Emphysema: what it is, symptoms, causes, treatment and outlook

The NHS says COPD is the name for a group of lung conditions that cause breathing difficulties. It includes emphysema, which is damage to the air sacs in the lungs, and chronic bronchitis, which is long-term inflammation of the airways.

COPD is a common condition that mainly affects middle-aged or older adults who smoke. The NHS says many people do not realise they have it, and that the breathing problems tend to get gradually worse over time and can limit normal activities, although treatment can help keep the condition under control.

The NHS says COPD develops slowly over many years and you may not be aware you have it at first. Most people with COPD do not have any noticeable symptoms until they reach their late 40s or 50s. The common symptoms are:

• Shortness of breath: this may only happen when exercising at first, and you may sometimes wake up at night feeling breathless.

• A persistent chesty cough with phlegm that does not go away, which some people dismiss as a "smoker's cough".

• Frequent chest infections.

• Persistent wheezing.

The NHS says there may be periods when symptoms get suddenly worse, known as a flare-up or exacerbation, and that it is common to have a few flare-ups a year, particularly during the winter.

Less common symptoms include weight loss, tiredness, and swollen ankles from a build-up of fluid. The NHS says chest pain and coughing up blood are usually signs of another condition, such as a chest infection or possibly lung cancer, and only tend to happen when COPD reaches an advanced stage.

If you have sudden or severe worsening of breathlessness, chest pain or coughing up blood, get prompt medical assessment through your GP or NHS 111, and call 999 if you cannot get your breath or feel very unwell.

The NHS says COPD happens when the lungs and airways become damaged and inflamed. The main cause is smoking, thought to be responsible for around 9 in every 10 cases, and the likelihood increases the more you smoke and the longer you have smoked. Some research suggests passive smoking may increase the risk.

• Fumes and dust at work: the NHS lists cadmium dust and fumes, grain and flour dust, silica dust, welding fumes, isocyanates and coal dust. The risk is even higher if you also smoke.

• Air pollution: long-term exposure can affect how well the lungs work, though the NHS says the link with COPD is not conclusive.

• Genetics: you are more likely to develop COPD if you smoke and have a close relative with the condition.

• Alpha-1-antitrypsin deficiency: a rare genetic problem in which the lungs are more vulnerable to damage. The NHS says people with it usually develop COPD at a younger age, particularly if they smoke.

• The NHS says COPD can sometimes affect people who have never smoked.

The NHS says to see a GP if you have persistent symptoms of COPD, particularly if you are over 35 and smoke or used to smoke. The GP will ask about your symptoms, examine your chest, ask whether you smoke or have smoked, and may calculate your BMI and ask about family history of lung problems.

The NHS says there is currently no cure for COPD, but treatment can help slow progression and control symptoms. The main treatments are stopping smoking, inhalers and tablets, pulmonary rehabilitation, and, for a very small number of people, surgery or a lung transplant.

The NHS advises taking prescribed medicines, including inhalers, as this helps prevent bad flare-ups. Everyone with COPD is encouraged to have the annual flu jab and the one-off pneumococcal vaccination.

It also suggests eating foods high in protein and enough calories to maintain a healthy weight, keeping an eye on the weather as cold spells and hot, humid periods can cause breathing problems, and avoiding things that can worsen symptoms, such as dusty places, fumes, smoke, air freshener sprays, strong-smelling cleaning products, hairspray and perfume. You will have regular reviews with your care team.

The NHS says the outlook for COPD varies from person to person. The condition cannot be cured or reversed, but for many people treatment can keep it under control so it does not severely limit daily activities. In some people it may continue to get worse despite treatment, eventually having a significant impact on quality of life and leading to life-threatening problems.

The NHS says that, if you smoke, stopping can help prevent further damage even in more advanced COPD. Ask your care team about your own outlook, as it varies from person to person.

The NHS says there are several conditions that cause similar symptoms to COPD, such as asthma, bronchiectasis, anaemia and heart failure, and that a simple breathing test can help determine if you have COPD.

Most people with emphysema are diagnosed through their GP with spirometry, then managed by the practice with respiratory nurses, pulmonary rehabilitation and, where needed, hospital respiratory teams. Specialist services handle surgery, lung volume reduction and alpha-1-antitrypsin deficiency.

Some people use private respiratory consultations or CT scans to be seen sooner. Share results with your GP, and make sure inhaler technique, vaccinations and a stop smoking plan stay part of your NHS care.