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Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition

Emphysema

by Debra Wood, RN

Category: Health issues

Definition: Emphysema is a chronic obstructive disease of the lungs. The lungs contain millions of tiny air sacs called alveoli. In emphysema, these sacs lose their elasticity and air becomes trapped within. It becomes difficult to expel oxygen-depleted air from the lungs, which diminishes the normal exchange of air. Emphysema is classified as a chronic obstructive pulmonary disease (COPD).

Causes

Emphysema develops due to smoking; inhaling toxins or other irritants; and apha1-antitrypsin deficiency (A1AD), a genetic defect which can cause emphysema at an early age in nonsmokers.

Risk Factors

Factors such as smoking, exposure to long-term secondhand or passive smoke, and exposure to pollutants in the environment increase the chances of developing emphysema. Other risk factors include a family history of emphysema, a medical history of frequent childhood lung infections, HIV infection, and connective tissue disorders. Individuals at age fifty years or older also have a greater risk of developing emphysema.

Symptoms

Early symptoms of emphysema include coughing in the morning, coughing up clear sputum (mucus from deep in the lungs), wheezing, and shortness of breath with physical activity. As the disease progresses, symptoms experienced may include increased shortness of breath, rapid breathing, fatigue, and a choking sensation when lying flat. Other symptoms include trouble concentrating, increase in chest size (barrel chest), enlargement of the right chamber of the heart, heart failure, swelling in the legs, weight loss, breathing through pursed lips, a desire to lean forward to improve breathing, and more frequent flare-ups (periods of more severe symptoms).

Screening and Diagnosis

A thorough review of the patient’s medical history and a physical examination are performed. The examination may include testing, such as chest X-rays, a test that uses radiation to take pictures of structures inside the chest; CT scan, a type of X-ray that uses a computer to generate 3-D images of the internal organs; arterial blood gas test, a blood test used to assess the amount of oxygen and carbon dioxide in the blood; and lung function tests (spirometry).

Treatment and Therapy

There is no cure for emphysema. Instead, treatment aims to ease symptoms and improve one’s quality of life. Treatments involve smoking cessation, which slows the progression of the disease; environmental management, or limiting the number of irritants in the air to make breathing easier; and medication, which helps to ease the symptoms and reduce complications.

Medications include bronchodilators to relax the airways and open breathing passages (may be given as pills or inhaled), corticosteroids to decrease inflammation and swelling in the breathing passages, antibiotics to fight bacterial infections, and expectorants to loosen mucus and make it easier to cough up.

Oxygen may also be given to supplement the air taken in by the body. Increasing the amount of available oxygen helps to increase energy levels and heart and brain function. In addition, because emphysema makes individuals prone to influenza and pneumonia, doctors recommend an annual flu shot and a pneumococcal vaccine.

Lastly, special exercises can strengthen chest muscles and make breathing easier. Physical activity builds endurance and improves quality of life, while special breathing exercises with and without an incentive spirometer can help to bring more air into the lungs and force trapped air out of the lungs. A small number of patients may benefit from surgery, including a bullectomy (removal of a bulla—a large, distended air space in the lung) or a lung transplant.

Living with Emphysema: An Interview

Sandy, a fifty-year-old woman, is married with three grown children. She started smoking at age fourteen and continued until she was forty-eight years old. She quit for one full year, but has recently started smoking again. She says that one cigarette was all it took to return to smoking. She is struggling to quit again, and she is retired because of her emphysema. The following is a brief interview with Sandy:

Q. What was your first sign that something was wrong? What symptoms did you experience?

A. My first sign was being short of breath. I had been short of breath for years, but it became much worse over two years ago. I found it increasingly difficult to climb stairs or walk for any distance. I noticed that I could not even walk a whole city block without having to stop and rest. Surprisingly, it was after I had quit smoking for a month that I really noticed an increase in my shortness of breath. It was strange to me that I was more short of breath when my expectation was that I would be breathing easier.

Q. What was the diagnosis experience like?

A. I saw my primary care provider first. I wasn’t referred to a specialist right away. My doctor felt that I probably was in the early stages of emphysema and decided to treat me first with medication and inhalers. He didn’t feel that my condition was severe enough to require a specialist. I wasn’t completely happy with that but felt that he must know what he was talking about. It wasn’t until eight or nine months later, when I had a cold and possible lung infection, that I was referred to a specialist and given a pulmonary function test. When the test results came back, my primary care doctor admitted that he had not realized how bad my condition was.

Q. How do you manage your disease?

A. I am currently seeing a pulmonary specialist. This is my second pulmonary specialist; I was not happy with the attitude of the first specialist, so I switched. I am seen every three months and usually have a spirometry done in the office. I am on three different inhalers: Advair, Combivent, and Flovent. I also use Accolate twice a day and I keep prednisone on hand for flare-ups. I have had blood work, chest X-rays, and a dobutamine stress test. Next month, I will have a CAT scan on my lungs to see what kind of condition they are in.

Currently, I am operating at 30 percent lung function, and the doctor has told me that this is as good as it gets. I have been fortunate to not need supplemental oxygen yet. Recently, the doctor has mentioned the word transplant. He explained that at age fifty, I am young enough to endure a transplant. By the time I’m sixty, I may have only 15 percent lung function left.

I am also taking an antidepressant. So you can see that this illness has caused some stress and depression.

Prevention

Individuals can reduce the chances of developing emphysema by not smoking, avoiding exposure to secondhand smoke, avoiding exposure to air pollution or irritants, and wearing protective gear if exposed to irritants or toxins at work.

Citation Types

Type

Format

MLA 9th

Wood, Debra. "Emphysema." Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition, edited by Paul Moglia, Salem Press, 2018. Salem Online, online.salempress.com/articleDetails.do?articleName=Addictions2e_0120.

APA 7th

Wood, D. (2018). Emphysema. In P. Moglia (Ed.), Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition. Salem Press. online.salempress.com.

CMOS 17th

Wood, Debra. "Emphysema." Edited by Paul Moglia. Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition. Hackensack: Salem Press, 2018. Accessed September 13, 2025. online.salempress.com.

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