Emphysema And Smoking

What is emphysema?

Emphysema is a common lung disease worldwide characterized by airflow obstructions that develop gradually and cause respiratory problems. It is part of a group of diseases known as a chronic obstructive pulmonary disease (COPD), which besides emphysema, also includes chronic bronchitis.1,2

The disease usually results from a combination of long-term environmental exposure to harmful substances and individual factors, including genetics. In this context, smoking is the main risk factor for emphysema, while other risk factors include air pollution and occupational exposure. Even though there is no cure for emphysema, there are effective treatments that can slow its progression.1,2

To understand how emphysema occurs, we need to consider that our lungs have millions of small air sacs called alveoli. In a healthy scenario, the alveoli are elastic, so when we inhale air, the alveoli fill up and draw oxygen to the blood, and when we exhale, they shrink and force carbon dioxide out. In emphysema patients, the alveoli are damaged and lose their elasticity or even rupture, forming a big sac instead of many small ones. This, in return, decreases the amount of oxygen being carried to the blood and traps the air in the alveoli, making it difficult for the air to flow in and out of the lungs.1,2


The symptoms of emphysema usually develop gradually over the years, meaning that in the beginning, people with the condition might have no symptoms or just mild symptoms, which evolve into more severe symptoms as the disease progresses.1,2

Symptoms of emphysema include:

  • Shortness of breath - the most common symptom of emphysema. It usually evolves gradually, occurring only with more intense physical activity in the beginning, and then progresses to occurring with simple daily tasks or even at rest.
  • Long-term coughing - usually with an increased amount of mucus.
  • Wheezing - a squeaky sound that occurs when breathing, mainly when pushing the air out.
  • Feeling a tightness in the chest
  • Fatigue
  • Weight loss

Other symptoms might occur, and several conditions can cause a similar set of symptoms. Therefore, if you have any symptoms or concerns, consult with your doctor as only they can determine if you have emphysema.  

What does smoke do to the lungs?

Smoking is the main risk factor for emphysema worldwide, mainly because it leads to changes in the lungs that cause an irreversible limitation of airflow. Tobacco smoke irritates and inflames the alveoli, making the alveoli lose their elasticity and even rupture. These changes, in turn, cause the air to be trapped in the lungs and decrease the amount of oxygen carried to the blood. The damage to the alveoli caused by smoking is irreversible, thus, emphysema cannot be cured.1,2

Smoking causes flare-ups of emphysema

Because tobacco smoke irritates and inflames the alveoli in the lungs, smoking is a prominent trigger that can lead to emphysema flare-ups. Flare-ups are characterized by a sudden worsening of respiratory symptoms that require additions or changes in treatment. Second-hand smoke is also a trigger for emphysema flare-ups, so people with the condition should avoid being around others who are smoking. It is important to note that emphysema flare-ups require proper and careful management because it can be a life-threatening condition.1,2

Emphysema flare-ups can be life-threatening

Besides negatively affecting lung function, worsening the quality of life of people with the condition, and the disease’s prognosis, emphysema flare-ups can be life-threatening. Most commonly, emphysema flare-ups are triggered by a respiratory tract infection causing a worsening of respiratory symptoms, with the most common symptom being shortness of breath. Mild cases can usually be treated at home, following doctors’ prescriptions, but more severe cases may require hospitalization. In such cases, patients often have to be readmitted to the hospital within 90 days after discharge and mortality greatly increases after repeated readmissions.1,2

Tips for quitting smoking

From a public health perspective, smoking cessation is considered the most effective treatment for emphysema. It decreases emphysema symptoms and improves the quality of life of people with the condition, so it is highly advisable that people with emphysema stop smoking.2,3

Smoking cessation comes with challenges, but several effective treatments and forms of support are available. Pharmacological treatments include nicotine replacement therapy, varenicline, and bupropion. Behavioural treatments include motivational interviews and cognitive behaviour therapy (CBT). Additionally, mobile applications for smoking cessation are a promising intervention that might help people to stop smoking.2,3 Discuss with your general practitioner what type of treatment best suits you. 

Useful tips that can help with smoking cessation include:

  • Pick a quit date and plan accordingly
  • Inform family and friends about your plan to quit
  • List the reasons that make you want to quit
  • List the situations that trigger you to smoke and try to avoid them as much as possible
  • If you managed to stop smoking before, remember what helped and make use of that

For many people, it takes a few attempts before they can quit smoking, so do not be demotivated in case it takes you a few tries before you successfully stop smoking. Any time spent not smoking is beneficial for your respiratory health, and with every attempt, you learn new techniques that work for you to stop smoking. 


Emphysema is a lung disease characterised by shortness of breath due to airflow obstructions. Besides shortness of breath, its symptoms include long-term coughing, wheezing, tightness in the chest, fatigue, and weight loss. Tobacco smoking is the main risk factor for emphysema worldwide as tobacco smoke irritates and inflames the lungs, which can lead to changes that cause an irreversible limitation of airflow. Additionally, smoking can cause emphysema flare-ups, characterized by a sudden worsening of respiratory symptoms requiring treatment. Proper management of flare-ups is essential since emphysema can be a life-threatening condition. Importantly, smoking cessation is the most effective treatment for emphysema, and many treatments are available to help people stop smoking. Moreover, useful tips for people that are quitting smoking include picking a quit date and informing family and friends about their quitting plan. 


  1. Rabe KF, Watz H. Chronic obstructive pulmonary disease. The Lancet 2017;389:1931–40. https://doi.org/10.1016/S0140-6736(17)31222-9.
  2. Reis AJ, Alves C, Furtado S, Ferreira J, Drummond M, Robalo-Cordeiro C. COPD exacerbations: management and hospital discharge. Pulmonology 2018;24:345–50. https://doi.org/10.1016/j.pulmoe.2018.06.006.
  3. Hartmann-Boyce J, Livingstone-Banks J, Ordóñez-Mena JM, Fanshawe TR, Lindson N, Freeman SC, et al. Behavioural interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database of Systematic Reviews 2021, Issue 1. Art. No.: CD013229. https://doi.org/10.1002/14651858.CD013229.pub2.

Juliana Lima Constantino

Medical Doctor and Master Student in Epidemiology, University of Groningen, Netherlands

Juliana completed her studies in Medicine in Brazil in 2019, during which she studied a year abroad in The Netherlands at Vrije Universiteit Amsterdam and took a Medical Elective in England at Oxford University.

After graduating, she worked as a general practitioner and as an emergency doctor in the frontline against COVID-19 in Brazil. In 2021, she moved to the Netherlands to do her Master in Epidemiology.

She is currently working on her Master Thesis in the Global Health Department, with a focus on maternal and child health. She is passionate about medical writing as it serve as a way of spreading trustworthy knowledge to everyone.

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