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Updated 30 June 2021

What is Emphysema? – Symptoms, Diagnosis, and Treatment

Patient with Emphysema using a nasal tube to help with breathing

What Is Emphysema?

Emphysema is a progressive and chronic lung condition that leads to difficulty breathing, coughing and other symptoms. In particular, those who smoke are at a higher risk of developing these problems. Along with chronic bronchitis and, for some people with severe  asthma, they are features of a broader condition called Chronic Obstructive Pulmonary Disease (COPD). In Australia, this condition will often be grouped into COPD by medical and allied health professionals. According to the Australian Bureau of Statistics, around 4.8% of citizens are diagnosed with COPD, equating to more than 450,000 people. Due to a lack of awareness, testing and progressive onset of symptoms, approximately 50% of those with COPD will not know they have it. This is concerning given that it is the 5th leading cause of death in Australia. However, with proper treatment and proper lifestyle changes, symptoms can be significantly controlled.
 

Emphysema Causes

What causes emphysema and COPD will often depend on a combination of genetic and environmental factors. Globally, the leading and main cause of this emphysema is smoking. Toxins released from smoking causes inflammatory changes in the lung, including narrowing of airways, damage to the lung's lining, and harms the air sacs. Substantial damage to the lungs affects your capacity to breathe in and out. Other causes of emphysema disorder and COPD also include:
  • Second-hand smoke (being in the presence of someone else smoking)
  • Industrial workplaces with exposure to dust, fumes and chemicals.
  • Certain genetic factors, such as being deficient in alpha-1-antitrypsin protein
  • Ageing, particularly over the age of 45
  • Asthma
  • Any lung infections at an early age
  • Outdoor and indoor air pollutants
 

Transmission

Emphysema is considered a chronic disease and is not considered contagious. However, second-hand smoke can be harmful for the lung health of those nearby.
 

Emphysema Symptoms

The inflammatory and destructive changes to the lungs are usually gradual, especially if healthy lifestyle choices are not made (e.g. quitting smoking, exercise, etc.). In the earlier stages, signs of emphysema may not be as obvious. However, over months and years, symptoms can worsen as the condition of the lung deteriorates. Common symptoms associated with both emphysema include:
  • Difficulty breathing can increase as the condition becomes more severe. Towards the advanced stages, even simple tasks such as walking can lead to shortness of breath.
  • Persistent cough.
  • Constant production of phlegm.
  • Fatigue, particularly during physical activity.
  • Wheezing
 

Emphysema Complications

During the earlier stages of emphysema, the symptoms listed above will only be mild. Many people will feel breathless or experience a persistent cough, especially with vigorous movements, such as playing sports or exercise. However, as the condition is irreversible, symptoms can become more frequent and severe as it progresses. However, specific treatments can help preserve the quality of life and overall health.

The Effects of Emphysema on the Lungs

Even simple daily tasks, such as gardening or even slow-paced walking, can become challenging towards the more advanced stages. Due to the constant inflammation and permanent damage, the ability of the lungs to function normally becomes harder. These gradual changes in the lungs include:
  • Reduced elasticity of the lungs
  • Damage to the air sacs, which are responsible for oxygen exchange
  • Air being trapped in the lungs leading to a barrel chest appearance

What happens during the later emphysema stages?

As changes in the lungs and symptoms progress, the state of the body's overall health can become affected. Examples of these complications include:
  • Difficulties with day-to-day activities (e.g. walking, sleeping, exercise, etc.)
  • Lower back pain
  • Insufficient oxygen circulating in the bloodstream (also known as hypoxaemia).
  • Impaired blood pressure in the lungs (also known as pulmonary hypertension)
  • Heart failure
  • Lung infections (e.g. pneumonia, etc.)
  • Increased risk of blood clots and stroke
 

Emphysema Diagnosis and Tests

Spirometry is the gold standard test for the detection of emphysema. This test assesses the rate of airflow from the lung. However, results from spirometry alone may not be able to diagnose COPD or emphysema. Other diagnostic tests and considerations can also be used, which include:
  • Medical history (e.g. smoking status, asthma, family history, previous workplaces, etc.)
  • Response to medication (e.g. bronchodilators)
  • X-rays of the lungs
  • Genetic testing
  • Blood tests
  • Additional breathing assessments
 

Emphysema Treatment

Although GPs are able to manage most people with emphysema, a multidisciplinary approach involving multiple health professionals (e.g. GP, respiratory specialist, pharmacist, physiotherapist, etc.) may be recommended. Examples of these treatments include:
  • Counselling to help quit smoking
  • Medications to preserve lung health (e.g. inhalers, including bronchodilators, corticosteroids, etc.) and prevent infections (e.g. suitable antibiotics for emphysema, etc.)
  • Oxygen delivery
  • Regular physical activity and exercise
  • Pulmonary rehabilitation classes which include supervised exercise, educational seminars and group support
  • Adjusting meal plans with the support of a nutritionist or dietitian
  • Flu and coronavirus vaccinations to prevent infections
  • Cardiorespiratory physiotherapy for breathing exercises and strategies for managing symptoms
  • Hospitalisation if the symptoms are worsening and not resolving
It's essential to communicate with your GP about emphysema and your current condition regularly. The GP's primary role is to help coordinate and refer to these treatments based on specific needs and requirements.
 

Recovery from Emphysema

Although irreversible, those diagnosed with emphysema can continue to live relatively healthy lifestyles.  Early diagnosis and treatment are essential for limiting emphysema and COPD progression, reducing flare-ups and helping prevent hospital admission. However, specific lifestyle changes, such as smoking cessation and regular physical activity, needs to be actioned straight away. Ensure that an action plan is developed with an experienced GP. This ensures that the correct services are sought after to improve outcomes.
 

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References

  • Goldklang, M., & Stockley, R. (2016). Pathophysiology of emphysema and implications. Chronic Obstructive Pulmonary Diseases, (1), 454.
  • Mannino, D. M., & Buist, A. S. (2007). Global burden of COPD: risk factors, prevalence, and future trends. The Lancet, 370(9589), 765-773.
  • Oey, I., & Waller, D. (2018). The role of the multidisciplinary emphysema team meeting in the provision of lung volume reduction. Journal of thoracic disease, 10(Suppl 23), S2824.
  • Reddel, H. K., Valenti, L., Easton, K. L., Gordon, J., Bayram, C., & Miller, G. C. (2017). Assessment and management of asthma and chronic obstructive pulmonary disease in Australian general practice. Australian family physician, 46(6), 413-419.
  • Walters, J. (2010). COPD: Diagnosis, Management and the Role of the GP. Australian family physician, 39(3), 100.
  • Yang, I. A., Brown, J. L., George, J., Jenkins, S., McDonald, C. F., McDonald, V. M., ... & Dabscheck, E. (2017). COPD‐X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update. Medical Journal of Australia, 207(10), 436-442.