Stage 2 (Moderate) Emphysema

Medically Reviewed by Paul Boyce, MD on November 17, 2021
4 min read

Emphysema happens when smoke from tobacco or other pollutants slowly 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.

That can trap air in your lungs and overfill them. You may need more effort to breathe in and out, which leaves you feeling short of breath. The disease is progressive, meaning that over time, it’ll get harder and harder for you to breathe.

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 to rank emphysema by four stages, with 4 being the most serious. Doctors use the staging as one of many ways to decide how serious your emphysema may be.

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

Forced vital capacity (FVC): How much air you can breathe out after taking the biggest breath you can.

Forced expiratory volume-one second (FEV1): 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 2 emphysema is when the amount of air you can breathe out in 1 second falls between 50% and 79% of the average for someone of your age, sex, and height.

Stage 2 is also called moderate emphysema. But that doesn’t always mean that your disease is moderate.

If you’re young and otherwise healthy, you could have severe lung damage and still be at stage 2. On the other hand, if you’re older, especially over age 65, moderate breathing problems can seriously interfere with basic daily tasks like dressing, cooking, or climbing stairs. And the breathing problems are 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-related infections
  • Show signs of scarring, holes, or enlargement in your lungs on X-rays and other imaging scans


Emphysema is one of three conditions that fall under the umbrella of chronic obstructive pulmonary disease (COPD). The other two are:

You can’t reverse your emphysema or COPD. 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, and all COPD conditions. 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.

Emphysema is a condition that gets worse over time. But treatments can ease your symptoms or slow down your disease progress.

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’s most useful if you have severely low blood oxygen levels, not just moderately low. You and your doctor will typically reassess your oxygen needs every 2 to 3 months.

Surgery: In serious cases, your doctor might suggest lung volume reduction surgery to remove or block off a diseased part of your lung. The purpose is to help improve the stretchiness of your lungs and take pressure off the muscles that help you breathe. This treatment is not right for everyone, but it has shown some promise in certain types of patients with emphysema.

Transplant: If other treatments haven’t helped you, your doctor might recommend surgery to take out one or both of your lungs and replace them with donated organs. Transplants are for people who likely will die without it.