Shortness of breath is by far the most common of emphysema symptoms. Most people with emphysema first notice something’s wrong when they become winded during a previously routine activity. This might be climbing stairs or mowing the lawn.

The shortness of breath in emphysema results from structural changes in the lungs. These occur over years in response to lung damage, usually from smoking:

  • The linings between air sacs are destroyed, creating air pockets in the lungs.
  • Air is trapped in these air pockets and is difficult to breathe out.
  • The lungs slowly enlarge, and breathing takes more effort.

In people with emphysema, the muscles responsible for breathing have to work harder, and tire out sooner. The result is feeling breathless — at first with activity — and at rest in advanced emphysema.

Other Emphysema Symptoms

Virtually everyone with emphysema experiences shortness of breath, especially with exertion. Many people with emphysema develop some of the other emphysema symptoms:

  • Wheezing: This symptom of emphysema is shared with asthma. Wheezing often improves with inhaled medicines called bronchodilators.
  • Cough: A large proportion of people with emphysema experience a cough. Often this is related to smoking. However, cough can persist as one of the symptoms of emphysema after quitting smoking.
  • Chest tightness or pain: These may be symptoms of emphysema or of coexisting heart disease. Chest tightness occurs more often with exercise or during periods of breathlessness.

People with emphysema may also face some other less common emphysema symptoms:

  • Loss of appetite and weight loss
  • Depression
  • Poor sleep quality
  • Decreased sexual function

These symptoms of emphysema occur more often in its advanced stages.

Symptoms of Emphysema Are Slowly Progressive

Symptoms of emphysema are progressive, meaning they can be expected to get worse over time. The rate at which breathlessness worsens depends mainly on whether someone with emphysema continues to smoke.

The lungs slowly lose function with age, even in nonsmokers. In people with emphysema, smoking accelerates this loss of lung function. If a smoker with emphysema quits, he or she can reduce the rate of decline to that of a nonsmoker.

Most people experience the onset of emphysema slowly and gradually. In smokers who develop emphysema, symptoms usually begin between age 45 and 60.

It’s difficult to predict the rate of progression of emphysema symptoms. Much is unknown about why emphysema occurs and in whom.

In some people, emphysema symptoms progress faster than in others. It’s believed that genetic factors make some people more vulnerable to developing emphysema. Genetics may also cause some people’s emphysema symptoms to progress more rapidly.

The majority of people with emphysema, though, can expect relatively slow progression of emphysema symptoms, provided they quit smoking.


Symptoms of emphysema describe what a person with emphysema feels. Signs of emphysema are what doctors look for to help identify emphysema and its severity. Signs of emphysema include:

  • Barrel chest: People with emphysema may have a rib cage that’s larger than normal, especially from front to back. This results from the lung expansion in emphysema.
  • Clubbing: The tips of the fingers may become rounded, because of low blood oxygen levels in advanced emphysema.
  • Pursed-lip breathing: To make breathing easier in severe emphysema, people may breathe rapidly through pursed lips.
  • Polycythemia: The body produces an excessive amount of hemoglobin and red blood cells, which carry oxygen in the blood.
  • Hypoxemia (hypoxia): Low oxygen levels in the blood, detected on pulse oximetry or arterial blood gas testing.
  • Hypercarbia: High levels of carbon dioxide in the blood. This results from an inability to exhale carbon dioxide properly in emphysema.
  • Cyanosis: Blue-tinged lips, from low blood oxygen in severe emphysema.
  • Malnutrition: Muscles slowly waste away in advanced emphysema.

Most signs of emphysema develop only in its advanced stages, when emphysema symptoms are severe.

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