Stage 1 (Mild) Emphysema

Medically Reviewed by Paul Boyce, MD on March 08, 2024
3 min read

Emphysema happens gradually as tobacco smoke or other pollutants damage the tiny air sacs in your lungs called alveoli. Normally, some 300 million alveoli help bring oxygen into your body and get rid of carbon dioxide. As the alveoli break down, your bronchial tubes can start to collapse, too.

Emphysema can’t be cured. It’s progressive, so over time it will get harder and harder for you to catch your breath. But you might not know you have the disease for the first few years unless your doctor tests your breathing.

Emphysema stages are a measure of how well you can breathe. One widely used guideline is called the Global Initiative for Chronic Obstructive Lung Disease (GOLD). It’s a formula that ranks emphysema in four stages, with 4 being the most serious. Doctors use it as one of many ways to measure your emphysema.

A machine called a spirometer tests your breathing for the GOLD stages. It takes two key measurements:

Forced vital capacity (FVC). This is how much air you can breathe out after taking the biggest breath you can.

Forced expiratory volume-one second (FEV1). This is how much air you can breathe out in the first second after that big breath.

Your doctor uses those numbers to calculate how well you compare to your healthy peers.

You have emphysema if the ratio of FEV1 to FVC is less than 70%. That means that after you exhaled for 1 second, 30% or more of the air in your lungs hasn’t emptied out.

Stage 1 emphysema is when the amount of air you can breathe out in 1 second (your FEV1) is 80% or more of the average for someone of your age, sex, and height.

Stage 1 is also called mild emphysema. But that doesn’t mean your disease is mild.

You could have significant lung damage before you even notice the breathing problems of stage 1, especially if you’re relatively young and otherwise healthy. On the other hand, if you’re older, especially over age 65, even minor breathing problems can start to interfere with basic daily tasks like dressing, cooking, or climbing stairs, and they’re more likely to cause symptoms or send you to the hospital.

Once your doctor diagnoses your emphysema and determines your GOLD stage, they’ll look at a number of other signs and symptoms to fully evaluate your condition. They’ll want to know if you:

  • Have problems sleeping
  • Make high-pitched wheezing sounds when you breathe
  • Cough often, or cough up colored mucus
  • Have low blood-oxygen levels
  • Have flare-ups when your breathing worsens
  • Have gone to the hospital for your emphysema symptoms
  • Get lung infections
  • Show signs of scarring, holes, or enlargement in your lungs on X-rays and other imaging scans

You can’t reverse your emphysema. But you can ease your symptoms and slow the progress of the disease. And the earlier you act, the better.

Quit smoking. It’s the No. 1 cause of emphysema. If you smoke, quitting is the single best step you can take.

Breathe smarter. You can learn to breathe with pulmonary rehabilitation therapy. You follow a set of breathing techniques and physical exercises to lessen breathlessness and boost your stamina. Your doctor or a specialized breathing therapist can help design a program for you.

Get to a healthy weight. In early emphysema, you may need to lose some pounds. But as your disease gets worse, you might find yourself needing to put weight back on. Nutritional therapy from your doctor or a nutritionist can help you customize a diet based on your size, health, and activity level.

Bronchodilators. You inhale these medications to relax and to expand your airways. This allows more air into your lungs so your body gets more oxygen. Talk to your doctor about which type is right for you.

Oxygen. If your blood oxygen levels get low for too long, your doctor might suggest taking in extra oxygen from a machine through tubes that go into your nose. It helps the most if you have severely low blood oxygen levels, not just moderately low. You and your doctor will go over your oxygen needs every 2 to 3 months.