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Understanding emphysema: Emphysema – Symptoms and causes

Understanding the First Signs of Emphysema

The Centers for Disease Control and Prevention (CDC) estimates that about one in seven U.S. adults, from middle age to advanced age, suffer from a lung disorder. While as many as 10 percent of those people have mild cases, lung issues are the third leading cause of death in the U.S.

People who have common lung diseases, like asthma, emphysema, chronic bronchitis and chronic obstructive pulmonary disease (COPD) have reduced air flow, which causes shortness of breath. No matter what your age, shortness of breath can impact your daily life and limit your ability to participate in activities you enjoy. Seniors who live in communities, like Lakeland Rehabilitation and Health Care Center, are in the care of experts with experience supporting symptoms of these diseases and helping to maintain a lifestyle they enjoy.

If you or a loved one may have a lung disease, it helps to understand the first signs of COPD in seniors, as well as the first signs of emphysema and how to find the support you need on your health journey.

What are the First Signs of COPD in Seniors?

In the early stages, COPD may be mild enough that you do not experience or notice any symptoms. Overall, symptoms vary from person to person; however, the disease is progressive and the first signs of COPD in seniors often include:

  • A chronic cough (meaning a cough that persists for longer than two months)
  • Producing too much mucus
  • Tiredness and shortness of breath

Because your lungs are in a weakened state, COPD patients are more susceptible to chest infections, such as pneumonia, the common cold and the flu. As the disease progresses, you might exhibit symptoms such as:

  • Chest pain
  • Wheezing
  • Chest tightness
  • Coughing up blood
  • Swelling in the lower legs
  • Unintentional weight loss

What are the First Signs of Emphysema?

Emphysema is one of the most commonly known diseases of the lungs and it is a type of COPD. The most common cause of emphysema is long-term exposure to irritants that can damage your lungs, such as tobacco smoke. The disease causes breathing to become more difficult over time. So, what are the first signs of emphysema? Those include:

  • A cough that produces a large amount of mucus
  • Frequent coughing or a cough that wheezes
  • Tightness of the chest
  • A squeaky sound when you breathe
  • Shortness of breath, especially during or after physical activity

It is common for people with emphysema to frequently get sick with respiratory infections, like the flu or a cold. In severe cases of emphysema, patients can have weakness in the lower muscles, swelling in the ankles, legs or feet and weight loss.

Finding Care and Comfort

At Lakeland Rehabilitation, our focus is to help you or your loved one to reach established health goals, in a safe environment, by following a personalized care plan. We work closely with your specialty doctors, personal physician and your family to create an individual plan based on your health goals and your lifestyle. From our fitness programs to our on-site salon and barber shop, we are ready to provide you with a healing experience for your mind, body and spirit.

Contact us today to schedule a tour and learn more about our services and our community.

COPD Stages and the GOLD Criteria: 4 Stages Explained

Written by Matthew Hoffman, MD

Medically Reviewed by Poonam Sachdev on May 15, 2023

  • What Is the GOLD System for Grading COPD?
  • Spirometry and Your COPD Stage
  • GOLD Stages or Grades
  • Symptom Grades
  • Spirometry Grades
  • Exacerbation Risk
  • Other Health Problems
  • COPD Groups
  • COPD Stages
  • Can You Postpone Advanced or End-Stage COPD?
  • The BODE Index
  • More

Chronic obstructive pulmonary disease (COPD) may sound like a single condition, but it includes three kinds of lung disease:

  • Chronic bronchitis
  • Emphysema
  • Chronic obstructive asthma

 All of them can make you feel breathless. Doctors use stages to describe how severe your COPD is. This system is called the GOLD staging or grading system. Your grade will affect what treatment you get.

The system looks at many things. The basic idea is to understand how severe your COPD is and what type of treatment you need.

The GOLD system bases the stage of your COPD on several things:

  • Your symptoms
  • How many times your COPD has gotten worse
  • Any times you’ve had to stay in the hospital because your COPD has gotten worse
  • Results from spirometry, a test that checks the amount of air and speed that you can exhale

GOLD stands for the Global Initiative for Chronic Obstructive Lung Disease. The National Heart, Lung, and Blood Institute, National Institutes of Health, and the World Health Organization started it in 1997.

GOLD helps raise awareness of COPD and works with doctors and other health experts to create better ways to prevent and treat this condition. It also creates the guidelines most doctors use to classify and treat COPD.

Spirometry results are based on two measurements:

  • Forced vital capacity (FVC). This is the largest amount of air you can breathe out after breathing in as deeply as you can.
  • Forced expiratory volume (FEV-1). FEV-1 shows how much air you can exhale from your lungs in 1 second.

The original GOLD system used the term “stages” to refer to the different levels of COPD. Now they’re called “grades.” Experts believe this new system allows doctors to better match patients with the right treatments. The original stages also relied only on FEV results. But now doctors consider other things, too.

Your doctor will assign grades to these four things:

  • How severe your current symptoms are
  • Your spirometry results
  • The chances that your COPD will get worse
  • The presence of other health problems

You’ll answer some questions, either on the COPD Assessment Test (CAT) or the Modified Medical Research Council (mMRC).

CAT scores range from 0 to 40, and mMRC scores have five grades. For example, if you report that you only get winded when you do hard exercise, you might have mMRC grade 0. If you report being so breathless you can’t even leave the house or get dressed, you could have mMRC grade 4.

To check how well your lungs work, your doctor will look at your spirometry results. These results have four grades, too:

  • GOLD 1: Mild
  • GOLD 2: Moderate
  • GOLD 3: Severe
  • GOLD 4: Very severe

Another thing that’s part of your overall COPD assessment is your exacerbation risk. An exacerbation is a time when your COPD symptoms get so much worse that you need to make a change in your medication. Your doctor might also call it a flare. These flare-ups are more likely if your spirometry result is GOLD 3 or GOLD 4.

Your doctor will consider other health problems you have, too. It’s all part of grading your COPD and deciding what type of treatment is best for you.

Based on all of these things – your symptoms, spirometry results, and exacerbation risk – your doctor will put your COPD into one of these groups:

  • Group A (GOLD 1 or 2): Your symptoms are very mild. Your FEV-1 is 80% or more. You might have had no flare-ups over the past year, or perhaps just one. You weren’t hospitalized for your symptoms.

  • Group B (GOLD 1 or 2):Your FEV-1 is between 50% and 80%. You have more symptoms than people in Group A. This is the stage where most people see their doctor for coughing, wheezing, and shortness of breath. You might have had one major flare-up, but you haven’t been in the hospital for your symptoms within the past year.

  • Group C (GOLD 3 or 4): Air flow into and out of your lungs is severely limited. Your FEV-1 is between 30% and 50%. You’ve had more than two flare-ups in the past year, or you’ve been admitted to the hospital at least once.
  • Group D (GOLD 3 or 4): It’s extremely hard for you to breathe in or out. You’ve had at least two flare-ups in the past year, or you’ve been hospitalized at least once. Doctors call this “end-stage” COPD. That means you have very little lung function. Any new flare-ups could be life-threatening.

You may hear people talk about the old system, which staged COPD based on your FEV-1 score alone. There were four stages:

  • Stage 1: Mild – FEV-1 ≥ 80%: You may have no symptoms. You might be short of breath when walking fast on level ground or climbing a slight hill.
  • Stage 2: Moderate – FEV-1 50-79%: If you’re walking on level ground, you might have to stop every ­few minutes to catch your breath.
  • Stage 3: Severe – FEV-1 30-49%: You may be too short of breath to leave the house. You might get breathless doing something as simple as dressing and undressing.
  • Stage 4: Very Severe – FEV-1 ≤ 30%: You might have lung or heart failure. This can make it hard to catch your breath even when you’re resting. You might hear this called end-stage COPD.

It depends on how advanced your COPD is and how well you respond to treatment. No two people are the same. But following these steps for a healthy lifestyle can help:

  • Don’t smoke. If you do, get help to quit.
  • Avoid unhealthy air. Keep away from dust, fumes, and smoke. Stay inside on bad air days.
  • Get a yearly flu shot. Ask your doctor if you need the pneumonia vaccine, too.
  • Eat healthy food. Talk to your doctor about how to keep your weight where it should be.
  • Keep moving. Make sure you get enough exercise.

The BODE Index staging system is an alternative or addition to the GOLD criteria. It measures how much emphysema impacts your daily life. It looks at four main areas:

  • B for body mass index: This describes how much body fat you have, compared to your height and weight.
  • O for obstruction of air: Your doctor can tell how damaged your lungs are by how well you do on pulmonary (lung) function tests.
  • D for dyspnea (breathlessness): Your doctor will ask you a series of questions about how often you feel like you’re out of breath, and when.
  • E for exercise capacity: This measures how far you can walk in 6 minutes.

Studies show the BODE Index gives doctors a good sense of your prognosis. And they can use those findings to see how well you’ll respond to medications, lung rehab therapy, and other treatments.

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Medical Library Dobrobut

Publication date: 2020-03-24

Emphysema: symptoms, causes, diagnosis, treatment

Emphysema is a pathological condition characterized by the expansion of the alveoli and destructive changes in their walls. There are primary (idiopathic) emphysema – an independent nosological form that develops without previous bronchopulmonary pathology, and secondary (obstructive) that occurs against the background of other respiratory diseases. The frequency of pathology increases significantly in the age group over 60 years. The disease belongs to COPD (chronic obstructive pulmonary disease). You should know what emphysema is and how to treat it.

Signs of pulmonary emphysema, causes of the disease

Symptoms of pulmonary emphysema:

  1. Shortness of breath. At the first stage of the disease, it worries patients only with significant physical exertion. With the progression of emphysema, shortness of breath becomes permanent.
  2. Cough. Usually hoarse, unproductive.
  3. Cyanosis. Characteristic for patients with secondary pulmonary emphysema.
  4. Weight loss. Patients are slender and may appear cachectic.

Signs of pulmonary emphysema upon examination of the patient – barrel-shaped chest, hyperfunctioning of the auxiliary respiratory muscles (shoulder girdle, neck, abdominals).

X-ray examination reveals a low location of the dome of the diaphragm, an increase in the retrosternal (retrosternal) space (the so-called Sokolov’s sign), the thread-like nature of the vascular pattern. The most characteristic sign of the condition is a decrease in VC (vital capacity of the lungs) with an increase in their total capacity (TLC). The ECG shows a deviation of the electrical axis of the heart to the right. Data from laboratory studies of the lung disease emphysema – an increased level of hemoglobin and the number of red blood cells.

Causes of the disease

Secondary emphysema develops due to COPD. In primary pulmonary emphysema, the causes may be:

  1. Ecology. Environmental pollution causes damage to the alveolar walls, which leads to the development of emphysema.
  2. Smoking. Tobacco smoke causes the migration of neutrophils, which produce proteolytic enzymes that destroy the walls of the alveoli.
  3. Genetically determined deficiency of alpha-1 antitrypsin, shift towards proteolysis and damage to the alveolar walls.
  4. Occupational hazardous environment, eg miners.
  5. Senile age.

In case of bullous emphysema, bullae are present in the tissues of the organ – swollen areas larger than 10 mm. There is also a decrease in the content of alpha-1-antitrypsin in the blood. This type of emphysema is characterized by the development of spontaneous pneumothorax (accumulation of air in the pleural cavity).

Pulmonary emphysema: treatment

There is no specific treatment for emphysema, therefore, general therapeutic programs are used for all COPD. It is important to eliminate all the factors that caused the development of emphysema (smoking, chronic infection, exposure to polluted air).

Treatment of pulmonary emphysema:

  1. The drugs of choice are bronchodilators: β2-agonists, m-anticholinergics, long-acting theophylline preparations.
  2. Glucocorticosteroids are given orally in short courses. If there is no effect, hormone therapy is no longer prescribed. With a positive result of therapy, it is advisable to continue treatment with inhaled hormonal drugs.
  3. Long-term use of acetylcysteine ​​reduces the frequency of exacerbations of COPD and, consequently, the progression of secondary emphysema.
  4. Thoracoscopic bullectomy – surgical reduction of lung volume by resection of peripheral areas. After the operation, the functional state of the lungs improves significantly.
  5. With the development of spontaneous pneumothorax, the pleural cavity is drained and air is removed.
  6. In severe respiratory failure, oxygen therapy is indicated.
  7. A group of American researchers reported that regular intake of acetylsalicylic acid (aspirin) slows down the progression of emphysema and COPD.
  8. Respiratory gymnastics for pulmonary emphysema is aimed at training the respiratory muscles.

Prevention consists in smoking cessation, prevention of respiratory diseases, influenza vaccination, adequate treatment of chronic inflammatory diseases of the respiratory tract, improvement of working conditions, sanatorium treatment of patients with COPD. Read more about the prevention of emphysema on our website dobrobut.com.

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Bullous emphysema and bullous disease

Emphysema is a disease of the lung in which the lung tissue is “overinflated” due to the gradual destruction of the alveoli. There is a lot of air, but this air does not participate in gas exchange. With bullous emphysema, air bubbles form in the lungs. These blisters are called bullae and are filled with air.

  • Bulla is an air bladder with a diameter of at least 1 cm and having a thin wall (no more than 1 mm).
  • Single or multiple bullae constitute bullous emphysema and bullous lung disease.
  • Bullous emphysema and bullous lung disease are different.
  • 12% of people over 30 years of age have various bullous changes in the lungs.

Bullae occur when the structure of the alveoli and the walls between them are destroyed. Alveoli are tiny sacs made up of a thin membrane. In the alveoli, the process of respiration takes place – oxygen enters the blood, and carbon dioxide from the blood enters the exhaled air.

The process of forming bulls is similar to blowing soap bubbles, when small bubbles combine into large ones, and then even larger ones. The cause of the destruction of the alveoli and interalveolar septa is COPD or congenital pathology of the lungs.

Bullous emphysema is more common in patients with COPD due to panacinar and centrilobular emphysema of both lungs.

In bullous disease – lung tissue without emphysema, and there may be several or one bull. In congenital syndromes such as Marfan and Ehlers-Danlos syndromes, primary bullous lung disease is distinguished


For convenience of description and classification, bullae can be single or multiple.

In case of multiple spread, variants are determined:

  1. several bullae within one (focal) lobe
  2. several bullae in several lobes (multifocal).
  3. bullae are observed in all lobes of the lungs and are called diffuse.

Bullae located near the pleura or scars in the lung tissue can be large. There are such bullae with paraseptal emphysema, they are devoid of blood vessels and interalveolar septa. Another type of bullae are located superficially, may contain vessels and fragments of lung tissue. These bullae lead to pneumothorax.

The third type of bulla is located deep in the lungs. These bullae are rich in vessels and contain a lot of lung tissue.

A special place is occupied by giant bullae – this is a super bulla that occupies more than 1/3 of the lung and compresses the surrounding lung tissue. Giant bullae are characteristic of the lungs of a person who smokes tobacco or marijuana.

Bullous patients, younger than patients with bullous emphysema. This is mainly due to congenital deficiency of α1-antitrypsin, as well as congenital genetic diseases (see Marfan syndrome of Ehlers-Danlos syndrome).

Symptoms of bullous emphysema

Bullous lung disease may be asymptomatic or have severe and life-threatening consequences.

The asymptomatic course of bullous lung disease is a characteristic feature of the disease. Even giant bullae may not cause shortness of breath. After all, there is no emphysema in this condition and gas exchange may not be disturbed.

Shortness of breath, cough are typical symptoms of COPD, against which bullous emphysema occurs as a complication of COPD. Bullae occur in this case against the background of panacinar or centrilobular emphysema.

Bullae may or may not increase in size. Cases of their disappearance or reduction are also described.

Bullae in the lungs can lead to respiratory failure, pneumothorax, bullae suppuration, empyema, hemoptysis.

Bullous deformity may predispose to cancer. According to the literature, lung cancer develops four times in the lung tissue adjacent to the bullae. Therefore, it is necessary to carefully evaluate the lung tissue around the bullae.

Diagnosis of bullous disease

Bullae are detected by CT of the lungs. This study measures the number of bullae, their size and shape. Also, CT will allow you to assess changes in lung tissue, the presence or absence of emphysema, bronchiectasis or other cavities.

CT scan of the lungs excludes cystic diffuse lung disease. They may resemble a bullous deformity.

When diagnosing bullous changes in the lungs, respiratory tests are used – respiratory function, body plethysmography and diffusion test.

For example, bullous emphysema is characterized by obstructive disorders of pulmonary ventilation. And for bullous disease, restrictive violations will be more expected. The exact answer to restriction and obstruction is given by the body plethysmography test.

The diffusion test will evaluate respiratory failure.

Measurement of α1-antitrypsin levels is mandatory for all patients with giant bullae.

All diagnostic tests are required for the following tasks:

  • Exclude other lung diseases similar to bullous disease
  • Determine contraindications for surgical treatment
  • To identify the cause-and-effect relationship of the occurrence of bulls: smoking, marijuana, connective tissue diseases.

Treatment of bullous emphysema

Conservative treatment

If bullous lung disease is detected, a person must stop all types of smoking.

If bullous changes are part of COPD, then standard COPD therapy is used. Bull pills and inhalers do not exist.

During life, bullae may increase in size and number. The patient should be aware of this possibility and understand what symptoms to look out for. The patient should know what symptoms indicate immediate medical attention.

Because bullae may progress over time, patients need to be monitored closely and informed about warning symptoms that require medical attention. There is no conservative treatment for bullous changes.

Surgical treatment

Surgical treatment is called a bullectomy. If a person has a giant bulla, then this is an indication for surgical treatment. The small size of the bullae is difficult to surgically treat and the effect of the operation is negligible.