What Is Emphysema and How Does Smoking Cause It?

Emphysema is long-term damage to the tiny air sacs in your lungs that makes breathing harder over time. Most cases come from years of smoking. It is usually counted as a form of COPD. This page is general information from public health sources, not a diagnosis, and only a clinician can tell you what is going on in your lungs.

What is emphysema?

HealthLinkBC describes emphysema as a long-term lung disease that damages the tiny air sacs in the lungs, usually after years of smoking. Health Canada puts it as the gradual and irreversible damage of lung tissue, resulting in shortness of breath. HealthLinkBC’s COPD page explains that in COPD the air sacs are damaged and lose their stretch, which makes it harder to move air in and out.

How does emphysema relate to COPD and chronic bronchitis?

The Public Health Agency of Canada calls COPD an umbrella term for a number of diseases, including chronic bronchitis and emphysema. HealthLinkBC says emphysema is often a type of COPD. Health Canada describes chronic bronchitis as inflammation of the main airways that causes a long-term cough producing phlegm. A doctor may simply say COPD when both are present. For the other half of the picture, see chronic bronchitis, and for the wider overview see our lung diseases guide.

What are the symptoms of emphysema?

The sources we opened describe the main symptom in general terms. HealthLinkBC says breathing gets harder and shortness of breath worsens over time. Health Canada says the main symptom of COPD is shortness of breath during everyday activities, and that symptoms take several years to develop. The Public Health Agency of Canada adds that COPD symptoms usually do not appear before age 55, although the lung changes begin much earlier.

That slow start is why many people put breathlessness down to age or fitness. A fuller list is on our COPD symptoms page, and a cough that will not go away is covered in the guide to smoker’s cough and when to see a doctor. In an emergency, call 9-1-1 or your local emergency number.

What causes emphysema, and how big is the smoking link?

HealthLinkBC says most cases are linked to long-term smoking. The Public Health Agency of Canada reports that cigarette smoking is the principal underlying cause in 80% to 90% of COPD cases. That figure covers COPD as a whole, and we found no Canadian government page that gives a smoking share for emphysema alone.

A rare inherited form exists. HealthLinkBC says it comes from a missing protein called alpha-1 antitrypsin. If you have never smoked and have breathing trouble, raise it with your doctor. To see how your own history adds up, try the pack-year calculator, and read about what smoking does to the lungs.

How is emphysema diagnosed?

The pages we opened do not lay out a diagnostic pathway for emphysema specifically. HealthLinkBC does describe spirometry, a test that measures the amount of air your lungs can move in and out and how fast. You breathe in as deeply as you can, then blow out as hard, fast and completely as you can into a device called a spirometer. It is done in a doctor’s office or hospital and is not painful. Our COPD stages page shows how a spirometry result is used to grade COPD in British Columbia.

If you have smoked for years, lung cancer screening is a separate question. Check the screening eligibility rules and the signs listed under lung cancer symptoms.

Can emphysema be treated?

HealthLinkBC says COPD cannot be cured, but medicines and lifestyle changes may help reduce symptoms. Health Canada lists drugs, oxygen therapy and surgery as treatment options for COPD. Which of these applies to a person is for their care team to decide, and we give no treatment advice here.

What does quitting smoking change?

Health Canada says quitting smoking is the single most effective intervention in preventing further damage to the lungs. It also says the risk of COPD starts to decrease after quitting, that breathing symptoms such as a persistent cough tend to improve, and that the chance of dying from COPD goes down. HealthLinkBC says the best way to slow COPD is to stop smoking.

Since the air sac damage is described as irreversible, quitting protects the lung tissue you still have. Free help is listed in our quit-smoking help by province guide, and the quit smoking hub covers the wider options.

What we could not confirm

• A Canadian government figure for the share of emphysema cases, as opposed to all COPD cases, caused by smoking.
• A step-by-step diagnostic process for emphysema. The spirometry page we opened does not name the diseases the test is used for.
• Whether vaping causes emphysema. None of the pages we opened address it, so we make no claim either way.