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Advanced Emphysema

Emphysema is one of the diseases that comprises chronic obstructive pulmonary disease, or COPD. Emphysema is the result of gradual and progressive damage to the lung tissue resulting in destruction of the alveoli or air sacs where oxygen uptake takes place, making it difficult to breath.

Experts at UT Southwestern Medical Center provide comprehensive care plans for patients with advanced emphysema. This starts with evaluation by pulmonologists experienced in the management of advanced COPD, who provide initial evaluation, conventional and new medical therapies, and a comprehensive pulmonary rehabilitation program.

Our team of highly specialized thoracic surgeons and interventional pulmonologists performs leading-edge procedures to treat patients with advanced stages of emphysema. Treatment options include lung volume reduction surgery (LVRS), bullectomy (removing large areas of emphysema or bullae), lung transplantation, and clinical trials involving minimally invasive bronchoscopic techniques.


  • Blue discoloration of lips and nail beds
  • Cough, and coughing a lot of phlegm or mucus
  • Depression
  • Fatigue
  • Frequent lung infections
  • Morning headaches
  • Shortness of breath
  • Sleep problems
  • Weight loss
  • Wheezing

Diagnosis and Staging

More than 3 million people are diagnosed each year with emphysema. It is the 4th leading cause of death in the U.S. The most common cause of emphysema is exposure to tobacco; up to 25 percent of smokers may have emphysema, and many do not know it. Emphysema can also occur in nonsmokers – air pollution, age, and genetic factors, such as alpha-1 antitrypsin deficiency, also play a role.

If we believe that you have advanced emphysema, we will conduct an initial evaluation that includes a physical examination, tests, procedures, and thoracic (chest) imaging studies that may include:

  • A comprehensive pulmonary function test (PFT)
  • Arterial blood gas analysis on room air or on oxygen to determine oxygen and carbon dioxide levels in the blood (a test that measures the function of your lungs)
  • Chest X-rays (radiographs)
  • Computed tomography (CT), including screening for lung cancer
  • Questionnaires to evaluate the degree of breathlessness (dyspnea) and effects of daily activities
  • Overnight oximetry to evaluate oxygen needs during sleep
  • Six-minute walk test to evaluate oxygen needs at rest and during activity

Based on the results of your tests, we will determine the severity (stage) of the disease using the following staging systems:

  • GOLD emphysema staging system: This four-stage system measures disease severity, with stage I referring to less advanced cases of emphysema and stage IV referring to the most advanced cases (measures the degree of airflow limitation on PFTs).

    FEV 1 Staging for Emphysema

    Stage I = mild: Greater than or equal to 80 percent predicted

    Stage II = moderate: Less than 80 percent, greater than 50 percent predicted

    Stage III = severe: Less than 50 percent, greater than 30 percent predicted

    Stage IV = very severe: Less than 30 percent predicted, or less than 50 percent in chronic respiratory failure

  • BODE index – This test evaluates the disease’s impact on a patient’s overall health and ability to function. BODE measures body mass index (BMI), air flow obstruction (FEV1 on PFT), breathlessness or dyspnea, and exercise capacity.


Initial treatment of emphysema is directed at handling or improving emphysema symptoms – mainly shortness of breath, reducing the number of hospitalizations, and helping preserve lung function. These include:

If symptoms and disability persist after maximum medical therapy, our experienced thoracic surgeons, interventional pulmonologists, and transplant pulmonologists treat end-stage emphysema with advanced therapies that include:

  • Placement of endobronchial valves or coils
  • Lung volume reduction surgery (LVRS): Surgeons remove the most diseased parts of the lung, which enables the remaining parts to function more effectively by promoting lung elasticity and improving breathing muscle function
  • Bullectomy: Reserved for patients with giant bulla (functionless large air spaces) that cause hyperinflation of the lung and impair adjacent lung function
  • Resection of lung lesions combined with lung volume reduction surgery in patients with nodules suspicious for malignancy
  • Lung transplantation: Surgeons remove the diseased lungs and replace them with healthy donor lungs

Clinical Trials

In addition to standard treatments for advanced emphysema, UT Southwestern provides access to the most promising new therapies through clinical trials. This includes a variety of new and promising bronchoscopic techniques. Talk with your doctor to see if a clinical trial is right for you.

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