You can have emphysema for many years without noticing any signs or symptoms. The main symptom of emphysema is shortness of breath, which usually begins gradually. You may start avoiding activities that cause you to be short of breath, so the symptom doesn’t become a problem until it starts interfering with daily tasks. Emphysema eventually causes shortness of breath even while you’re at rest.

Shortness of breath is the most common symptom of emphysema. Cough, sometimes caused by the production of mucus, and wheezing may also be symptoms of emphysema. You may notice that your tolerance for exercise decreases over time. Emphysema usually develops slowly. You may not have any acute episodes of shortness of breath. Slow deterioration is the rule, and it may go unnoticed. This is especially the case if you are a smoker or have other medical problems that limit your ability to exercise.

The shortness of breath in emphysema results from structural changes in the lungs.

The linings between air sacs are destroyed, creating air pockets in the lungs.

Air is trapped in these air pockets and is difficult to breathe out.

The lungs slowly enlarge, and breathing takes more effort.

In people with emphysema, the muscles responsible for breathing have to work harder, and tire out sooner. The result is feeling breathless — at first with activity — and at rest in advanced emphysema.

Signs of emphysema include:

1. Barrel chest: People with emphysema may have a rib cage that’s larger than normal, especially from front to back. This results from the lung expansion in emphysema.

2. Clubbing: The tips of the fingers may become rounded, because of low blood oxygen levels in advanced emphysema.

3. Pursed-lip breathing: To make breathing easier in severe emphysema, people may breathe rapidly through pursed lips.

4. Hypoxemia (hypoxia): Low oxygen levels in the blood, detected onpulse oximetry or arterial blood gas testing.

5. Cyanosis: Blue-tinged lips, from low blood oxygen in severe emphysema.

6. Malnutrition: Muscles slowly waste away in advanced emphysema.