery (LVRS) has itself become a successful treatment for select patients with chronic obstructive pulmonary disease (COPD), emphysema and disabling shortness of breath. It can significantly improve the patient’s health and reduce feelings of breathlessness. In some cases, LVRS may negate the need for lung transplant altogether. 

Learn More About LVRS

Managing Emphysema Symptoms 

In addition to treatment, there are many things you can do to manage your symptoms. These can improve your quality of life and facilitate treatment.

Quit Smoking 

Quitting smoking is the most effective step to slow emphysema progression. It reduces inflammation, improves lung function, decreases symptom flare-ups and enhances quality of life. 

Medications 

Pharmacologic approaches include inhaled bronchodilators for all patients. Certain patients may benefit from additional medications, including inhaled corticosteroids (ICS), phosphodiesterase inhibitors, biologic agents, chronic antibiotics and oral corticosteroids. 

Pulmonary Rehabilitation 

Pulmonary rehabilitation combines supervised exercise, breathing techniques, education and psychosocial support. Benefits include improved lung function, greater exercise tolerance, fewer hospitalizations and enhanced quality of life and improved survival after exacerbations. 

Oxygen Therapy 

For patients with low blood oxygen levels, long-term oxygen therapy improves survival and daily functioning. Oxygen is prescribed based on arterial blood gas or pulse oximetry readings. Home delivery is common. 

Nutrition and Weight Management 

Proper nutrition supports breathing effort and overall health. Recommendations include: 

• Small, frequent meals to avoid breathlessness 
• Low-carb, higher-fat diets to reduce CO₂ production 
• Adequate protein to maintain muscle mass 
• Maintaining healthy weight to prevent both unintentional weight loss and obesity. 

Vaccinations and Infection Prevention 

Staying up to date on vaccines helps prevent infections that could worsen emphysema. Recommended immunizations include:

• Annual influenza 
• Pneumococcal vaccines (PCV and PPSV) 
• COVID-19 and RSV vaccines as indicated 

These reduce the risk of respiratory infections, exacerbations, hospitalization and mortality. 

Why Choose Froedtert & MCW Pulmonary Team for Emphysema Care 

Our nationally recognized pulmonary team provides comprehensive care for emphysema and other complex lung conditions, combining advanced diagnostics, innovative treatments and leading-edge research. As the region’s only academic medical center, we offer access to specialized programs — including accredited cystic fibrosis and pulmonary hypertension centers — along with unique services like tobacco dependence counseling and clinical trials. From state-of-the-art procedures to personalized care plans, we deliver expertise and options you won’t find anywhere else in southeast Wisconsin.

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