The patient with emphysema predominating is from 50 to 75 years old (and most often male) when he first feels the need to see his doctor. He complains of pronounced breathlessness that has suddenly begun bothering him regularly during active pursuits (like playing with grandchildren). Unlike his chronic bronchitic counterparts, the emphysema patient does relatively little coughing, his sputum production is scanty, and upper respiratory infections are only occasional. He tends to be thinoften to the point of emaciationand anxious.

The degree of airflow obstruction in nonsmoking emphysema patients is normally mild. More pronounced airflow obstruction is usually due to an accompanying chronic bronchitis. If this chronic bronchitis component is small, the emphysema patient can remain essentially symptom-free for life aside from his intense breathlessness during mild activitytermed exertional dyspnea.

As long as any coexisting chronic bronchitis remains minor, this patient's oxygen level will fall only temporarilyat the start of an upper respiratory infection. In this "benign" state of affairs, he is much less likely than his chronic bronchitis counterpart to develop cor pulmonale.

The natural history of patients with emphysema predominating, compared to predominantly chronic bronchitis, holds many more gradations in severity. It ranges from increasing shortness of breath during exertion