Emphysema

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Emphysema facts

  • Emphysema is a destructive disease of the lung in which the alveoli (small sacs) that promote oxygen exchange between the air and the bloodstream are destroyed.
  • Smoking is the primary cause of emphysema, which makes it a preventable illness.
  • There are also less common genetic causes of emphysema including alpha-1 antitrypsin deficiency.
  • The primary symptom of emphysema is shortness of breath. It is a progressive complaint by affected individuals, worsening over time. Early in the disease, shortness of breath may occur with exercise and activity but symptoms gradually worsen and may occur at rest.
  • Diagnosis of emphysema is based upon history, physical examination, and pulmonary function studies.
  • Once present, emphysema is not curable, but its symptoms are controllable.
  • Medication regimens are available to preserve function for daily activities and quality of life for an individual with emphysema.
  • Oxygen supplementation may be required for a person with emphysema.
  • Exercise training and education are essential components of emphysema therapy and pulmonary rehabilitation.
  • Surgical options for individuals with emphysema have been developed and but are not expected to be available for widespread use.
  • Emphysema does not affect quantity of life, but rather quality of life. There are no studies that can predict life-expectancy in individuals with emphysema.

What is emphysema?

Emphysema is a chronic obstructive pulmonary disease (COPD) that presents as an abnormal and permanent enlargement of air spaces distal to the terminal bronchioles. It frequently occurs in association with obstructive pulmonary problems and chronic bronchitis. It is unusual for someone to have pure emphysema unless it is a result of genetic abnormalities. Most people have some combination of emphysema and chronic bronchitis with varying degrees of airway bronchospasm. This condition is commonly referred to as COPD (and in the United Kingdom, as chronic obstructive lung disease, COLD).

There are three morphological types of emphysema; 1) centriacinar, 2) panacinar, and 3) paraseptal.

  1. Centriacinar begins in the respiratory bronchioles and spreads peripherally mainly in the upper half of the lungs and is usually associated with long-standing cigarette smoking.
  2. Panacinar predominates in the lower half of the lungs and destroys the alveolar tissue and is associated with homozygous alpha-1 antitrypsin deficiency, a genetic disease.
  3. Paraseptal emphysema preferentially localizes around the septae of the lungs or pleura, often associated with inflammatory processes, like prior lung infections.

What are the stages of emphysema?

Emphysema staging helps determine how much lung damage is present and how severe it is. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) uses FEV1 measurements to help with this determination:

Stage FEV1
I = mild greater than or equal to 80% predicted
II = moderate less than 80%, greater than 50% predicted
III = severe Less than 50%, greater than 30% predicted
IV = very severe Less than 30% predicted, or less than 50% in chronic respiratory failure

Medically Reviewed by a Doctor on 4/16/2014

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