Emphysema usually develops in older individuals (50- 60 years) with a long smoking history. However, people with severe genetic deficiency of Alpha 1 Antitrypsin usually develop symptoms of COPD by the time they reach early middle age (30- 40 years).

Symptoms develop slowly and the patients lose 50- 70% of the lung tissue by the time symptoms begin to appear.

  • Shortness of breath during activity which later on is observed even at rest.
  • Chronic cough may be present but is usually not severe and does not produce much mucus.
  • Wheezing (whistling sound).
  • Bluish discoloration (cyanosis) of skin because of lack of oxygen.
  • Emphysema patient presents as “pink puffers” (because of hypoxia).
  • Other associated symptoms include :
    • Nasal flaring
    • Bulging of eyes with vision abnormalities
    • Difficulty in breathing especially on lying down
    • Dizziness and fatigue
    • Excessive drowsiness especially in daytime
    • Loss of sleep or difficulty in falling asleep
    • Unrefreshing sleep
    • Frequent awakening at night
    • Anxiety and stress
    • Impaired ability to concentrate
    • Memory loss
    • Clubbing of fingers and toes (a sign of chronic hypoxemia i.e. lack of oxygen in blood))
    • Swelling of ankle, feet and legs
  • Signs include :
    • Decreased breath sounds
    • Abnormal breath sounds (rales)
    • Prolonged expiration (expiration is twice as long as inspiration)
    • Barrel shaped chest