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What causes emphysema other than smoking: Lung development may explain why some non-smokers get COPD and some heavy smokers do not

Lung development may explain why some non-smokers get COPD and some heavy smokers do not

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Tuesday, June 9, 2020

These CT scans of airways (red) and lungs (black) show the spectrum of dysanapsis, with smaller airways in proportion to lung size (left) compared with normal size airways (middle), and larger than normal airways (right).

According to a new study, people with small airways relative to the size of their lungs may have a lower breathing capacity and, consequently, an increased risk for COPD—even if they don’t smoke or have any other risk factors. The study, funded in part by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, will publish in the June 9 issue of JAMA.

Chronic obstructive pulmonary disease (COPD), a debilitating lung condition, often develops as a result of smoking, but researchers have long puzzled over why nearly a third of cases occur in people who never smoked. Now they may finally have an answer—and it may be linked to how lungs develop in certain people. 

“This work, stemming from the careful analysis of lung images of COPD patients, shows that an abnormal lung development may account for a large proportion of COPD risk among older adults,” said James Kiley, Ph.D., director of NHLBI’s Division of Lung Diseases. “More research is needed to understand what drives this occurrence and to devise possible interventions.”

COPD, the fourth leading cause of death in the United States, causes airflow blockage and breathing-related problems that can severely limit a person’s day-to-day activities. Smoking, asthma, or air pollution account for many COPD cases, but up to 30% of cases occur in people who never smoked, and only a minority of heavy smokers develop the disease, suggesting that there are other risk factors at play.

Previous research offered a clue about a possible cause, finding that about half of older adults with COPD appeared to have low lung function early in life. Benjamin Smith, M.D., a pulmonary physician in the Department of Medicine at Columbia University Irving Medical Center, New York City, who was involved in the new study, explained the phenomenon.

When people breathe, they move air through their airways, beginning with the windpipe or trachea, which branches out to smaller airways called bronchi and bronchioles. As people grow, their airways are thought to develop in proportion to their lungs, but in some people, the airways grow smaller or larger than expected—a condition called dysanapsis— for reasons that are not clear.

To find out if small airways might be the culprit for COPD in people who did not smoke or have other risk factors, a team led by Smith looked at records for more than 6,500 older adults participating in three studies that included smokers and nonsmokers with and without COPD. Each study—the Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study, the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS), and the Canadian Cohort of Obstructive Lung Disease (CanCOLD) study—assessed dysanapsis using computed tomography (CT) scans of the lungs.

The MESA Lung study, based in six U.S. cities, included white, African American, Hispanic, and Chinese American people who were age 69 on average. The participants from the CanCOLD study were age 67 on average and came from nine Canadian cities. SPIROMICS, based at 12 U.S. medical centers, included people who were age 63 on average and reported 20 or more pack-years of smoking.

In the MESA Lung and CanCOLD studies, participants with smaller airways relative to lung size were much more likely to develop COPD compared with those with the larger airways relative to lung size. The association remained after considering standard COPD risk factors, including smoking, pollutants, and asthma.

The researchers then focused on participants from the CanCOLD study who never smoked and heavy smokers from the SPIROMICS study. Never smokers with COPD had much smaller airways relative to lung size, whereas the heavy smokers who did not have COPD had larger than normal airways.

“These results show that small airways relative to lung size are a very strong risk factor for COPD,” said Smith, the lead study author. “This helps us to understand why 30% of COPD can occur in people who never smoked.” With normal aging, lung function declines, so people who already have low lung function to begin with may develop COPD later in life, even if they don’t smoke, he explained.

Smith added that the findings may also help explain why some lifelong heavy smokers do not develop COPD. People with larger airways relative to lung size may be able to withstand lung damage from smoking and still have enough breathing reserve to prevent them from developing COPD. Still, given the multiple health problems caused by tobacco, Smith emphasized that smokers should do their best to quit.

The MESA Lung Study was funded by NIH/NHLBI grants R01-HL130506, R01-HL077612, RC1-HL100543, R01-HL093081, and R01-HL121270. MESA was supported by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute. SPIROMICS was supported by contracts from the NIH/NHLBI (HHSN268200900013C, HHSN268200900014C, HHSN268200900015C, HHSN268200900016C, HHSN268200900017C, HHSN268200900018C, HHSN268200900019C, HHSN268200900020C), grants from the NIH/NHLBI (U01 HL137880 and U24 HL141762). Additionally, co-authors Norrina B. Allen, M.D., David J. Couper, Ph.D., Mark T. Dransfield, M.D., Ani Manichaikul, Ph.D., Fernando J. Martinez, M.D., Elizabeth C. Oelsner, M.D., and Robert Paine III, M.D., report receiving grants from NHLBI. Additional institutions outside of NIH also provided funding for research or co-authors involved in this study. For a more complete funding disclosure, please see the full research article.

About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives. For more information, visit www. nhlbi.nih.gov.


About the National Institutes of Health (NIH):
NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health®


Association of dysanapsis with chronic obstructive pulmonary disease among older adults doi:10.1001/jama.2020.6918


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Symptoms, Risk Factors, and More

COPD is a group of lung diseases that most often affects people with a history of smoking. But people who have never smoked can also get COPD.

Smoking is a major risk factor for chronic obstructive pulmonary disorder (COPD). But not all smokers get COPD, and not everyone who has COPD smokes. Even people who have never smoked can get COPD.

COPD is a general term used for conditions marked by permanent inflammation of the bronchi, the tubes that bring air into the lungs. COPD also includes damage to the air sacks of the lungs. This can make it hard to breathe.

COPD affects an estimated 65 million people worldwide. One estimate from the U.S. Centers for Disease Control and Prevention puts the number of people in the United States with COPD at 15.7 million. The actual number is probably much higher, as researchers believe that many more people are not aware that they have the condition.

Also, studies suggest the disease is much more common among non-smokers than previously believed. Between 10 and 20 percent of people with COPD have never smoked. A recent large study of Canadian residents found that non-smokers make up almost 30 percent of those with COPD.

Learn more: COPD’s effects on the lungs in pictures »

Both people who currently do not smoke (non-smokers) and people who have never smoked (never-smokers) can get COPD. Other risk factors besides smoking help predict COPD in never-smokers.

Four major risk factors for COPD are:

  1. Exposure to secondhand smoke: Being exposed to secondhand smoke as an adult can lead to COPD.
  2. Exposure to air pollution: You can develop COPD if you are exposed long-term to air pollution. You can also develop COPD from inhaling dust or the fumes of fuel burned for cooking or heating purposes. COPD can also be caused by chemicals or fumes found in the workplace.
  3. Genetics: COPD has a strong genetic component. As many as 5 percent of people with COPD have a genetic condition known as alpha-1 antitrypsin deficiency. People with this condition have too little alpha-1 antitrypsin, a protein helps protect the lungs from damage. Having too little of it can cause your lungs to deteriorate, leading to COPD. This condition also affects the liver.
  4. Age: Most people who have COPD are over 40 years old.

Additional factors include stressors to young, developing lungs. These factors include maternal smoking during pregnancy, low birth weight, tobacco exposure in childhood, and childhood respiratory infections. These conditions might also help identify people at risk for COPD.

Having asthma may also play a role in developing COPD. One study found that the presence of asthma helped predict COPD in non-smokers.

Common symptoms of COPD include:

  • needing to clear your throat often due to excessive mucus
  • being short of breath, even after mild exercise
  • wheezing, or noisy breathing
  • chest tightness
  • chronic cough
  • having low energy
  • recurrent respiratory infections

The symptoms of COPD are the same in both smokers and non-smokers. But research has shown that never-smokers with COPD may have milder symptoms than both current and former smokers. A Danish study looked at the results of 6,623 people with COPD. Of these people, 1,476 had never smoked, 2,696 were former smokers, and 2,451 were current smokers. People who had never smoked experienced fewer symptoms, a milder form of the disease, and less inflammation than current or former smokers.

COPD is often first diagnosed when people raise concerns with their doctor because shortness of breath has become a problem. However, the symptoms of COPD usually don’t appear until there is already significant lung damage. Because the disease can be less severe in non-smokers, this can lead to them being diagnosed with COPD at a later age.

Non-smokers also have fewer comorbidities, or other conditions that occur at the same time as COPD. But non-smokers can still experience flare-ups of their COPD symptoms, known as exacerbations.

There is no single test to diagnose COPD. Doctors rely on your medical history, physical examination, lung function tests, and chest imaging tests like an X-ray or CT scan.

A key tool used for diagnosing COPD is the lung function test known as spirometry, a test that measures airflow out of your lungs. However, some doctors may rely instead on the presence of smoking and physical symptoms. That has led to a concern that the disease might be overdiagnosed in smokers and underdiagnosed in non-smokers.

To help primary care doctors identify who should be tested for COPD with spirometry, researchers have been working on a simple, five-question test. It’s called CAPTURE: COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk.

“It actually does not include a question about smoking,” says Dr. MeiLan King Han, an associate professor of medicine at the University of Michigan. She says that according to their research, factors other than smoking were more likely to predict who was likely to be diagnosed with COPD. Dr. Han is one of the researchers who helped develop the questionnaire, which appears below.

Learn more: How to manage COPD »

Tips for preventing for COPD usually revolve around telling smokers to quit. If you don’t smoke, don’t start. Another way to reduce your risk of developing COPD is by avoiding secondhand smoke, air pollution, and other fumes or chemicals.

There’s no cure for COPD, but you can prevent the condition from becoming worse. Getting a diagnosis early on and following your treatment plan are the most important steps to slowing the progression of your COPD.

Emphysema: symptoms, treatment and prevention


  • 1 Emphysema: causes, symptoms and treatment
    • 1.1 Emphysema: symptoms, treatment and prevention
    • 1.2 What is emphysema?
    • 1.3 Symptoms of pulmonary emphysema
    • 1. 4 Diagnosis of pulmonary emphysema
    • 1.5 What treatment can be used for pulmonary emphysema?
      • 1.5.1 Main treatments:
    • 1.6 Prevention of emphysema
    • 1.7 Complications of pulmonary emphysema
    • 1.8 Folk remedies for the treatment of pulmonary emphysema
      • 1.8.1 1. Herb tincture
      • 1.8.2 2. Onion decoction
      • 1.8.3 3. False pepper in the treatment of emphysema
      • 1.8 .4 4. Milk decoction with honey
    • 1.9 Problems in the treatment of emphysema
    • 1.10 Types of emphysema
    • 1.11 How can emphysema be prevented?
    • 1.12 Doctors who can help with emphysema
    • 1.13 Related videos:
    • 1.14 Q&A:
        • What is pulmonary emphysema?

Emphysema is a chronic disease that destroys lung tissue and impairs lung function. Symptoms, causes and methods of treatment of this disease are in the article on our website.

Pulmonary emphysema is a disease that is characterized by the destruction of the walls of the small bronchi and alveoli, which leads to a violation of gas exchange in the human body. This is one of the most common respiratory diseases, which often develops against the background of chronic obstructive bronchitis.

Among the main causes of emphysema are tobacco smoking, inhalation of chemicals, as well as hereditary factors. Signs of the disease can appear for a long time, so it is important to consult a doctor in time and start treatment.

An important component of treatment is prevention, which includes quitting smoking, drinking alcohol, regular exercise and proper nutrition. In addition, it is recommended to conduct a timely medical examination to detect diseases in the early stages and the correct prescription of treatment.

Pulmonary emphysema: symptoms, treatment and prevention

Pulmonary emphysema is a chronic disease characterized by gradual destruction of the walls of small air bubbles in the lungs (alveoli). It leads to disruption of gas exchange and a decrease in lung volume.

Treatment of emphysema is aimed at improving the patient’s quality of life and slowing the progression of the disease. This may include medication, physical rehabilitation, and oxygen therapy. In some cases, surgery may be required.

Prevention of emphysema may include avoiding smoking, reducing lung exposure to harmful substances, weight control, and regular physical activity.

What is emphysema?

Emphysema is a chronic disease characterized by destruction of lung tissues and damage to their walls. The main cause of emphysema is smoking, although some forms of the disease can also be inherited or result from occupational activities.

Emphysema leads to a gradual deterioration in lung function and to the development of respiratory failure. Symptoms of emphysema include shortness of breath, fatigue, and intermittent coughing with sputum production. Skin changes on the neck and chest may also occur.

Treatment of emphysema is based on symptom control and improvement of the patient’s quality of life. Doctors usually recommend smoking cessation and also prescribe medications to make breathing easier. In some cases, oxygen therapy or even surgical treatment may be required.

  • Smoking is the main cause of emphysema.
  • Symptoms of emphysema include shortness of breath, fatigue, cough and skin changes.
  • Treatment is aimed at controlling symptoms and improving the patient’s quality of life.

Symptoms of emphysema

Cough: the appearance of a persistent dry cough, which is often aggravated by physical exertion.

Difficulty breathing: at first it appears only during exercise, but eventually begins to occur at rest.

Fatigue: Patients experience rapid fatigue when performing routine tasks such as walking or climbing stairs.

Chest pain: occurrence of pain or pressure in the chest.

Blueness of nails and lips: lack of oxygen can cause pale skin and mucous membranes.

Chest expansion: In advanced emphysema, the chest may expand.

Wheezes and whistles: unusual sounds in the lungs that can be heard when breathing.

Although symptoms may vary, emphysema is characterized by persistent difficulty breathing and fatigue. If you notice any of these symptoms, see your doctor for a proper diagnosis and treatment.

Diagnosis of emphysema

Emphysema is a chronic disease that causes damage to the alveoli of the lungs, causing them to lose their elasticity and become large and inflated.

X-ray tomography or computed tomography can be used to diagnose this disorder. It will allow the doctor to see changes in the lungs and assess their condition.

When diagnosing emphysema, your doctor may also do blood and sputum tests to determine the cause.

What is the treatment for emphysema?

Emphysema is a chronic disease often caused by smoking or long-term exposure to harmful substances. Treatment for emphysema aims to reduce symptoms, improve quality of life, and prevent progression of the disease.

Primary treatments:

  1. Smoking cessation: Smoking cessation is the first step in treating emphysema. If the patient continues to smoke, no medication or procedure can lead to a complete recovery.
  2. Breathing exercises: special breathing exercises help to improve the patient’s quality of life, reduce the frequency of attacks and increase pulmonary ventilation.
  3. Medications: Your doctor may prescribe medicines that dilate the bronchi and improve breathing. Also, anti-inflammatory and mucolytic drugs may be prescribed to reduce inflammation and thin the mucus, respectively.
  4. Oxygen Therapy: This method is used for severe cases of emphysema when the oxygen level in the blood is very low. Oxygen is delivered through a mask or nasal cannula.
  5. Surgery: In some cases, for patients with severe emphysema, surgery may be recommended, such as pulmonary volume resection or lung transplantation. However, these methods are used only in extreme cases.

It is important to remember that emphysema is a chronic disease that cannot be completely cured. Effective treatment can help improve the patient’s condition and prevent disease progression.

Prevention of emphysema

Emphysema is a chronic disease that affects the respiratory system and leads to poor quality of life. However, there are methods that can help prevent the development of this disease:

  • Smoking cessation. Smoking is one of the main causes of emphysema. Therefore, it is important to completely abandon this bad habit.
  • Proper nutrition. The diet should contain vitamins and minerals that contribute to the health of the respiratory system.
  • Healthy lifestyle. Regular exercise and a healthy lifestyle in general will help strengthen the immune system and prevent the development of lung diseases.

If you have a predisposition to developing emphysema, or have already been diagnosed, see your doctor. He will be able to talk about additional methods of prevention and help develop an individual treatment program.

Complications of emphysema

Emphysema is a serious disease that can lead to serious complications. One of the most common complications is chronic obstructive pulmonary disease, which can lead to a deterioration in the patient’s quality of life.

In the case of emphysema, it is very important to take measures to prevent the development of complications. This may include quitting smoking, regular exercise, proper nutrition, and treatment with anti-inflammatory drugs.

  • Chronic obstructive pulmonary disease: impairment of the patient’s quality of life.
  • Hemorrhages in the lungs: Impaired lung function and increased risk of infections.
  • Lung cancer risk: the possibility of developing cancer.
  • Respiratory failure: deterioration of the patient’s condition and impaired lung function.

Folk remedies for the treatment of emphysema

1. Herbal tincture

One of the most common ways to treat emphysema with the help of folk remedies is a tincture of herbs. Cornflower, forest St. John’s wort, St. John’s wort, and also dandelion are usually used as grass.

2. Onion water

Onion is one of the most affordable and effective products for the treatment of emphysema. To prepare onion broth, you need to take 2-3 onions, cut them and pour water. Then the mixture must be brought to a boil and insisted for 30-40 minutes.

3. False pepper in the treatment of emphysema

False pepper is known for its anti-inflammatory properties and can be used to treat emphysema. To do this, you need to prepare a decoction of false pepper, which can be added to food or drunk as a tea.

4. Milk decoction with honey

Milk with honey is a long-known antitussive recipe of folk medicine. It can also be used to treat emphysema. To prepare a decoction, you need to mix milk and honey, heat over a fire and drink daily.

Problems in the treatment of emphysema

The treatment of emphysema may encounter several problems that can hinder the healing process. One such problem is the lack of efficacy of drugs used to reduce inflammation and improve lung function. This can lead to aggravation of symptoms and the development of complications.

Another problem can be the misapplication of lifestyle advice such as quitting smoking and increasing exercise. Failure to follow these recommendations can slow down the healing process and lead to an aggravation of the patient’s condition.

Finally, one of the main problems in the treatment of pulmonary emphysema is the lack of an effective way to restore damaged lung tissue. With severe emphysema, the recovery process may be limited, which can lead to chronic breathing problems.

Types of pulmonary emphysema

Centrilobular emphysema – when the destruction of the alveoli occurs along the central path of the air ducts, and the air channels retain their normal size. This type of emphysema most commonly develops in male smokers and may be associated with upper respiratory disease.

Panacinar emphysema – when the air channels, starting from the small bronchioles, and then the alveoli, are completely expanded. This type of emphysema is most often associated with alpha-1 antitrypsin deficiency.

Bullous emphysema – when huge air pockets – bullae – form in one or more places in the lungs. This type of emphysema can be congenital or acquired and is usually seen in young adults who exercise and smoke.

How can emphysema be prevented?

Like many other diseases, emphysema can be prevented or delayed if certain measures are taken. A few tips to help you avoid this disease:

  • Do not smoke: This is one of the main risk factors for emphysema. If you smoke, you must immediately quit this habit.
  • Avoid harmful substances: Some harmful substances such as dust, toxic fumes, chemical fumes can damage the lungs.
  • Keep your immune system in good shape: This will help you avoid lung infections that can cause emphysema.
  • Maintain a healthy lifestyle: Proper nutrition and regular exercise will help strengthen the lungs and improve their function.

By taking these steps, you can reduce your risk of developing emphysema and stay healthy.

Doctors who can help with emphysema

Emphysema is a chronic disease that cannot be completely cured, but symptoms can be managed and the progression of the disease can be slowed down. There are several specialists who can help patients with emphysema:

  • Therapist . This doctor can help in the diagnosis and initial treatment of emphysema. He will monitor the progress of the disease and refer the patient to other specialists if necessary.
  • Pulmonologist . This doctor specializes in the treatment of lung diseases. Often he will be the chief physician who cares for patients with emphysema. He will provide treatment advice, medication selection and lung monitoring.
  • Physiotherapist . This specialist can help improve respiratory function, which can reduce the symptoms of emphysema. He can recommend exercises that will improve the quality of life and help manage loss of strength.
  • Surgeon . People with severe emphysema who are not benefiting from medications and other treatments may be referred to a surgeon for a procedure to remove part of their lungs. It can improve respiratory function and quality of life.

It is important to find experienced professionals who can help the patient to deal with emphysema. Discuss your options with your therapist and seek the opinions of others who have dealt with emphysema.

Related videos:


What is pulmonary emphysema?

Emphysema is a disease that causes damage to the structure of the lungs and deterioration of respiratory function.

Pulmonary emphysema: diseases, treatment and effects of smoking – GSD

Publication date: 28-07-2022

Updated: 28-04-2023

Subject: Lung diseases

Reading time: 1 min

Author of article

Carolina Cappello

Medical Editor

George Cremona (George Cremona)

Editor and translator

Viktoria Luhakova

According to 2022 data, almost one in four Italians (24. 2% of the population) is a smoker. Rates are up 2% from pre-pandemic levels, not seen since 2006.

Smoking is now well known to be an important risk factor for many diseases, including emphysema. According to the latest estimates, it affects about 210 million people worldwide and can lead to the death of 3 million people every year.

In the past, emphysema was more common in men who were heavy smokers. However, in recent years the scenario has changed: female smokers also suffer from emphysema and much more often than men from chronic obstructive pulmonary disease, which is associated with emphysema, as we will see below.

Early intervention, especially to prevent deterioration in lung function, is not only possible but necessary. We discussed the pathology, its causes, symptoms, methods of diagnosis and treatment together with Dr. George Cremona, Head of Pulmonology and Pathophysiology at Ospedale San Raffaele Hospital.

What is pulmonary emphysema and its types?

“The alveolar tissue is destroyed due to a strong reduction in the surface for gas exchange: once destroyed, the alveolar tissues cannot return to their previous state, they are irreparably damaged,” the doctor explains.

From a morphological point of view, different types of pulmonary emphysema are classified:

  • centrilobular (or centroacinar) pulmonary emphysema, the most common form in smokers;
  • panlobular (or panacinar) emphysema;
  • paraseptal emphysema;
  • atypical lung emphysema.


“One of the first symptoms of emphysema is certainly wheezing and shortness of breath, which progressively increase: first they appear with intense physical exertion, then with routine tasks (for example, climbing stairs) and, finally, in a state of rest. In addition, the progressive destruction of the alveoli and pulmonary capillaries, as well as the lack of oxygen, can lead to an increase in pressure in the pulmonary artery, which can lead to right ventricular heart failure (RVF).

Finally, patients with emphysema are more likely to develop a pneumothorax or tear in the lung tissue, leading to lung collapse.”

In addition to shortness of breath and heart failure, there may be:

  • dry cough and with chronic expectoration of sputum;
  • fatigue;
  • heart problems;
  • fever;
  • cyanosis of lips and nails.

Cigarette smoke and respiratory inflammation

“Inhalation of toxic fumes such as cigarette smoke damages cells and promotes inflammation. This includes removing damaged cells while at the same time inhibiting natural repair mechanisms, leading to the development of emphysema.

The lungs lose their elasticity, the alveoli rupture, creating large air spaces that reduce the surface needed by the body for the exchange of oxygen and carbon dioxide,” explains Dr. Cremona.

This process, associated with chronic inhalation of harmful substances such as cigarette smoke, often occurs together with a condition of chronic inflammation of the airways (chronic bronchitis), leading to another complex disease – chronic obstructive pulmonary disease.

“Let’s not forget that persistent infections of the lower respiratory tract also cause inflammation and, by increasing the secretion of mucus, can contribute to the development of the disease,” the specialist clarifies.

Diagnosis: Tests and Tests

Emphysema usually affects smokers in their 50s and presents insidiously with shortness of breath on exertion, which the patient often associates with age or a sedentary lifestyle.

“Unfortunately, often the patient goes to the doctor only because of bronchitis, after which he can no longer breathe as before. However, by this time the disease is already quite advanced. For this reason, it is very important that GPs proactively screen for the disease in their smoking patients over 40 by finding out whether they often cough or notice shortness of breath during exercise, ”explains Dr. Cremona.

Persistent cough and shortness of breath: early signs

People who smoke should contact their doctor if:

  • cough almost every day for at least 3 months a year for 2 consecutive years,
  • shortness of breath during physical exertion, which did not bother him a year ago.

The general practitioner will be able to take the correct history and physical examination, and then arrange appropriate examinations with a pulmonologist to determine the best therapy and prevention of complications.


The most important test for diagnosing chronic obstructive pulmonary disease is spirometry, which shows the degree of airflow obstruction. This is a non-invasive, economical, easy to conduct and interpret study.

It will be enough for the patient to blow strongly into the air flow device, starting with a deep breath. Normally, a healthy person should be able to exhale 70-80% of all air for the first second of the procedure.

Patients with airway obstruction or loss of lung compliance, as occurs with emphysema, take much longer. This type of obstruction is usually almost refractory to treatment with bronchodilators.

Y other functional tests

When determining the clinical picture, the diagnosis can be confirmed by performing other functional tests, including alveolar-capillary diffusion, which assess both hyperinflation of the lungs and a decrease in the efficiency of gas exchange a, typical of emphysema. In addition, computed tomography of the lungs can early reveal areas of alveolar destruction.

In the most severe cases, pulse oximetry measurement will provide information on blood oxygenation. In addition, arterial blood gas analysis will be useful to check the correct gas exchange in the alveoli, the level of oxygen in the blood, and to predict the correct function of the lungs.


There are no specific treatments to restore lost respiratory function. The only element that can change the natural course of emphysema is a complete cessation of smoking.

“Cessation of smoking reverses the accelerated decline in lung function, slowing down the progressive course of the disease. Unfortunately, it is not easy to get rid of the habit of smoking, but today we have anti-smoking centers that can help in the fight against nicotine addiction and provide psychological support. This combined approach significantly increased smoking cessation success among motivated individuals,” confirms the pulmonologist.

In addition to quitting smoking, the patient is advised to maintain a healthy lifestyle, maintain regular physical activity, and be vaccinated against influenza and pneumococcus.


“Among therapies are bronchodilators, which are used to reduce expiratory restriction by reducing lung hyperinflation and reducing shortness of breath.

Anti-inflammatory drugs are also used, which in some patients can reduce bronchial obstruction and prevent exacerbation of bronchitis and thus preserve lung function. These drugs can relieve symptoms and thus improve the quality of life of patients.

Antibiotics are indicated only in case of exacerbation of chronic bronchitis or pneumococcal pneumonia,” explains Dr. Cremona.

Other treatments

For patients with severe forms that lead to respiratory failure, supplemental oxygen for at least 18 hours per day is recommended to help prevent right ventricular failure.

On the other hand, patients who experience shortness of breath interfering with their daily activities may benefit from respiratory rehabilitation. It consists of a multidisciplinary program to improve exercise tolerance through physiotherapy to strengthen the limbs and respiratory muscles, and to provide educational and nutritional support to help patients cope with disability.

Complications due to emphysema

The most common complications are episodes of worsening shortness of breath and cough, which can sometimes be life threatening. These episodes can lead to further damage to lung function, resulting in a higher degree of disease severity.

Exacerbations are often caused by viral, sometimes bacterial infections or pneumonia. Sometimes they can also be complicated by heart attacks or episodes of heart failure.

“Extra effort should be made to find patients with this disease at the earliest possible stage, immediately start secondary prevention and smoking cessation, initiate appropriate drug therapy, and change his/her lifestyle to counteract the development of the disease from its onset,” — concludes Dr.