From the Guidelines
Emphysema's primary risk factor is smoking, with long-term cigarette smokers facing the highest risk, as stated in the 2017 report by the Global Initiative for Chronic Obstructive Lung Disease 1. The more you smoke and the longer you smoke, the greater your risk becomes. Other significant risk factors include:
- Exposure to secondhand smoke
- Occupational dust and chemical fumes (such as coal, cotton, grain, or wood)
- Indoor air pollution from burning fuel in poorly ventilated homes
- Outdoor air pollution Age is also a factor, as emphysema typically develops slowly over many years, usually becoming noticeable after age 40. Genetics plays a role, particularly alpha-1 antitrypsin deficiency, a rare genetic condition that can cause emphysema even without smoking, as mentioned in the 1997 BTS guidelines for the management of chronic obstructive pulmonary disease 1. This hereditary disorder reduces a protective protein that shields the lungs. Emphysema develops because these risk factors damage the alveoli (air sacs) in the lungs, destroying their elasticity and causing them to collapse during exhalation, trapping air and making breathing difficult. The best prevention is avoiding tobacco smoke completely, protecting yourself from occupational exposures with proper equipment, and ensuring good ventilation when exposed to indoor pollutants, as emphasized in the 2017 Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease report 1. Additionally, factors in early life, such as childhood disadvantage factors, can also affect lung growth and development, increasing the risk of COPD, as noted in the 2017 report 1. It is essential to consider these risk factors and take preventive measures to reduce the likelihood of developing emphysema and other chronic obstructive lung diseases.
From the Research
Risk Factors for Emphysema
- Genetic factors: Alpha-1 antitrypsin deficiency (AATD) is a known genetic cause of emphysema 2, 3, 4, 5, 6
- Environmental factors: Smoking is the most important risk factor for non-AATD emphysema 2, 6
Mechanisms Underlying Emphysema
- Protease/antiprotease imbalance 2
- Increased oxidative stress 2
- Programmed cell death and autophagy 2
- Impaired repair mechanisms 2
Clinical Variability and Assessment
- Clinical guidelines have prohibited the use of emphysema as a diagnosis, but non-AATD emphysema is a relevant clinical entity 2
- Emphysema associates with dyspnea, reduced exercise capacity, and relevant outcome measures 2
- Assessment and treatment of alpha-1 antitrypsin deficiency have evolved over the years, with intravenous replacement therapy and gene therapy being explored 3, 5