Emphysema

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Questions to Ask Your Pulmonary Care Team
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Signs and Symptoms

Symptoms of emphysema vary from mild to severe and include shortness of breath (dyspnea), cough, and difficulty breathing upon exertion (e.g., exercise). Emphysema is a chronic (long lasting), progressive condition, which means the symptoms usually worsen over time.

Because the onset of the disease is gradual, many cases are not diagnosed until irreversible damage has occurred. Episodes of worsening symptoms (called exacerbations) are common in patients who have emphysema. Exacerbations become more frequent in advanced disease.

Other symptoms of emphysema include the following:

• Cyanosis (bluish tint to the lips, fingertips, and skin; caused by low levels of oxygen [O2] in the blood)
• Edema (swelling; commonly in the feet and ankles)
• Fatigue
• Headaches (especially upon waking in the morning as a result of retaining carbon dioxide [CO2] during sleep)
• Weight loss

Patients who have emphysema often have chronic bronchitis as well. Chronic bronchitis results in a productive cough that is present for at least 3 months during 2 consecutive years.

Signs of emphysema include the following:

• Barrel chest (i.e., change in the shape of the chest caused by enlargement of the lungs and chest wall and the ineffective use of breathing muscles)
• Crackles and wheezes during inhalation, decreased breath sounds, and distant heart sounds (often heard through a stethoscope)
• Irregular movement of breathing muscles (e.g., inspiratory excursion)
• Prolonged periods of exhalation and grunting during exhalation
• Vibration of the chest during speaking (called tactile fremitus)

As emphysema progresses, many patients experience shortness of breath from the slightest activity or even while sedentary. They often exhibit pursed-lip breathing, which is a way to make each breath more effective by breathing through puckered ("pursed") lips.

Patients also may have a tendency to lean forward and support themselves with their arms on a surface in front of them or on their knees. This position can help make breathing easier by allowing patients to use accessory breathing muscles (i.e., muscles in the back, abdomen, or neck that are not normally used during breathing) more effectively.

Emphysema can cause a number of complications and the disease has a high mortality rate. Anxiety, depression, and sleep disturbances are common in patients who have emphysema.

Complications include the following:

• Cor pulmonale (pulmonary hypertension and right-sided heart failure)
• Heart failure
• Pneumonia and other lung infections
• Pneumothorax (collection of air within the membrane that surrounds the lungs [pleural space])
• Polycythemia (excess red blood cell production that occurs in response to low oxygen levels in the blood; can block small blood vessels)
• Respiratory failure

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