Pulmonary emphysema as a clinical picture of COPD

The term pulmonary emphysema is often used by doctors in connection with COPD, diagnoses and lung diseases.

  • But what exactly is pulmonary emphysema?
  • How does it differ from chronic bronchitis?
  • Which treatments and therapies really help with emphysema?

In this article you will find answers to these and other questions.

What is pulmonary emphysema?

The word emphysema means something like “blown in”. In emphysema, the small alveoli at the end of the respiratory tracts – where the oxygen exchange takes place – have been damaged and permanently enlarged. [1]

However, the alveoli are not only enlarged, they also permanently lose their elasticity. [2]

And since the lungs can then no longer contract or can only contract to a limited extent, it becomes more difficult for those affected to exhale completely. In a way, a lung with emphysema behaves like an old, brittle rubber band. [3]

What is COPD with pulmonary emphysema?

Besides chronic bronchitis, pulmonary emphysema is one of the two main symptoms of COPD. Chronic bronchitis is defined by symptoms: Cough and sputum on most days for at least three months in two consecutive years. Emphysema, in turn, describes a change in the structure of the lung, namely a larger volume in the area of the alveoli, as these lose their elasticity. [4]

Pulmonary Emphysema as part of COPD
COPD and asthma are two different diseases. Most people with asthma suffer from an allergy to a certain substance in the environment, but people with COPD are often not allergic. Some people also suffer from both diseases at the same time, this is called “ACOS”.

Many patients with emphysema also suffer from chronic bronchitis and vice versa. A sharp separation between the clinical pictures is also often not possible. However, they share the same main risk factor: smoking. [5]

Causes and development of pulmonary emphysema

Emphysema is therefore part of the clinical picture of COPD, which is based on structural changes in the lungs – in particular on the destruction of the alveoli.

The walls of the alveoli loose elasticity

Gas exchange takes place in the lungs: Oxygen is absorbed into the blood through the thin walls of the alveoli, while CO2 is released into the air by the blood and then exhaled. This oxygen is then distributed throughout the body and serves as fuel for our muscles. [6]

When pollutants, e.g. cigarette smoke, enter the lungs, the cells in the walls of the alveoli react and the tissue becomes inflamed. This inflammation affects the function of the thin walls of the alveoli. This means less oxygen and CO2 can be exchanged. So the body has less fuel. [7]

Inflammation also triggers a reaction. This leads to the release of enzymes that dissolve elastic fibres and thus reduce the elasticity of the respiratory tract. [2]

Instead of stabilizing, the walls of the respiratory tracts become very unstable due to the inflammatory processes and can easily collapse. Collapse means that the airways collapse as described in the next section.

Pressure from breathing can become too high

When you exhale, the air flows through your respiratory tract at high speed and “behind” it, a vacuum is created, like a train passing through a tunnel. It’s like the suction you feel when you stand close to a railway or subway tunnel when a train passes by.

Breathing air triggers a suction in the respiratory tracts – like a train in a tunnel.

Healthy, elastic respiratory tracts can resist this “suction” and remain open. In emphysema, however, this stability has been lost. The bronchial walls are weakened and collapse when exhaled. Once the respiratory tracts have collapsed, air can no longer flow through them. It’s called an obstruction.

Emphysema can collapse airways
Collapsed respiratory tracts in with emphysema

This blockage of the respiratory tracts means that part of the air in the alveoli can no longer be exhaled. If during exhalation the chest and diaphragm continue to press on the lungs, this cut-off air is blown up into alveoli and can damage them. The result is an over-expansion of the lungs. [8]

This can cause the fine walls between the alveoli to dissolve. This slowly transforms the many small air sacs into thin, ever larger air sacs (see picture). This reduces the overall surface area of the lungs and less oxygen can enter the blood from the air. [9]

Overblown air sacs by emphysema
Air sacs in a healthy state (left) and overblown by emphysema (right)

In a healthy person, the alveoli make up an area of 200 m². This is where the gas exchange takes place and this area is almost as big as a tennis court. However, as more and more partitions dissolve, the area becomes smaller and smaller as the disease progresses.

Limited gas exchange due to emphysema
Lung emphysema overblown alveoli can exchange less gas

Pulmonary emphysema can be caused by pollutants such as cigarette smoke and then occurs more centrally in the lungs. On the other hand, it can occur in a so-called “alpha-1-antitrypsin deficiency” – a congenital disease with enzyme deficiency – and then affects the entire lung equally. [10]

The changes in breathing caused by emphysema

During emphysema, the airways obstruct each other and thus block the air’s way out. As described above, the lungs can no longer empty properly when exhaled and the air remains trapped inside the lungs – the so-called air trapping – and cannot be exhaled any further. [11]

Therefore, the maximum amount of air people can exhale with a COPD is less than people without COPD.

Exhale less air, inhale more

Paradoxically, patients with emphysema can often inhale more air than patients with a healthy lung. The alveoli expand very quickly, which is due to the already described lower elasticity of a COPD lung.

Like a loose balloon, more air can be blown in, its resistance is relatively low. However, this air also remains in the balloon, as it no longer contracts as strongly and there is also less tissue and therefore more space overall.

The lung capacity, i.e. the total amount of air in the lungs, of patients with emphysema is often increased.[12]

Fun fact: A study has shown that this air can be exhaled better by strong laughter (here triggered by a clown) – a little humor definitely does not harm and laughter seems to make you really healthy 😉 [13]

Sometimes laughter is really good medicine – even scientifically proven!

Cough, sputum or shortness of breath: symptoms of emphysema of the lungs

Although pulmonary emphysema as a clinical picture is also part of COPD, the symptoms can differ from chronic bronchitis. In most cases, however, patients are affected by both, although not to the same extent.

Difficulty in breathing

The leading symptom of pulmonary emphysema is shortness of breath. However, this develops slowly: The stress limit, i.e. the time until one feels the shortness of breath during movement, only decreases slowly and one gets more and more accustomed to it during the course of the illness.

Many patients think that breathlessness is simply a part of ageing. This is why people see a doctor rather late when the emphysema is already advanced.

To counteract the shortness of breath, for example, you can use the so-called pursed lip breathing: when exhaling, your lips are pressed together or you exhale through a straw.

The pursed lip breathing increases the pressure in the airways. They no longer collapse and a larger part of the trapped air can be exhaled again. [14]

Weight loss

Another symptom of pulmonary emphysema is weight loss. Since less oxygen can be absorbed by the blood, every effort is extremely stressful for those affected by these symptoms. In this way, they often avoid sport and other movements and then suffer from the loss of their muscles and strength. [15]

Many lung emphysema patients suffer from weight loss.

The intensive breathing effort of an emphysema patient consumes a lot of energy. Besides, they often eat less. They perceive eating as strenuous and so pulmonary emphysema often leads to weight loss.[16]

Cough and sputum

The productive cough with sputum often described by COPD patients is not caused by emphysema but mainly by chronic bronchitis and the irritation it causes. You can read more about this in our article on chronic bronchitis.

From the beginning to the end stage: What is the life expectancy in pulmonary emphysema?

Just like chronic bronchitis, emphysema is an incurable disease. Depending on the progress of the disease, life expectancy develops. However, the exact course of the disease varies greatly from patient to patient and is very difficult to predict. [17]

However, both in the early and late stages, there are many ways in which a healthy lifestyle and the right treatment can have a positive effect on the symptoms and progress of the disease.

 Even in an advanced stage you can still enjoy a very high quality of life with the right lifestyle. [18]  

The most important thing is to stop smoking: The symptoms reduce rapidly and the quality of life increases. Life expectancy can also increase drastically. [19] A doctor, the family environment or one of the many lung sports groups, for example, can help you change to a better lifestyle. The Kaia COPD medical app can also help you learn how to deal better with COPD with emphysema.

Treatment and therapies for pulmonary emphysema

There are many drugs against COPD with many different names and new ones are constantly being added. However, they can easily be divided into a few groups that are used at different disease levels.


As a rule, a rapidly effective bronchodilating spray is used and the therapy is extended depending on the stage of the disease. The next options are a particularly long-lasting spray or a practical combination spray of the two classes.

These sprays widen the airways and increase the self-cleaning function, so that pollutants can be better removed[20]. With all these sprays you can quickly lose the overview and that makes it more difficult to inhale them correctly.

Inhalation with medication is part of everyday life for many COPD patients – the right technique is important.

But there are some very good instruction videos. These can also be found in the Kaia COPD App, which can be downloaded here. In the rare cases in which the cause of pulmonary emphysema is an “alpha-1-antitrypsin deficiency”, an attempt is made to remedy the enzyme deficiency by substitution. Regular infusions are therefore used to compensate for the deficiency.


Chronic shortness of breath in the case of pronounced pulmonary emphysema can also be reduced by applying oxygen. The improved oxygen supply then also gives the respiratory muscles the opportunity to recover from their more difficult breathing.

For oxygen therapy there are both large stationary and small, portable devices. However, a minimum of 16 hours per day is required to improve the prognosis. Moreover, the prescription is bound to clear guidelines[21].


Once structural damage has occurred, i.e. the formation of the airbags, it can unfortunately no longer be reversed. In the case of particularly large alveoli that compress the adjacent lung tissue, surgery can sometimes relieve shortterm respiratory distress. [22]

Lung surgery always carries a risk and is only recommended if all other therapies have already been tried.

We would also like to mention that pulmonary emphysema is also the most common cause of lung transplantation. However, this is only possible if all other therapy methods have already been tried without success. [23]

More detailed explanations can be found in the current COPD guideline. Thus, prevention and avoidance of harmful substances (stop smoking!) play the most important role imaginable.

Effective therapies without medication and pulmonary rehabilitation for pulmonary emphysema

It is now undisputed among experts that non-drug therapy measures should be given greater priority in COPD. [24]

The most efficient and thus most important measure in the fight against chronic bronchitis is smoking cessation. The symptoms of COPD are diminishing and the quality of life is increasing rapidly. Besides, your life expectancy will most likely be dramatically increased. [25]

Pulmonary rehabilitation includes, among other things, useful breathing exercises.

Compared to drug therapy, for example, pulmonary rehabilitation also leads to a significant improvement in respiratory distress, performance and quality of life. [26]

Therefore, pulmonary rehabilitation is now generally recommended in every medical guideline, both nationally and internationally, for the treatment of pulmonary emphysema and COPD. In pulmonary rehabilitation you will not only learn efficient techniques to stop smoking, but also the right relaxation and breathing techniques.

The App Kaia COPD is also a good aid for practicing breathing, relaxation and movement exercises. We daily show you the best exercises to effectively treat your COPD yourself at home. Test here for seven days for free.

Sources and scientific studies
  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699955/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658707/
  3. https://my.clevelandclinic.org/health/diseases/9370-emphysema/
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645422/
  5. https://www.ncbi.nlm.nih.gov/pubmed/23204254/
  6. https://www.sciencedirect.com/topics/medicine-and-dentistry/gas-exchange
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966160/
  8. https://copdrp.biomedcentral.com/articles/10.1186/s40749-015-0008-8https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2713323/
  9. http://thorax.bmj.com/content/53/6/501/
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933347/
  11. https://www.atsjournals.org/doi/full/10.1513/pats.200508-094DO
  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528214/
  13. https://www.ncbi.nlm.nih.gov/pubmed/16100149/
  14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695204/
  15. https://link.springer.com/chapter/10.1007/978-88-470-0552-5_33/
  16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672796/
  17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467665/
  18. http://www.atsjournals.org/doi/abs/10.1164/rccm.201204-0596PP/
  19. https://www.ncbi.nlm.nih.gov/pubmed/27922741/
  20. https://www.ncbi.nlm.nih.gov/pubmed/19012226/?dopt=AbstractPlus
  21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645317/
  22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608618/
  23. https://www.aerzteblatt.de/archiv/196398/Rehabilitation-und-Trainingstherapie-bei-chronisch-obstruktiver-Lungenerkrankung
  24. https://www.aafp.org/afp/2010/0915/p655.html/http://www.nejm.org/doi/full/10.1056/NEJMct0804632/

Important notice:

This article contains general information only and may not be used for self-diagnosis or self-treatment. It cannot replace a visit to the doctor.


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