It’s possible for lung damage caused by COVID-19 to lead to emphysema-like changes. This usually happens in more severe cases of COVID-19, often when mechanical ventilation is needed.

Emphysema happens when the air sacs in your lungs become damaged, making them less elastic. This makes it harder to breathe properly. Smoking is one of the main causes of emphysema.

COVID-19 can also damage your lungs, leading to a variety of respiratory complications. In rare situations, they may include emphysema-like changes. Keep reading to learn more.

SARS-CoV-2, the virus that causes COVID-19, binds to a receptor called ACE2 in order to enter cells. ACE2 is found in many parts of the body. This includes your respiratory tract, which is often the first area exposed to the virus.

Once you’ve contracted SARS-CoV-2, your immune system works to respond to the infection. This response creates inflammation in the body.

For some, COVID-19 mainly affects the upper respiratory tract, leading to symptoms that are more consistent with a cold or the flu. However, sometimes COVID-19 can affect the lower respiratory tract as well.

In the lower respiratory tract, the effects of the virus and immune response can damage lung tissue, including the air sacs where carbon dioxide is exchanged for vital oxygen. This can lead to pneumonia and potentially respiratory failure.

It’s possible for COVID-19 to lead to emphysema-like changes. This has mostly been reported in people with more serious COVID-19 that has required hospitalization.

Let’s take a look at what some of the research into this topic has found so far:

  • A 2021 study examined the lungs of 48 people who had severe COVID-19 and required mechanical ventilation. Follow-up CT scans found that 25% of people had emphysema-like lung changes.
  • In a 2022 study of 32 people, follow-up CT scans showed significant emphysema-like changes in the lungs of people who had mild to severe COVID-19 that wasn’t treated with mechanical ventilation.
  • In another 2022 study, follow-up CT scans of 287 individuals hospitalized with COVID-19 found that 11% of people had detectable emphysema-like changes. This was more common in people who had CPAP or mechanical ventilation during treatment.

Case reports — including one from 2022, one from 2021, and another two from 2021 — also described emphysema-like changes in people who went to the hospital with COVID-19. Many of these individuals were younger, with no preexisting lung disease.

It’s not known exactly what causes emphysema-like changes in people who’ve had COVID-19. One possibility is direct lung damage from the infection and the associated inflammation. Another thought is that the effects of mechanical ventilation may contribute to lung damage.

Can COVID-19 make emphysema worse?

Respiratory infections can make chronic lung conditions like emphysema worse. As such, the Centers for Disease Control and Prevention (CDC) notes that people with chronic lung conditions are at an increased risk of serious COVID-19.

Indeed, research from 2021 has found that having chronic obstructive pulmonary disease (COPD), which includes emphysema, is associated with an increased risk of hospitalization and death due to COVID-19.

COVID-19 may also worsen emphysema. The 2021 study discussed above noted that in some individuals, emphysema-related changes were actually a worsening of preexisting emphysema after COVID-19.

In the short term, COVID-19 can cause lung complications like pneumonia and acute respiratory distress syndrome (ARDS), a life threatening respiratory condition.

It’s also possible to have other lung complications as you recover from COVID-19, such as:

  • fibrosis, when lung tissue becomes thick and scarred, making it harder to breathe
  • pulmonary embolism, which is when a blood clot blocks the flow of blood to your lungs
  • bronchiectasis, where airways become widened, making it harder for mucus to clear from them
  • collapsed lung, which is where air leaks out of your lungs and into the surrounding space

People who’ve had COVID-19 can also develop long COVID, which includes persistent respiratory symptoms like shortness of breath and cough. Other symptoms of long COVID can include fatigue, brain fog, and difficulty sleeping.

We’re still learning about the long-term effects of COVID-19 on the lungs. It’s possible that lung function may gradually improve. However, this may take some time.

For example, a 2021 study looked at recovery in 83 people who were hospitalized with COVID-19. It found that, while lung function improved in most people over 12 months, some people still had persistent issues with lung function at that time.

The best way to prevent lung complications from COVID-19 is to take steps to reduce your risk of contracting the virus. According to the CDC, these include:

  • staying up to date on your COVID-19 vaccines
  • avoiding contact with people who have confirmed or suspected COVID-19
  • washing your hands frequently
  • moving indoor activities outside, if possible
  • improving airflow indoors, such as by opening windows or using fans
  • wearing a mask or practicing physical distancing, if necessary

There are also steps you can take to help improve your overall lung health, such as:

It’s possible for damage from COVID-19 to lead to emphysema-like changes in the lungs. However, this is uncommon and has mostly been reported in people who were very ill due to COVID-19.

Besides emphysema-like changes, COVID-19 can cause other lung complications, such as pneumonia, fibrosis, lung scarring, or a collapsed lung.

You can lower the likelihood of lung complications due to COVID-19 by reducing your risk of developing COVID-19, as well as taking steps to improve the health of your lungs.