Emphysema, pathological or physiological enlargement or over distention of the air sacs of the lungs.
A major cause of pulmonary insufficiency in chronic cigarette smokers, emphysema is a progressive disease that commonly occurs in conjunction with chronic bronchitis. It is found predominantly in people over age 45, but a genetically based early-onset form also exists. Symptoms are difficulty in breathing, cough with thick sticky sputum, and a bluish tinge of the skin. Progressive disease can result in disability, and in severe cases heart or respiratory failure and death.

Symptoms of Emphysema

Clinical signs at the fingers include cigarette stains (although actually tar) and asterixis (metabolic flap) at the wrist if they are carbon dioxide retainers (NOTE: finger clubbing is NOT a general feature of emphysema). Examination of the face reveals a ruddy complexion (if there is a secondary polycythemia), pursed-lipped breathing, and central cyanosis. Examination of the chest reveals increased percussion notes (particularly over the liver) and a difficult to palpate apex beat (all due to hyperinflation), decreased breath sounds, audible expiratory wheeze, as well as signs of fluid overload (seen in advanced disease) such as pitting peripheral edema.

Classically,clinical examination of an emphysematic patient reveals no overt crackles, however, in some patients the fine opening of airway ‘popping’ (dissimilar to the fine crackles of pulmonary fibrosis or coarse crackles of mucinous or oedematous fluid) can be heard.

Emphysema patients are sometimes referred to as “pink puffers”. This is because emphysema sufferers may hyperventilate to maintain adequate blood oxygen levels. Hyperventilation explains why mild emphysema patients do not appear cyanotic as chronic bronchitis (another COPD disorder) sufferers often do; hence they are “pink puffers” (able to maintain almost normal blood gases through hyperventilation and not “blue bloaters” (cyanosis; inadequate oxygen in the blood). However, any severely chronically obstructed (COPD) respiratory disease will result in hypoxaemia (decreased blood partial pressure of oxygen) and hypercapnia (increased blood partial pressure of Carbon Dioxide), called Blue Bloaters. Blue Bloaters are so named as they have almost normal ventilatory drive (due to decreased sensitivity to carbon dioxide secondary to chronic hypercapnia), are plethoric (red face/cheeks due to a polycythemia secondary to chronic hypoxia) and cyanotic (due to decreased hemoglobin saturation).


Symptoms of: | Emphysema | Emphysema Symptoms | Stages of Emphysema