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What Are the Stages of Emphysema?

What is emphysema?

Smoking is the most common cause of a serious lung condition called emphysema. With emphysema, the air sacs (alveoli) weaken and lose their ability to contract after expanding. Air can also get trapped in these sacs, causing some to break. This can make breathing difficult and ultimately decrease the amount of oxygen you get into your blood stream.

Emphysema typically occurs slowly in stages, usually due to years of smoking cigarettes or other types of tobacco. Smoking causes 80 percent of all emphysema. Other causes include:

  • secondhand smoke
  • marijuana smoke
  • air pollution
  • chemical fumes
  • alpha-1 antitrypsin deficiency, a genetic condition that affects the lungs

People over 40 years old, or people who smoked for long periods, are at higher risk for this condition. Once developed, emphysema can’t be reversed.

If you have emphysema, your doctor will likely diagnose the condition as chronic obstructive pulmonary disease (COPD). This is an umbrella term for lung diseases that get worse over time. They tend to cause increased breathlessness due to the combination of chronic bronchitis, emphysema, and obstructed lung airways. While COPD isn’t exactly the same, people who have emphysema are also more likely to have other lung diseases such as bronchitis, asthma, and lung cancer.

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Symptoms

Symptoms of emphysema

It’s common for most people to not feel the symptoms of emphysema until there’s 50 percent or more damage to the lung tissue. Early symptoms may appear gradually as shortness of breath and on-going fatigue. Sometimes they may only affect your body when you’re physically active.

But as the condition progresses, you may see an increase in:

  • coughing
  • chest tightness
  • shortness of breath
  • wheezing
  • more mucus production

Eventually the feeling that you aren’t getting enough air may will also occur when you’re resting. Other symptoms that may also appear due to strained breathing include a poor appetite and weight loss.

Stages

Stages of emphysema

Your doctor will determine your stage by looking at your symptoms and the results of your breathing tests.

Stages Definition
At-risk Your breathing test is normal, but you may have mild symptoms such as an on-going cough and increased mucus production.
Mild, or early stage The breathing test shows mild air flow blockage. You will have symptoms including an on-going cough and mucus production. But you may not be able to feel the effects of reduced air flow.
Moderate Most people seek medical attention at this stage when they can feel a decline in their airflow. Symptoms also usually include shortness of breath during physical activity.
Severe, or very severe Breathing tests show severe limited airflow.
 

Read more: How long can you live with stage 4 COPD? »

The spirometry and pulmonary function test (PFT) measures your airflow as you inhale and exhale. The PFT will show how much air your lungs can carry. Your doctor will then compare these results to normal results of people with a similar age, height, weight, and ethnic background.

Other tests your doctor may perform include:

  • tapping your chest to listen for a hollow sound, which means there’s air trapped in your lungs
  • blood tests to see how well your lungs transfer oxygen to your bloodstream and remove carbon dioxide
  • electrocardiogram (ECG) to check heart function and rule out heart conditions
  • a chest X-ray or a chest CT scan to look for small pockets of air in your lungs, but these aren’t helpful for detecting early stages
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Complications

Complications of emphysema

If left untreated, emphysema can develop into serious complications, such as:

Holes in lungs (giant bullae): These large holes make it difficult for your lung to expand. They can also get infected and may lead to a collapsed lung.

Collapsed lung: This is a life-threatening condition for people with emphysema because their lungs are already damaged.

Heart problems: Emphysema often increases pressure in the arteries connecting your lungs to your heart. This can cause an area of your heart to expand and then weaken.

Outlook

Outlook for emphysema

The outlook for people with emphysema depends on the severity of the condition and how early they start treatment. The earlier you start your treatment, the better your outcome. Lung damage from emphysema is irreversible. But you can slow the progression and improve your quality of life.

The prediction of life expectancy in COPD is correlated with your symptoms and the results of one of the PFT parameters, the FEV1. This is also known as your forced expiratory volume of air within the first second of forcefully breathing out (performed right after breathing in as much air in as possible). You can also use this calculator to get an estimate of your survival rates.

People who stop smoking and take steps to protect their lungs from further damage usually have a longer life expectancy. Talk to your doctor about your outlook. Everyone’s outlook depends on the severity of their stage, treatment, and what steps they take to manage their condition.

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Treatment

How is emphysema treated?

There’s no cure for emphysema. Current treatments aim to slow the progression of the disease and reduce symptoms. Your doctor will recommend a treatment based on the severity and stage of your condition. The first line of treatment is to stop smoking, if you haven’t yet.

Medications

Your doctor may prescribe medication, such as:

  • Bronchodilators: This helps open up airways to improve symptoms like breathing difficulty and coughing.
  • Corticosteroids: These medications can improve breathing by removing inflammation in the lung. But long-term use increases the risk of high blood pressure, diabetes, or cataracts.
  • Antibiotics: Your doctor may prescribe antibiotics if you develop infections such as bacterial pneumonia or bronchitis.

Your doctor may also recommend therapies to improve breathing and relieve symptoms. These include pulmonary rehabilitation where you'll learn various breathing exercises. For people who need extra oxygen, your doctor may prescribe oxygen therapy. You will use a nasal cannula device or wear a facemask to breathe oxygen through a machine.

Therapies

You may also need nutrition therapy if you have other conditions such as obesity that interferes with your health and contribute to breathlessness. For more severe cases that affect younger adults without additional complications, your doctor may recommend surgery to remove damaged lung tissue or a lung transplant.

Read more: Understanding emphysema treatments »

Clinical trials

Researchers who are studying emphysema are actively looking for participants. These trials range from evaluating current treatments to new management options for people with severe emphysema. If you’re interested in participating in a clinical trial, visit CenterWatch.com.

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See a Doctor

When to see a doctor

Make a doctor’s appointment if you have shortness of breath that lasts for several months and doesn't improve. Especially if breathlessness interferes with your daily activities. See a doctor even if your symptoms worsen, even if you already received a diagnosis.

The Mayo Clinic recommends seeking medical attention if you experience:

  • difficulty talking because you are so short of breath
  • a bluish or grayish tinge to your lips or fingernails
  • lack of mental alertness
  • a fast heartbeat
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Next steps

How to manage emphysema

Over 11 million people in the United States have COPD, according to the American Lung Association. Of those people, three million people have emphysema, according to the Cleveland Clinic. Once you’ve developed emphysema, the damage is irreversible. The first step you can take to manage your health is to stop smoking, if you smoke. You can also wear a mask to avoid secondhand smoking or inhaling dust and chemical fumes.

Following these steps can help prevent emphysema complications from occurring.

You can also talk to your family, friends, or a counselor to relieve stress that may come with this condition. You may want to consider joining a support group for people with emphysema or lung diseases. This can be a good way to express your feelings, find out about new treatments, and coping strategies. Contact your local chapter of the American Lung Association to find a support group near you.

Read more: What happens when you quit smoking? »

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