Emphysema is one of the biggest killers in the UK, but can be reduced by leading a healthy lifestyle. Robert Mair reports.

Emphysema is the destruction and deterioration of the lung and it belongs to a family of related diseases known as ‘Chronic Obstructive Pulmonary Disease’ (COPD), chronic obstructive airways disease and chronic bronchitis being the others).

The disease destroys tissue around small airways in the lungs, which makes it difficult for the lung to keep its shape when you exhale. The lungs work because they comprise millions of these airways, and each has air sacs at the end call alveoli. In a healthy lung, these would be elastic and able to expand when they fill with air, but in a lung riddled with emphysema the alveoli are enlarged and soak up less air. The result is a shortness of breath.

Several reasons contribute to the development of emphysema, but the biggest is cigarette smoking. As emphysema is a cumulative disease, a lifetime of smoking can greatly increase the chances of its development. The disease can also be brought on by an enzyme deficiency and air pollution.

Approximately 835,000 people in the UK have been diagnosed with emphysema or other COPD and there are probably a further 2 million people who remain un-diagnosed. COPD causes 25,000 deaths per year.

Men are more likely to develop emphysema and family genes can also play a part.


Cigarette smoking damages the lungs in several ways, and prolonged smoking over years can dramatically reduce the effectiveness of the lungs. The damage includes:

  • Killing off the cilia cells. These sweep the airways and clear the lower respiratory tract of mucous. Without them mucous builds up, and this is exacerbated by smoking. Consequently, the build-up of mucous is a fertile bacterial breeding ground that can lead to infection.
  • The cells that fight infection also slow down and they struggle to fight with tar from the cigarettes. Over a short period of time this can lead to lung infections, but prolonged smoking can cause these cells to release destructive enzymes into the body.

As well as a shortness of breath, other common signs of emphysema include coughing and wheezing. But as the disease develops over time, it will not be initially apparent that the lungs are no longer working properly – meaning disease often goes unnoticed. Emphysema also affects the ability to exercise, and people with the condition can find they tire quickly. One tell-tale sign is purse-lipped breathing, due to the difficulties somebody with emphysema will have in exhaling.

Nevertheless, as shortness of breath can also be a result of other diseases, including heart disease, medical advice should be sought immediately. To determine whether emphysema is present, the doctor will perform a chest x-ray, and will also examine the breathing pattern. A lung function test can test the mechanics of the lungs, while a blood test can determine if there is an enzyme deficiency. The seriousness of the emphysema can be found by an arterial blood gas test, which looks at the levels of oxygen and carbon dioxide in the blood.


There are several treatments available for emphysema. These include:

  • Medicated inhaler. These are the first course of action, and they allow the air passages to open more, which allows for better respiration.
  • Steroid medications. These reduce inflammation in the body, but are not always successful.
  • Antibiotics. Often severe shortness of breath can be exacerbated by an infection, and treatment of this can stop the development of pneumonia and acute bronchitis.
  • Oxygen. The use of oxygen tanks can help assist breathing, and help get the gas to the lungs.  In hospital, a tube may be placed down the windpipe for machine-assisted breathing. Oxygen tanks are also available for home use.
  • Lung reduction surgery. Because emphysema expands the lungs and kills off cells, lung reduction surgery removes dead lung tissue and improves the breathing quality and lung capacity of the sufferer.
  • Lung transplant. This is usually only offered to people at the most advanced stages of the disease, but it can produce a near cure. However, due to a shortage of donors, not everyone qualifies for a transplant.

No cure exists for emphysema, but there is one thing that can be done to reduce the chances of getting the disease – stop smoking.