OVERVIEW

What is emphysema?

Emphysema refers to a pathological condition characterized by decreased elasticity of the airways distal to the terminal bronchioles (respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli), leading to overinflation, excessive air retention, increased lung volume, and possible destruction of airway walls ^[1].

Essentially, it is not an independent disease but rather a pathological term describing the destruction of the gas-exchange area (alveoli) in the lung's anatomical structure.

What are the types of emphysema?

Based on the location, extent, and nature of the lesions, emphysema can be classified into the following types ^[1]:

1. Alveolar emphysema (also known as obstructive emphysema): Occurs in the pulmonary acinus (including respiratory bronchioles and their distal structures—alveolar ducts, alveolar sacs, and alveoli). It is further divided into:

   • Centrilobular emphysema: Involves dilation of the respiratory bronchioles at the center of the pulmonary acinus. Most common in elderly smokers or those with chronic bronchitis.
   • Panlobular emphysema: Involves uniform dilation of the entire pulmonary acinus. Often seen in young adults or patients with congenital α1-antitrypsin (α1-AT) deficiency.
   • Paraseptal emphysema: Involves dilation of the distal alveolar ducts and sacs. Common in young adults and usually not associated with chronic obstructive pulmonary disease (COPD).

2. Interstitial emphysema: Caused by rupture of bronchioles or alveolar septa, allowing air to enter the lung interstitium. Often seen in rib fractures or penetrating chest injuries.

3. Other types include paracicatricial emphysema, compensatory emphysema, and senile emphysema.

The term "emphysema" commonly refers to obstructive emphysema, which is the most prevalent form.

SYMPTOMS

What are the common manifestations of emphysema patients?

Whether emphysema patients experience clinical symptoms depends on the severity of the condition:

In the early stages, patients may have no noticeable symptoms. However, as the disease progresses, they gradually develop shortness of breath after activity. Initially, patients may feel breathless during physical labor, climbing stairs, walking uphill, or brisk walking. Later, they may experience shortness of breath even during flat-ground activities. In advanced stages, daily activities such as speaking, dressing, bathing, or even resting quietly can cause breathlessness ^[2].

Additionally, systemic symptoms such as fatigue, loss of appetite, and weight loss may occur. When respiratory function severely declines, some patients may experience life-threatening symptoms like headaches, drowsiness, or even coma.

What serious consequences can emphysema cause?

Emphysema can lead to the following severe complications ^[2]:

• Spontaneous pneumothorax: When a pulmonary bulla ruptures, air enters the pleural cavity, causing sudden chest pain and difficulty breathing, which can be life-threatening in severe cases.
• Respiratory failure: Severe lung function impairment can lead to respiratory failure, manifesting as cyanosis, pronounced shortness of breath, excessive sweating, flushed skin, and elevated blood pressure. When the nervous system is affected, symptoms such as insomnia, agitation, headaches, daytime drowsiness, and nighttime insomnia may occur. In worsening cases, stupor or coma may develop.
• Chronic cor pulmonale: Prolonged emphysema-induced hypoxia can cause pulmonary heart disease. Patients may experience symptoms such as shortness of breath, palpitations, poor appetite, bloating, and nausea. Signs like engorged neck veins, rapid heartbeat, and lower limb edema may also appear.

CAUSES

What causes emphysema?

1. Smoking: Smoking is the most significant cause of emphysema. Prolonged exposure to harmful substances in cigarette smoke, such as nicotine and tar, damages the lungs and destroys the structure of alveoli, leading to emphysema ^[2].

2. Occupational dust and chemicals: Failure to take proper protective measures (e.g., wearing masks) in work environments with prolonged exposure to high concentrations of dust or harmful chemicals (e.g., sulfur dioxide, chlorine, ozone) can also cause emphysema ^[2].

3. Air pollution: Frequent exposure to dusty or polluted environments and inhaling these harmful substances can contribute to the development of emphysema.

4. Infections: Repeated respiratory infections caused by bacteria (e.g., Streptococcus pneumoniae, Haemophilus influenzae), viruses (e.g., influenza virus, rhinovirus, adenovirus), or mycoplasma, especially during childhood without timely treatment, may also trigger emphysema ^[2].

5. Genetic factors: Emphysema is linked to genetic predisposition. Individuals with hereditary alpha-1 antitrypsin (α1-AT) deficiency have a 15 times higher risk of developing emphysema compared to the general population ^[1]. Those with a family history of emphysema should take preventive measures, especially long-term smokers, who are more susceptible.

6. Other factors: Patients with chronic bronchitis (most common), asthma, bronchiectasis, or tuberculosis may develop emphysema as their conditions progress. Additionally, immune dysfunction, aging, previous lung resection, and other factors can also contribute to the onset of emphysema ^[1].

DIAGNOSIS

What tests are needed for emphysema diagnosis?

When patients present with chronic cough, sputum production, shortness of breath, and physical findings such as an increased anteroposterior chest diameter (barrel chest), prompt medical evaluation is necessary.

1. First, a chest X-ray or CT scan is required. If findings such as increased lung volume, hyperlucency, or reduced peripheral vascular markings are observed, emphysema should be considered ^[3].

2. Pulmonary function tests (PFTs) are also crucial. This non-invasive test accurately assesses lung function and only requires the patient to perform breathing maneuvers. Obstructive airflow limitation on PFTs further supports an emphysema diagnosis ^[4].

3. Additional tests, such as complete blood count (CBC), arterial blood gas (ABG) analysis, or electrocardiogram (ECG), may be performed as needed.

Which diseases can emphysema be confused with? How to differentiate them?

Emphysema must be distinguished from chronic bronchitis, chronic obstructive pulmonary disease (COPD), bronchial asthma, bronchiectasis, tuberculosis, lung cancer, and occupational lung diseases ^[2,3]. These conditions share symptoms like dyspnea, cough, and sputum production, making self-diagnosis difficult. Medical evaluation with imaging (e.g., chest X-ray) and PFTs is essential for accurate diagnosis and treatment—avoid self-medication.

1. Emphysema: Early stages may be asymptomatic. Classic symptoms include cough, sputum, and progressive dyspnea, eventually occurring even at rest.

2. Chronic bronchitis: Chronic cough, sputum, or wheezing lasting ≥3 months per year for ≥2 consecutive years.

3. COPD: Caused by coexisting emphysema and chronic bronchitis. Features persistent respiratory symptoms (chronic cough, sputum, dyspnea, or wheezing) and airflow limitation.

4. Bronchial asthma: Often begins in childhood, with nocturnal/early morning exacerbations. Symptoms include wheezing, chest tightness, and cough (sometimes cough-only).

5. Bronchiectasis: Large volumes of purulent sputum, often with bacterial infections.

6. Tuberculosis: Fever, fatigue, night sweats, weight loss, and TB exposure history.

7. Lung cancer: Long smoking history, with symptoms like persistent cough, hemoptysis, chest pain, and weight loss.

8. Occupational lung disease (e.g., pneumoconiosis): Cough, dyspnea, and chest pain (dull, aching, or stabbing), with exposure to dust (e.g., asbestos, silica).

Are emphysema, chronic bronchitis, and COPD the same disease?

Emphysema ≠ chronic bronchitis. Chronic bronchitis involves chronic cough/sputum for ≥3 months/year over ≥2 years and is a common cause of emphysema. Emphysema patients also develop dyspnea, hypoxia (e.g., cyanosis), and barrel chest ^[1].

Emphysema ≠ COPD. COPD is defined by persistent respiratory symptoms (cough, sputum, dyspnea) and airflow limitation. While all COPD patients have emphysema to some degree, emphysema alone only qualifies as COPD if accompanied by persistent airflow obstruction ^[2].

TREATMENT

Which department should I visit for emphysema?

Respiratory department.

How is emphysema treated?

Emphysema with no symptoms and normal lung function usually does not require treatment. Patients with symptoms such as cough, phlegm, or shortness of breath need active treatment. Common treatments include medication (using bronchodilators or corticosteroids to relieve respiratory symptoms), surgery (removing damaged lung tissue to preserve normal lung function), and oxygen therapy (alleviating hypoxia caused by breathing difficulties).

What medications are used to treat emphysema?

1. Bronchodilators, usually inhaled ^[2]. Common medications include:

   • Salbutamol aerosol: Suitable for stable patients or those with only one exacerbation in the past year. Possible side effects include headache, restlessness, and muscle tremors.
   • Ipratropium bromide aerosol: Suitable for stable patients or those with only one exacerbation in the past year. Possible side effects include headache, dizziness, and dry mouth.
   • Aminophylline sustained-release tablets: Used for patients with wheezing. Possible side effects include nausea, vomiting, insomnia, and irritability.

2. Corticosteroids: Suitable for patients with ≥ 2 exacerbations in the past year ^[2]. Common medications include:

   • Budesonide/formoterol inhaler: Possible side effects include rash and candidiasis infection.
   • Salmeterol/fluticasone inhaler: Possible side effects include headache and candidiasis infection.

3. Antibiotics may be used if there is a respiratory infection ^[2]. Corticosteroids should be used cautiously to avoid worsening infections.

Note: While medications may have side effects, they do not necessarily occur. Patients should discuss suitable treatment plans with their doctors without excessive worry.

Is surgery an option for emphysema?

Patients with large bullae may undergo surgical or bronchoscopic interventions ^[2]. For example, minimally invasive video-assisted thoracoscopic surgery can remove damaged lung tissue, relieve pressure on healthy tissue, improve lung function, and reduce symptoms ^[5].

Can oxygen therapy be used for emphysema?

In cases of severe hypoxia, oxygen therapy can be administered via unilateral or bilateral nasal cannula at low flow (1–2 L/min). For patients with CO₂ retention, 12–15 hours of daily oxygen therapy is recommended ^[4].

Can emphysema be cured?

Emphysema requires long-term treatment, and some patients may need lifelong medication. Treatment plans should be standardized and personalized under medical guidance. Avoid blindly trusting "advertised drugs," mail-order medications, or so-called "secret remedies." To date, there is no cure for emphysema, and any claim of a "complete cure" is fraudulent.

Does emphysema require hospitalization?

Mild cases can be treated outpatient. However, hospitalization is necessary if symptoms (cough, phlegm, fever, or shortness of breath) worsen despite outpatient treatment or if complications (pneumothorax, respiratory failure, or cor pulmonale) occur.

DIET & LIFESTYLE

What aspects should emphysema patients pay attention to in daily life?

1. Keep warm to avoid catching colds, strengthen nutrition (ensure a handful of fresh fruits daily, over 300 mL of liquid milk per day, and 6–7 eggs per week), drink plenty of water (1,500–2,000 mL daily), and focus on expectoration ^[3,4].

2. Quit smoking and avoid polluted work or living environments to prevent inhalation of dust and other harmful chemicals that irritate the respiratory tract ^[2].

3. Under medical guidance, choose suitable rehabilitation exercises, such as pursed-lip breathing (inhale slowly through the nose, then exhale slowly for 4–6 seconds while contracting the abdomen), Tai Chi, stair climbing, or cycling ^[4].

What should emphysema patients pay attention to in daily life?

Emphysema is a chronic condition. In addition to medication, the following lifestyle adjustments are necessary:

1. Maintain a healthy living environment:

   • Keep the room at a suitable temperature (18–20°C) and humidity (50%–60%) ^[4];
   • Ventilate the room daily for at least 30 minutes ^[6];
   • Avoid polluted work or living environments and exposure to harmful or irritating gases. For example, use a damp cloth for cleaning or clean when the patient is not present to prevent dust dispersion;
   • Install a high-power range hood in the kitchen.

2. Develop healthy habits:

   • First, quit smoking;
   • Strengthen nutrition with a balanced diet, including high-protein, high-calorie, vitamin-rich, light, and easily digestible foods. Ensure a handful of fresh fruits daily, over 300 mL of liquid milk per day, and 6–7 eggs per week ^[7];
   • Drink plenty of water (1,500–2,000 mL daily) to keep the respiratory tract moist and aid expectoration ^[4];
   • Exercise regularly to improve physical fitness, choosing suitable activities like deep breathing, Qigong, Tai Chi, jogging, or walking;
   • Avoid crowded public places, especially during flu season;
   • Maintain a positive and optimistic mindset, building confidence in overcoming the disease.

3. Master proper expectoration techniques ^[4]:

   • Drink plenty of water daily (1,500–2,000 mL);
   • Practice effective coughing to keep airways clear: Sit upright, perform diaphragmatic breathing (belly rises when inhaling) 5–6 times, then take a deep breath and hold for 3–5 seconds. Exhale slowly for 4–6 seconds with pursed lips, take another deep breath, lean forward, contract abdominal muscles, and cough forcefully 2–3 times;
   • Back percussion: Especially for bedridden patients with thick mucus, turn and percuss the back regularly to aid expectoration. Key points: Perform 2 hours after meals or 30 minutes before; 5–15 minutes per session; use gentle force; avoid the spine and shoulder blades; percuss from bottom to top and outside inward with cupped hands;
   • Airway humidification: Inhale steam from a thermos cup half-filled with hot water to moisten the respiratory tract and loosen mucus.

4. Use medications properly:

   • Follow the doctor’s instructions, especially for long-term medications. Do not stop taking them when symptoms improve;
   • Severe emphysema patients who cannot care for themselves should have home caregivers to prevent accidents;
   • Get annual flu and pneumonia vaccines during autumn and winter to reduce infection risks ^[2].

Does emphysema require follow-up? How?

Stable emphysema patients should visit the hospital for follow-ups every 3–6 months. Unstable or poorly responsive patients may need more frequent check-ups. Follow-ups should include at least a chest X-ray and pulmonary function test, with additional blood tests, arterial blood gas analysis, or ECG if necessary.

PREVENTION

Can emphysema be prevented? How to prevent it?

Emphysema is a preventable disease.

1. Quitting smoking is the most important measure, as its onset is primarily related to the inhalation of cigarette smoke and other harmful gases or particles ^[2].

2. Avoid staying in environments with air pollution, and prevent exposure to dust, harmful gases, and chemicals. Use occupational protective measures and wear masks when necessary ^[2].

3. Maintain healthy lifestyle habits, engage in regular physical exercise, and aim for at least 6,000 active steps daily ^[7].

4. Prevent recurrent respiratory infections, especially during childhood, and seek timely treatment if they occur ^[2].

5. Actively treat underlying lung conditions (such as chronic bronchitis) if present.

How can emphysema patients prevent complications?

Patients with emphysema may develop complications such as pneumothorax, respiratory failure, or pulmonary heart disease if the condition persists for a long time or is improperly treated ^[2]. Quitting smoking at any stage of the disease can help prevent the progression of emphysema ^[2]. Therefore, long-term smokers should quit as early as possible.

If symptoms of emphysema, such as chronic cough, phlegm production, or shortness of breath after activity, appear, seek medical attention at a respiratory specialist clinic promptly. Patients diagnosed with emphysema should follow their doctor's advice, modify unhealthy lifestyle habits, and adhere to standardized treatment.