Emphysema is a progressive COPD. The alveoli become enlarged and damaged, trapping air in the over expanded alveoli preventing an adequate exchange of oxygen and carbon dioxide.

Emphysema is caused by smoking cigarettes, by inhaling contaminants from the environment, or by the lack of the alpha1-antitrypsin protein. The lung contains bacteria that release proteolytic enzymes that destroy alveoli. The alpha1-antitrypsin protein inhibits proteolytic enzymes and protects the alveoli.

Excess mucus as well as the residue from cigarette smoking and airborne pollutants find their way down the airways and plug the terminal bronchioles. The network of alveoli then loses their fiber and become inelastic and unable to spring back to size after expanding during inspiration. Alveoli enlarge as many of the alveolar walls are destroyed. Air becomes trapped in the overexpanded alveoli leading to inadequate gas exchange (O2 and CO2).

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