COPD GUIDE · EMPHYSEMA
Emphysema: What Is Air Trapping and How Is It Treated?
Prof. Dr. Yalçın Karakoca · Last updated: 25 September 2026
SHORT ANSWER
Emphysema is the type of COPD in which the walls of the air sacs in the lungs break down and the lung loses its elasticity. When you breathe out, the air cannot empty fully and builds up in the lungs (air trapping). Its main symptom is shortness of breath on exertion that gradually gets worse. The diagnosis is confirmed with a chest CT scan. The basic treatment is medicines, exercise and, if needed, oxygen. In some patients with advanced emphysema, symptoms persist despite medicines. In selected patients, methods such as a lung valve, or surgery, may reduce shortness of breath. The valve is placed using a thin tube with a camera at its tip (bronchoscope), which is passed through the mouth.
Why does air trapping cause shortness of breath?
A lung that has lost its elasticity cannot empty itself when you breathe out. With each breath, a little more air stays inside. The overinflated lung flattens the diaphragm and widens the rib cage. The breathing muscles have to work under difficult conditions. During exertion, this process speeds up. This is why people need to stop after climbing two floors of stairs.
Types of emphysema: centrilobular, panlobular and paraseptal
Types of emphysema are named according to the part of the lung that is affected. Centrilobular emphysema is usually seen in the upper areas and in smokers; it starts at the centre of the air sacs. Panlobular emphysema involves the lower areas of the lung and affects all of the air sacs. Paraseptal emphysema occurs at the edges of the lung, in areas next to the lining.
Which type predominates, and how treatment will be planned, depends on your doctor’s assessment. In general, the following are kept in mind:
- Stopping smoking
- Using medicines regularly
- Exercise and breathing techniques
- Oxygen treatment if needed
You can read more on our pages on shortness of breath and COPD treatment.
Symptoms and diagnosis
There may be shortness of breath that increases with exertion and a reduced capacity for exercise. Weight loss, a barrel-shaped chest and prolonged breathing out may also be seen. Cough and phlegm are less prominent. A breathing test and measurement of lung volumes are used for diagnosis. A gas transfer test (DLCO) and a thin-section chest CT scan are also carried out. The CT scan shows in which parts of the lung the emphysema is concentrated and the condition of the membranes that separate the lobes. In people who develop emphysema before the age of 45, or who have emphysema in the family, one more test is done. The level of alpha-1 antitrypsin in the blood is checked. This is a protein that protects the lungs.
How does emphysema look on a chest X-ray and CT scan?
In emphysema, a chest X-ray often shows lungs that look more inflated with air than normal. The domes of the diaphragm may be flattened and the chest may be widened from front to back; the lung fields look more transparent. These findings suggest emphysema, but they are not always clear on an X-ray.
Emphysema is assessed in more detail with a CT scan. A CT can show the tissue loss in the air sacs and how widespread the disease is; these images guide the planning of treatment options.
- Over-inflation of the lungs with air
- Flattening of the diaphragm
- Lung fields that look transparent
- Widespread air spaces on CT
Imaging findings alone do not make a diagnosis; see your doctor for an assessment.
Treatment steps
- Stopping smoking, medicines (long-acting bronchodilator inhalers) and vaccines.
- Pulmonary rehabilitation: especially useful for patients with air building up in the lungs.
- Oxygen is used if needed. If the carbon dioxide level in the blood is rising, a breathing machine with a mask may be needed at home.
Bronchoscopic lung volume reduction (in selected patients):
| Method | Who is it suitable for? |
|---|---|
| Lung valve (Karakoca Valve and others) | Patients in whom the lobe to be treated is clearly identified and who have no air flow between the lobes |
| Coil (endobronchial coil) | Some patients who have air flow between the lobes |
| Vapour treatment | Emphysema concentrated in the upper lobes, with an uneven distribution |
Coils and vapour treatment are methods being studied in research and are not offered at every centre.
Surgery and transplant: Lung volume reduction surgery may be considered in some patients. These are patients whose emphysema is concentrated in the upper lobes and whose exercise capacity is low. In end-stage disease, a lung transplant may be considered in selected patients.
Balloon treatment is not aimed at emphysema itself. It is considered separately if there is also marked cough and phlegm alongside the emphysema. → Comparison
Is emphysema fatal?
The outlook varies with the stage of the disease and the person’s general health. Emphysema is a chronic and progressive disease, but its course is not the same in everyone. Stopping smoking, regular treatment and exercise markedly affect the course of the disease and quality of life.
- Shortness of breath may increase over time; this calls for everyday life to be arranged accordingly.
- Smoking can speed up the progression of the disease.
- Flare-ups (sudden worsening of breathlessness) can be brought under control with treatment.
- Medicines, oxygen and, if needed, interventional methods are planned by your doctor.
With the right treatment and follow-up, life with emphysema can be sustained. Decisions are made together with your doctor according to the stage of the disease and your personal situation. You can find the options aimed at reducing lung volume on the pages about the Karakoca Valve and who balloon treatment is for.
PRELIMINARY ASSESSMENT
Is it suitable for you?
Book an appointment and bring your breathing test and chest CT scan reports. We decide together at the consultation. If you are coming from outside Istanbul, an online preliminary consultation can be held first.
Please bring: your breathing test, your chest CT scan report and images (CD/USB), your list of medicines and, if you have one, your blood gas test result.
RELATED PAGES
HAVE A QUESTION?
Frequently asked questions
The questions our patients and their relatives ask most often, with answers. We discuss questions about your own situation together at the consultation.
APPOINTMENT
Book an appointment for a preliminary assessment
To find out whether you are suitable, book a preliminary assessment appointment. Bring your breathing test, chest CT scan report and list of medicines with you.
info@yalcinkarakoca.com · Rüzgarlıbahçe Mah. Cumhuriyet Cad. Hasoğlu Plaza Kat:3, Kavacık / Beykoz, İstanbul
REFERENCES
- International COPD guideline (GOLD 2026 report); Turkish Thoracic Society COPD Diagnosis and Treatment Consensus Report.
This page is for general information purposes. It does not replace a medical examination or diagnosis. Treatment decisions are made during an examination, on an individual basis. In an emergency, call 112.
Medical content review: Prof. Dr. Yalçın Karakoca, Pulmonologist · Last updated: 25 September 2026
References
- Klooster K, et al. Endobronchial valves for emphysema without interlobar collateral ventilation (STELVIO). N Engl J Med. 2015;373(24):2325-2335. PubMed
- Valipour A, et al. Endobronchial valve therapy in patients with homogeneous emphysema (IMPACT). Am J Respir Crit Care Med. 2016;194(9):1073-1082. PubMed
- Kemp SV, et al. TRANSFORM. Am J Respir Crit Care Med. 2017;196(12):1535-1543. PubMed
- Criner GJ, et al. LIBERATE. Am J Respir Crit Care Med. 2018;198(9):1151-1164. PubMed
- Criner GJ, et al. EMPROVE. Am J Respir Crit Care Med. 2019;200(11):1354-1362. PubMed
- Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management and Prevention of COPD, 2026 Report. goldcopd.org
- Agustí A, Celli BR, Criner GJ, et al. Global Initiative for Chronic Obstructive Lung Disease 2023 report: GOLD executive summary. Am J Respir Crit Care Med. 2023;207(7):819-837. PubMed