Emphysema
What is emphysema?
Emphysema is a disease that damages the tiny air sacs (alveoli) in the lungs, making it hard to breathe. Normally, the alveoli expand as you inhale and shrink to push air out when you exhale. With pulmonary emphysema, the lungs lose their elasticity, trapping air inside and making it difficult to take in fresh oxygen. Along with chronic bronchitis, emphysema is a common form of chronic obstructive pulmonary disease (COPD), a group of lung conditions that gradually reduce lung function.
Pulmonologists diagnose and treat respiratory diseases like emphysema and COPD. At Penn Medicine, our pulmonary specialists provide comprehensive care, bringing together radiologists, chest surgeons, lung doctors, advanced practice nurses, and respiratory therapists—all in one convenient location.
Types of emphysema
There are three main types of emphysema:
Centrilobular emphysema: The most common type, it usually begins in the respiratory bronchioles of the upper lungs and is often linked to long-term cigarette smoking.
Paraseptal emphysema: This type typically affects the outer areas of the lungs, like the septa or pleura, and is often associated with past lung infections or inflammation.
Panacinar emphysema: Usually found in the lower lungs, this type is linked to a genetic condition called alpha-1 antitrypsin deficiency.
Emphysema symptoms
The first signs of emphysema are mild and develop slowly, so you may not notice any changes until lung damage has already occurred. The most common symptoms are shortness of breath and fatigue. Other symptoms include:
- Coughing
- Wheezing
- Chest tightness
- Weight loss
- Barrel chest (caused by trapped air in the lungs)
- Ankle swelling
- Increased mucus (which can block airways)
What causes emphysema?
Emphysema develops when the lungs are damaged by harmful substances or certain health conditions.
Smoking is the leading cause of emphysema. It damages lung tissue, leading to inflammation, mucus buildup, and narrowed airways, which make breathing harder.
Other pollutants, like dust from grain, cotton, or wood, as well as chemical fumes and air pollution, can also harm the lungs. Exposure to smoke from burning biomass fuels, such as wood and grasses, releases toxins that increase the risk of lung disease.
Viral and bacterial lung infections, like acute bronchitis, pneumonia, and influenza, can worsen COPD and may lead to emphysema.
Genetic conditions
Alpha-1 antitrypsin deficiency (AATD) is the primary genetic cause of emphysema. This inherited condition reduces levels of a protein that protects the lungs.
Penn Medicine offers genetic testing and counseling to help you determine your risk of having or passing on the genes that cause AATD.
Diagnosing emphysema
To diagnose emphysema, your provider may order tests that measure your oxygen and carbon dioxide levels and how much air you can breathe in and out. If you have a family history of lung disease, genetic testing may be done for alpha-1 antitrypsin deficiency. Imaging tests can also help detect lung damage and rule out other conditions.
Emphysema treatment
While there’s no cure for emphysema, treatment can help manage symptoms and improve your quality of life. Your provider may prescribe medications to relax the airways and help reduce inflammation in your lungs.
Pulmonary rehabilitation, which includes breathing exercises, education, and fitness training, can also be beneficial. Lifestyle changes, such as quitting smoking, avoiding lung irritants, and staying active, can slow the disease’s progression. In severe cases, surgery may be an option.
Can emphysema be prevented?
The best way to lower your risk of emphysema is to avoid smoking or quit if you already smoke. Staying away from secondhand smoke and other lung irritants also helps protect your lungs.
Get annual flu shots and a pneumonia vaccine, and take steps to avoid colds or the flu. If you have a genetic risk, regular checkups and early treatment may help prevent severe lung damage.
Comprehensive care for emphysema
Penn Medicine’s lung specialists diagnose and manage complex breathing conditions, offering advanced testing and therapies for emphysema to help you breathe easier. The Harron Lung Center provides more leading-edge care options than any other lung program in the southeastern Pennsylvania and New Jersey regions.
For those looking to quit smoking, our smoking cessation programs offer dedicated support groups and resources to improve your quality of life while living with emphysema. If advanced intervention is needed, the Penn Transplant Institute is a leader in organ transplantation, performing the most transplants in the greater Philadelphia, Lancaster, and Princeton regions and ranking among the nation’s top 10 multi-organ transplant centers.