Emphysema

Emphysema is one of the two main forms of COPD (chronic obstructive pulmonary disease), the other being chronic bronchitis. In emphysema, the tiny air sacs of the lungs break down and merge, losing the surface area needed for oxygen exchange. The main cause in India is tobacco (cigarettes and biri); cooking smoke in rural women and occupational dust are the other big drivers.

Typical features

• Slowly progressive breathlessness, first on exertion (climbing stairs) and later at rest.
• Dry cough (often, but not always, less productive than chronic bronchitis).
• Wheeze, chest tightness, barrel-shaped chest in advanced disease.
• Purple lips, pursed-lip breathing, weight loss in severe cases.
• Worsening episodes ("exacerbations") with respiratory infections.

Diagnosis

• Spirometry (pulmonary function test) — confirms fixed airflow obstruction that doesn't fully reverse with an inhaler.
• Chest X-ray or HRCT shows hyperinflation and characteristic lung changes.
• Oxygen level check (pulse oximetry and sometimes arterial blood gas).
• In non-smokers or early-onset disease — test for alpha-1-antitrypsin deficiency.

Treatment

• Quit tobacco — the only intervention that slows the disease. No inhaler or medicine matches this.
• Long-acting bronchodilator inhalers (LAMA, LABA classes), often combined; inhaled corticosteroid added in some patients.
• Pulmonary rehabilitation — structured exercise, breathing retraining, education. Improves function and reduces hospital admissions.
• Vaccinations — annual flu shot + pneumococcal vaccine.
• Oxygen therapy at home when resting SpO2 is low.
• Non-invasive ventilation for selected advanced disease.
• Lung-volume reduction surgery or endobronchial valves in selected cases.
• Lung transplantation as a last resort.
• Nutritional support — many patients are underweight and benefit from dietary counselling.

Red flags — exacerbation

• Increased breathlessness, more phlegm, change in sputum colour, fever.
• Low SpO2 on home oximeter, confusion, drowsiness, blue lips — hospital urgently.
• Have an action plan with your doctor: antibiotic + steroid short course at first sign of a chest infection often prevents hospitalisation.