When you’re healthy, you don’t really give breathing a second thought, let alone a first. Sure, it’s one of life’s essential functions, but breathing in and out is so automatic (and hardwired into our brains) that it doesn’t really give you a reason to think about it. That is, until something goes wrong, and it gets harder to take air in and out.

One condition that can make breathing a challenge is emphysema, where damage in your lungs makes it more difficult to bring oxygen into your body. It’s a serious disease that affects over 3 million people in the U.S. – it’s also one of the most preventable.

We’ll go over what emphysema is and how it relates to chronic obstructive pulmonary disease (COPD). We’ll also tell you the main causes, symptoms and stages of emphysema, and give you a rundown on available treatments.

What is emphysema?

Pulmonary emphysema is a long-term lung health condition that causes shortness of breath. Over time, the air sacs in the lungs, also called alveoli, become damaged. The inner walls of these air sacs weaken and rupture, which creates larger air spaces in the lungs. When this happens, the surface area of the lungs is reduced, and so is the amount of oxygen that makes it to the bloodstream.

Emphysema is a chronic illness, and it can develop slowly over time. There isn’t a way to repair or regrow the damaged lung tissue, but there are ways to treat it to live more comfortably with the disease. These treatments can also help control symptoms and slow the progression of the disease.

Types of emphysema

There are several different types of emphysema that can affect different areas of the lungs, as well as the body:

  • Centrilobular emphysema (CLE) – CLE is the most common type of emphysema, and it occurs in the upper sections, or lobes, of the lungs.
  • Panlobular emphysema (PLE) – PLE affects the lungs as a whole but can affect the lower section of the lungs more severely.
  • Paraseptal emphysema (PSE) – PSE damages the air sacs in the outermost part of the lungs, but with more severe forms of PSE, damage can occur in other parts of the lungs too.
  • Bullous emphysema – This form of emphysema occurs when giant, bubble-like cavities filled with fluid or air develop in the lungs.
  • Subcutaneous emphysema – This is a rarer form of emphysema, where air or gas gets under skin tissue. It commonly occurs in the chest, neck or face, but it can also develop in other areas of the body. This form of emphysema isn’t typically caused by smoking or other lung irritants but brought on by certain medical procedures or injuries to the body, among others.

What is the difference between emphysema and COPD?

First, what exactly is COPD? Chronic obstructive pulmonary disease, or COPD, is a group of lung diseases that make breathing difficult, and gradually worsens over time. COPD typically occurs in people who have a history of smoking, but it can also occur with long-term exposure to lung irritants like secondhand smoke or air pollution.

Emphysema and chronic bronchitis, where the lining of airways is constantly irritated and inflamed, are the two most common conditions that contribute to COPD. Both conditions make breathing harder, leading to shortness of breath, coughing or wheezing. People diagnosed with COPD are frequently diagnosed with both emphysema and chronic bronchitis, but they can occur separately.

What causes emphysema?

Emphysema can be caused by several things, but the four most common are:


This is the number one cause of emphysema. Smoking destroys lung tissue and irritates airways, causing inflammation and damage that results in swollen airways, difficulty clearing airways and increased mucus production.

Long-term exposure to lung irritants

Some examples of lung irritants include air pollution, secondhand smoke and occupational lung irritants, such as coal or exhaust fumes.


Emphysema is most commonly seen in people 40 years of age or older, especially in those who smoked early on in life, still smoke or had long-term exposure to lung irritants. Emphysema can occur in young adults, but as emphysema generally develops slowly, older adults are more at risk.


It’s rare, but an inherited genetic condition called alpha-1 antitrypsin deficiency that weakens the lungs, can cause emphysema. Also, people with a history of smoking are more likely to develop emphysema if they have a family history of COPD.

Symptoms of emphysema

Because emphysema usually progresses slowly, symptoms can take a while to appear – a person can actually have emphysema for years and not know it. Early symptoms are generally mild and become more severe as the disease progresses. Symptoms or signs of emphysema can include:

  • A frequent and persistent cough
  • A cough that produces a lot of mucus
  • Frequent respiratory infections, like colds or the flu
  • Shortness of breath during daily activities and physical activity
  • Wheezing while breathing
  • Chest tightness or pain
  • Loss of appetite
  • Sleep problems
  • Depression
  • Unexplained weight loss

What does emphysema feel like?

Some of the first symptoms that can appear are shortness of breath and ongoing fatigue. These symptoms alone can be dismissed as minor or related to other illnesses, so when should you see your doctor? If breathing becomes more difficult even while not being physically active, or lung sounds change – from typical breathing to wheezing, clicking or crackling – it may be time to schedule a visit.

A woman at home breathes deeply from the oxygen mask she holds onto her face.

Diagnosing emphysema

A visit to the doctor will help diagnose emphysema with a few steps. Your doctor may recommend a chest X-ray, but an X-ray doesn’t always confirm a diagnosis. It can, however, rule out other causes of shortness of breath, such as pneumonia or asthma, and help diagnose advanced stages of emphysema.

Since an X-ray doesn’t always confirm diagnosis, your doctor may also recommend a computerized tomography (CT) scan. A CT scan takes X-ray images from multiple directions to create many different views of internal organs, helping to detect and diagnose emphysema.

Another step your doctor may take is to order a lab blood test, where blood is tested to determine how well lungs are transferring oxygen to your bloodstream, and how well they’re removing carbon dioxide.

Finally, your doctor may order lung function tests, called pulmonary function tests (PFTs). PFTs, such as spirometry, nitric oxide tests and arterial blood gas tests, are noninvasive tests that measure lung capacity, how well air flows in and out of the lungs, and how well lungs deliver oxygen to the bloodstream.

Why early detection of emphysema is important

Since emphysema can’t be reversed like other lung conditions, early detection is important. Emphysema symptoms worsen over time, and early detection can slow progression of symptoms and the disease, leading to improved quality of life. It can also help identify causes of the disease so you can limit exposure to them.

The four stages of emphysema

Emphysema is classified into four stages: early, moderate, severe and very severe. Doctors use these stages to describe the progression of the disease and provide the appropriate treatment for each stage.

Early emphysema

If someone is at risk for emphysema, like those with a history of smoking, it’s important to keep an eye out for symptoms such as a nagging cough or shortness of breath, even if it’s mild. Although it’s easy to dismiss the early warning signs. But catching emphysema in this stage may help slow progression, allowing you to maintain your health for longer.

Moderate emphysema

This stage occurs when symptoms such as frequent coughing, feeling tired, shortness of breath, trouble sleeping and wheezing affect daily life. Flare-ups of symptoms, where they intensify for a few days, may occur.

Severe emphysema

In this stage, symptoms become more severe: intensified shortness of breath, tiredness and coughing, and more frequent flare-ups. Also, there may be new signs of emphysema progression, such as more frequent respiratory infections, like a cold or the flu, tightness of the chest, trouble catching your breath and others.

Very severe emphysema

Emphysema likely will be affecting every activity in day-to-day life, and it may be difficult to breath even when not being physically active. Chronic respiratory failure may occur – which means not enough oxygen is moving from the lungs to blood, and when the lungs aren’t taking enough carbon dioxide out of the blood.

Treatments for emphysema

While there isn’t a cure for emphysema, there are treatments that may help slow the progression of the disease and help people with the disease to live more comfortably.

Pulmonary rehabilitation

The goal of pulmonary rehabilitation is to promote healthy lifestyle changes –using exercise, lifestyle education and diet to help improve quality of life and ability to exercise.

Oxygen therapy

If emphysema causes low levels of oxygen in the blood, oxygen therapy may help. With oxygen therapy, supplemental oxygen can help deliver more oxygen to the lungs and bloodstream.

Emphysema medications

These may include bronchodilators to relax airways and help breathing problems, inhaled steroids, aerosol sprays that reduce inflammation and help shortness of breath, and antibiotics to treat bacterial infections.


If the disease has progressed to the later stages, doctors may recommend lung volume reduction surgery, where damaged lung tissue is removed. If the damage is severe and other treatments haven’t worked, a lung transplant may be an option.

Lifestyle changes

Making changes to your lifestyle is easier said than done, but it’s the most important way to manage emphysema and keep living your life. Don’t be afraid to reach out for help – it’s a sign of strength, not weakness.

Stop smoking the right way for you

The number one priority is to figure out the best way to stop. Talk to your doctor about smoking cessation strategies – they may be able to prescribe gum, inhalers, patches or prescription medicines to help.

Avoid inhaled irritants

Avoiding air pollution, smoke from wood-burning fireplaces and dust may help you breathe a little easier.

Defend against infections

Washing your hands frequently when out in public, using hand sanitizer, avoiding people with respiratory illnesses, such as a cold or the flu, and getting an annual flu vaccination may help.

Stay active

Talk to your doctor, if necessary, to figure out a fitness regimen that works for you. Regular exercise can help decrease emphysema symptoms, improve circulation and help your body better use oxygen, strengthen your heart, improve mental health and so much more.

Eat well

This is an easy way to keep your immune system strong. Cutting back on red meat, processed foods and sugar, and eating a diet with more fruits, vegetables, nuts, whole grains, fish and olive oil may help reduce inflammation. Nutritional supplements may also be helpful – talk to your doctor about your options and what fits for your lifestyle.

When should you talk to your doctor?

Early detection is the best way to control your symptoms and the progression of emphysema. If you have shortness of breath or a history of smoking, reach out to your doctor sooner rather than later. They care about your respiratory health and will help you come up with a plan so you can live your best life.

Make an appointment