The Symptoms of Emphysema

When it first develops, emphysema, one of a group of lung diseases known as chronic obstructive pulmonary disease (COPD), is usually asymptomatic. As the illness progresses, however, it causes shortness of breath with activity and, eventually, a chronic cough with phlegm and frequent bouts of bronchitis or pneumonia. In the later stages of emphysema, potential complications can range from anxiety to heart problems.

Commonly caused by cigarette smoking or exposure to other lung irritants or pollutants that damage the alveoli in the lungs—where oxygen and carbon dioxide are exchanged—emphysema is a progressive illness without a cure, but its symptoms can be managed.

Frequent Symptoms

In the beginning, symptoms of emphysema are often silent. In fact, research suggests emphysema can present with no symptoms until alveoli damage occurs in more than 50% of the lungs. When symptoms do become obvious, they can be severe.

Shortness of Breath

Shortness of breath, also known as dyspnea, is the hallmark symptom of emphysema. When it first appears, it usually only occurs with exertion. As it progresses, it can be severe and even scary. People with emphysema often report feeling winded or like they are gasping for air. Over time, it can occur while resting and takes the form of labored breathing that can be described as "air hunger." 

Rapid Breathing

Tachypnea, the medical term for rapid breathing, is another common symptom of emphysema. The normal respiratory rate for a healthy adult ranges from 12 to 18 breaths per minute. Tachypnea is defined as taking more than 20 breaths per minute for at least several minutes.

Tachypnea commonly occurs during emphysema exacerbations and may be accompanied by:

• Rapid breathing
• Shallow breathing
• Shortness of breath
• Inability to walk
• A feeling that you want to lean over, sit down, or lie down
• A sense that you are running out of oxygen
• A strong feeling of anxiety
• Nausea and/or vomiting

Chronic Cough

A chronic cough is a long-term, persistent cough that does not go away in spite of treatment. Most healthcare providers consider a cough chronic if it's been going on for eight weeks or more.

In emphysema, the long-term cough can be described as productive (with sputum) or non-productive (without sputum).

Wheezing

Wheezing, a high-pitched whistle sound that occurs while breathing through the mouth or nose is a common symptom of emphysema. The sound is due to the narrowing of airways from inflammation and constriction, which makes it difficult for air to flow through the lungs. Though wheezing can occur on the inhale, in emphysema, it most often takes place on the exhale.

Reduced Exercise Tolerance

Exercise intolerance, in which it's difficult to engage in physical activity, tends to worsen as emphysema progresses. It occurs because air becomes trapped inside the lungs, a condition described as hyperinflation of the lungs, making it difficult to absorb enough oxygen to get the energy. Exercise intolerance may start as an inability to complete moderately strenuous activities like climbing stairs in your house, but as the disease progresses, walking from one room to another may become difficult.

Rare Symptoms

The following rare symptoms tend to occur in the later stages of the disease.

Loss of Appetite and Weight Loss

Shortness of breath during mealtimes can make it difficult to eat. Many pulmonologists recommend nutritional counseling for patients with emphysema. When not addressed, difficulty eating can lead to life-threatening malnutrition.

Appetite loss and unintentional weight loss also may indicate that other diseases are present, such as lung cancer or pulmonary tuberculosis.

Barrel Chest

A barrel chest is a rounded, bulging, barrel-like appearance of the chest that occurs when the lungs become chronically overinflated (hyperinflated) with air, forcing the rib cage to stay expanded for long periods of time.

Over time, the distention of the rib cage affects both the anterior (forward-facing) and the posterior (back-facing) chest wall. Muscle wasting, which develops in later-stage emphysema, can make a barrel chest more obvious.

Cyanosis

Cyanosis is a lack of sufficient oxygen in the tissues. It's characterized by a change in color of the lips, fingernails, and toenails that can range from light gray to dark purple. Cyanosis is a sign that prompt medical attention is needed.

Poor Sleep

Many symptoms of emphysema, such as a chronic cough and wheezing, can make it difficult to sleep. This can be especially problematic for people with chronic respiratory illnesses, because adequate rest is essential for the energy required to breathe efficiently and get through the activities of daily living. Often, nighttime oxygen therapy is necessary for people with emphysema who aren't able to sleep well.

Decreased Sexual Function

The shortness of breath, coughing, and fatigue characteristic of emphysema can interfere with intimacy. The illness can be especially problematic for men, as the restriction of air to the lungs can impact the ability to achieve or maintain an erection as well as the ability to orgasm.

Complications

Many complications can occur as a result of emphysema. Being aware of them can help you stay on top of your symptoms and get treatment as soon as possible if they occur.

Respiratory Infections

For people with emphysema, a common cold can easily lead to more serious respiratory infections such as bronchitis and pneumonia. If you have emphysema, it's vital to get a flu shot every year, and, if you haven't had it, the pneumococcal vaccine. In addition, steer clear of crowded areas during cold and flu outbreaks, wash your hands frequently, and consider wearing gloves indoors to avoid touching doorknobs, railings, and other common surfaces.

Anxiety and Depression

The emotional effects of emphysema and COPD are often overlooked. Anxiety and depression can affect physical health, quality of life, and may also increase the risk of exacerbation.

Panic attacks in particular are common among people with emphysema and can lead to a vicious cycle when combined with shortness of breath. Medications and other non-pharmacological treatments can help manage these concerns.

Heart Disease

Emphysema can weaken the arteries that connect the heart and lungs, putting additional strain on the heart. In addition, many people with emphysema have a history of smoking, which contributes to cardiovascular disease, including heart attacks and heart failure. What's more, chronic lung diseases may prevent full recovery after a heart attack.

Pulmonary Hypertension

High blood pressure in the arteries leading to the lungs, called pulmonary hypertension, is a common complication of emphysema, especially in the advanced stages of the disease.

Symptoms of pulmonary hypertension include shortness of breath, fatigue, chest pain, a racing heartbeat, pain on the upper right side of the abdomen, and decreased appetite. The condition is diagnosed via imaging and/or lab tests.

Respiratory Failure

Respiratory failure occurs when the lungs fail to do their job of passing oxygen into the bloodstream and removing carbon dioxide. As a result, cells in the body suffer from a lack of oxygen (hypoxemia), too much carbon dioxide (hypercapnia), or both.

Signs of respiratory failure include shortness of breath, rapid breathing, fatigue, lethargy, sleepiness, and confusion. As emphysema progresses, the efficiency of gas exchange in the lungs generally declines, leading to worsening symptoms, disability, and severe illness.

When to Get Medical Help

People with undiagnosed emphysema typically have a history of bronchitis and upper respiratory infections. If you have completed your course of treatment, but still have lingering symptoms talk to your healthcare provider.

You should also see your healthcare provider if you experience unexplained shortness of breath for several months, especially if it interferes with your daily activities. Some people mistakenly think they are out of breath because they are getting older or out of shape, and as a result delay getting a proper diagnosis. Be sure to discuss any unusual symptoms or changes you may be experiencing with your healthcare provider.

A Word From Verywell

Living with emphysema can present unique challenges, and there will be good days along with the bad. Work closely with your healthcare provider to manage your symptoms and have a plan in place to deal with exacerbations when they flare up. Preparing in advance can help to decrease the impact of emphysema on your lifestyle and help you continue to enjoy daily activities.