Emphysema and Smoking: A Nasty Relationship


What is Emphysema?

When you think about the long term damaging effects of smoking, certain diseases come to mind. Emphysema is one of the most common diseases that results from smoking cigarettes. Emphysema is a progressive lung disease that destroys the capillary blood vessels. When this happens, it limits the amount of air that you can get into your lungs because air and blood can’t mix, which reduces the exchange of oxygen and carbon dioxide.


Symptoms of Emphysema

Emphysema is a sub-type or earlier stage of chronic obstructive pulmonary disease, or COPD.  The symptoms of emphysema include the following:

  • Shortness of breath
  • Wheezing
  • Coughing
  • Chest tightness or pain

At first, these symptoms will be most noticeable when you’re exercising or being active. However, as the disease progresses, eventually you will experience these symptoms even at rest and while you’re lying down.


Early Stages of Emphysema

As mentioned above, emphysema happens gradually. When it first starts out, it may just feel like it’s harder to get enough air into your lungs.  The alveoli are little air sacs or cavities in the lungs, which give a honeycomb kind of appearance.  In early stages of emphysema, the walls of the alveoli collapse when you breathe out. When this happens, the lung tissue also loses elasticity, so the lungs don’t stretch as well when you breathe.  This causes something called bullae to form, which are sacs of air that don’t actually function. The amount of space they take up in your lungs is dangerous because they can rupture.


Stages of Emphysema

stages of emphysemaEmphysema is a progressive disease that always gets worse. However, there are stages of the disease, which correlate to how much lung damage is present. The Global Initiative for Chronic Obstructive Lung Disease, or GOLD, uses FEV1 measurements to evaluate and determine the extent of lung damage and progression of the disease. FEV stands for Forced Expiratory Volume, which measures the amount of air you can exhale after holding air in your lungs for a short period. A lower FEV1 level is a sign of worse health because it means that your lungs cannot hold as much air.

Stage 1: mild disease, with FEV1 levels greater than 80 percent

Stage 2: moderate disease, FEV1 levels greater than 50 percent but less than 80 percent

Stage 3: severe disease, FEV1 levels between 30 percent and 50 percent

Stage 4: very severe disease, FEV1 levels less than 30 percent or less than 50 percent with accompanying chronic respiratory failure.


Emphysema Gets Worse

emphysema patientBecause emphysema is progressive, that means that it doesn’t ever get better once you have it. One of the worst aspects of emphysema is that it gradually destroys the tissue inside your lungs, and not surprisingly that makes it harder to breathe.  When more lung tissue is destroyed, the amount of oxygen in your bloodstream becomes less concentrated, which means that the problem affects far more than just your lungs. Your body tries to compensate for this lower oxygen concentration by breathing faster. Your skin can even start to turn blue – also called cyanotic – because you’re not getting enough oxygen in your blood.

Eventually as this process continues, the arteries in your lungs will get narrower and your heart will have to beat harder to pump more blood through them. The longer your heart has to work harder to pump more blood, the greater it increases your risk of heart failure. As you can probably see, emphysema isn’t just a problem with your lungs; eventually it can create major problems with your heart, too.



Although emphysema isn’t curable, there are many medications available that can improve your quality of life with the disease and make you more comfortable.  Short acting bronchodilators are medications like albuterol that are inhaled and can open up the lungs to make you breathe more easily.  Long acting bronchodilators include medications like Serevent and Spiriva, and they are supposed to have a longer lasting effect. Many people with emphysema use both a long acting bronchodilator as maintenance medication and a short acting bronchodilator as a “rescue” medicine to manage acute attacks that break through.

As the disease progresses, corticosteroid medications are often prescribed to further reduce inflammation in the airways. Eventually, most patients with emphysema will also need supplemental oxygen. At first, supplemental oxygen is only used at night and after exercise or other physical activity, but more oxygen will be needed throughout the day just to function as the disease progresses.


Quit Smoking Anyway

Once you have emphysema, it’s not curable. However, you may be able to prevent it from getting worse after you start to show symptoms.  It’s never too late to quit smoking, even when you have emphysema. Even if your emphysema is at an incurable point, quitting smoking can still improve your quality of life.

Most people with emphysema do not die from the disease directly but from other causes of organ failure caused by the lack of oxygen associated with emphysema.