There may be few symptoms at the beginning of the disease. As the air sacs become damaged, shortness of breath with physical activity is usually the first symptom. As emphysema progresses, you may experience shortness of breath even when you're resting. This can make normal activities such as eating difficult, which can lead to a reduced appetite and weight loss. Other symptoms include chest tightness, fatigue, and chronic cough.
As the air sacs become more stretched, air gets trapped in pockets called bullae that form in the lungs. This can produce a characteristic "barrel chest," which is the shape of the hyper-expanded chest.
Chronic lung damage prevents the heart from circulating blood normally. Lung damage can cause pressure elevations in the part of the heart that moves blood through the lungs. This is called pulmonary hypertension and is suspected when people with emphysema develop leg swelling, abdominal bloating, or prominent pulsations in the veins in the neck.
Bullae can rupture outside the lung into the pleural space (the space that surrounds the lung). As the air accumulates outside the lung, it may result in a life-threatening condition called pneumothorax. The body will also attempt to compensate for the low oxygen level by increasing the number of red blood cells (secondary polycythemia). Sometimes, the increase in red blood cells can be so severe that it causes blood clots.