Because the onset of the disease is gradual, many cases are not diagnosed until irreversible damage has occurred. Episodes of worsening symptoms (called exacerbations) are common in patients who have emphysema. Exacerbations become more frequent in advanced disease. Other symptoms of emphysema include the following: Cyanosis (bluish tint to the lips, fingertips, and skin; caused by low levels of oxygen [O2] in the blood) Edema (swelling; commonly in the feet and ankles)