What is emphysema?

Emphysema is a chronic (long-term) lung condition. It is one of several lung problems that cause chronic obstructive pulmonary disease (COPD).

Your lungs are made up of many little air sacs, called alveoli. In people with emphysema, the walls of the alveoli are damaged. This causes the small airways in your lungs to collapse when you breathe out, making it hard for air to flow into your lungs and even harder for it to flow out.

The damage also makes the alveoli become bigger and less elastic. Over time, your lung tissue becomes stiff and cannot take oxygen into your body as effectively.

Subcutaneous emphysema

The term 'subcutaneous emphysema' refers to air getting in under your skin. This makes it feel crackly when you press on it. It is not necessarily related to lung emphysema.

What are the symptoms of emphysema?

The symptoms of emphysema depend on how severe the underlying lung damage has become.

People with emphysema are often short of breath. As the damage progresses, the periods of breathlessness become more frequent. It becomes harder to do everyday activities or to exercise. Your breathing becomes easier when you rest. Eventually you might become short of breath even after very little physical activity.

People with emphysema may also have:

• a persistent cough
• phlegm
• wheezing
• weight loss
• muscle weakness

At times, your symptoms may get worse suddenly. This is known as an exacerbation of COPD. Exacerbations are often caused by respiratory (lung) infections.

What causes emphysema?

The most common cause of emphysema is smoking. You are still at risk if you have smoked in the past.

A very small number of people get emphysema because they inherited a faulty gene. This is called alpha-1 antitrypsin deficiency. It means they are missing a protein that normally helps to keep the air sacs of the lungs healthy.

Other causes of emphysema include:

• passive smoking — including if your parents smoked when you were young
• exposure to industrial dust and chemicals
• exposure to air pollution

Vaping can also cause emphysema, and like smoking, makes emphysema from other causes worse.

When should I see my doctor?

See your doctor if you have symptoms of emphysema. If you have already been diagnosed with emphysema, see your doctor if you have symptoms of an exacerbation of COPD, such as:

• shortness of breath or cough that is worse than usual
• more or thicker phlegm than usual
• getting tired more easily
• fever

It's also important to see your doctor if you have swelling of your feet and legs. This can be a sign of a heart problem.

How is emphysema diagnosed?

Most people with emphysema are diagnosed after 45 years of age, although if you have a faulty gene, you may be diagnosed earlier.

Your doctor can diagnose emphysema by talking to you, examining you and doing a breathing test called spirometry, which measures how well your lungs work.

They may also arrange:

• blood tests
• a chest x-ray
• a blood test from an artery to check your oxygen levels
• further breathing tests, called lung function tests
• a CT scan of your lungs
• an ECG (electrocardiogram) or echocardiogram to look at your heart

How is emphysema treated?

The damage to your lungs caused by emphysema cannot be reversed, but many treatments can help manage your symptoms and improve your quality of life. These treatments improve the flow of air in your lungs and prevent complications.

The type of treatment depends on how severely emphysema is affecting your health and your ability to do things.

Quitting smoking is the best treatment to slow the worsening of emphysema symptoms.

If you have emphysema, inhaled medicines can help open up your airways and reduce inflammation. You may need antibiotics if you have a chest infection.

It's helpful to participate in a pulmonary (lung) rehabilitation program, which provides exercises and education to help you manage your breathlessness. It may help you with:

• exercises to increase your physical abilities
• breathing techniques
• how to use medicines correctly
• how to save your physical energy

In more severe cases, people with emphysema may need to breathe oxygen from a portable cylinder. Very occasionally, surgery can be useful.

Other things you can do to manage emphysema include:

• eating a balanced diet
• maintaining a healthy weight
• getting enough rest
• exercising regularly
• avoiding air pollution and other people's smoke
• getting vaccinated against the flu and pneumococcal pneumonia
• having regular check-ups with your doctor

What are the complications of emphysema?

Emphysema can make you more likely to develop:

• respiratory (lung) infections
• heart failure and ischaemic heart disease
• osteoporosis and fractures
• anxiety and depression
• lung cancer
• gastro-oesophageal reflux
• type 2 diabetes

COPD is the fifth most common cause of death in Australia.

Can emphysema be prevented?

The best way to prevent emphysema is to quit smoking.

You can also prevent emphysema by:

• being physically active
• using personal protective equipment (such as masks) if you are exposed to dust, gases or fumes at work

Resources and support

Visit the Lung Foundation Australia website for more information and support.

If you are trying to quit smoking, help is available via Quitline on 13 7848.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

Other languages

Find information about quitting smoking in a variety of community languages.

Looking for information for Aboriginal and/or Torres Strait Islander people?

See this flipchart for information about COPD for Aboriginal and/or Torres Strait Islander people.

Check out this action plan to help you manage your COPD.

For help with quitting smoking, call Aboriginal Quitline on 13 7848 and ask to speak to a counsellor for Aboriginal and/or Torres Strait Islander people.