Emphysema
Emphysema | |
---|---|
lung volume reduction[4] | |
Medication | Inhaled bronchodilators and corticosteroids[4] |
Emphysema is any air-filled enlargement in the body's tissues. and is also known as pulmonary emphysema.
Emphysema is a
When associated with significant airflow limitation, emphysema is a
There are four types of emphysema, three of which are related to the anatomy of the
Signs and symptoms

Emphysema is a respiratory disease of the
Early symptoms of emphysema vary. They can include a cough (with or without sputum), wheezing, a fast breathing rate, breathlessness on exertion, and a feeling of tightness in the chest. There may be frequent cold or flu infections.[1] Other symptoms may include anxiety, depression, fatigue, sleep problems and weight loss. These symptoms could also relate to other lung conditions or other health problems;[21] therefore, emphysema is often underdiagnosed.[citation needed] The shortness of breath emphysema causes can increase over time and develop into chronic obstructive pulmonary disease.
A sign of emphysema in smokers is a higher number of alveolar macrophages sampled from the bronchoalveolar lavage (BAL) in the lungs. The number can be four to six times greater in those who smoke than in non-smokers.[22]
Emphysema is also associated with barrel chest.
Types
There are four main types of emphysema, three of which are related to the anatomy of the
Only the first two types of emphysema – centrilobular and panlobular – are associated with significant airflow obstruction, with that of centrilobular emphysema around 20 times more common than panlobular.[17] The subtypes can be seen on imaging but are not well-defined clinically.[18] There are also a number of associated conditions including bullous emphysema, focal emphysema, and Ritalin lung.
Centrilobular

Centrilobular emphysema, also called centriacinar emphysema, affects the centre of a
Panlobular
Panlobular emphysema, also called panacinar emphysema, affects all of the alveoli in a lobule, and can involve the whole lung or mainly the lower lobes.
Complications
Likely complications of centrilobular and panlobular emphysema, some of which are life-threatening, include: respiratory failure, pneumonia, respiratory infections, pneumothorax, interstitial emphysema, pulmonary heart disease, and respiratory acidosis.[25]
Paraseptal
Paraseptal emphysema, also called distal acinar emphysema, relates to emphysematous change next to a pleural surface, or to a fissure.[18][26] The cystic spaces known as blebs or bullae that form in paraseptal emphysema typically occur in just one layer beneath the pleura. This distinguishes it from the honeycombing of small cystic spaces seen in fibrosis that typically occurs in layers.[26] This type of emphysema is not associated with airflow obstruction.[27]
Bullous
When the subpleural bullae are significant, the emphysema is called bullous emphysema. Bullae can become extensive and combine to form giant bullae. These can be large enough to take up a third of a hemithorax, compress the lung parenchyma, and cause displacement. The emphysema is now termed giant bullous emphysema, more commonly called vanishing lung syndrome due to the compressed parenchyma.[28] A bleb or bulla may sometimes rupture and cause a pneumothorax.[17]
Paracicatricial
Paracicatricial emphysema, also known as irregular emphysema, is seen next to areas of
HIV associated
Classic lung diseases are a complication of HIV/AIDS with emphysema being a source of disease. HIV is cited as a risk factor for the development of emphysema and COPD regardless of smoking status.[30] Around 20 percent of those with HIV have increased emphysematous changes. This has suggested that an underlying mechanism related to HIV is a contributory factor in the development of emphysema. HIV associated emphysema occurs over a much shorter time than that associated with smoking; an earlier presentation is also seen in emphysema caused by alpha-1 antitrypsin deficiency. Both of these conditions predominantly show damage in the lower lungs, which suggests a similarity between the two mechanisms.[31]
Alpha-1 related
Emphysema may develop in some people with alpha-1 antitrypsin deficiency, the only genotype of chronic obstructive pulmonary disease. This usually occurs a lot earlier (as does HIV associated emphysema) than other types.[32]
Ritalin lung
The intravenous use of
CPFE
Combined pulmonary fibrosis and emphysema (CPFE) is a rare syndrome that shows upper-lobe emphysema, together with lower-lobe interstitial fibrosis. This is diagnosed by CT scan.[34] This syndrome presents a marked susceptibility for the development of pulmonary hypertension.[35]
SRIF
Smoking-related interstitial fibrosis (SRIF) is another type of fibrosis that occurs in emphysematous lungs and can be identified by pathologists. Unlike CPFE, this type of fibrosis is usually clinically occult (i.e., does not cause symptoms or imaging abnormalities). Occasionally, however, some patients with SRIF present with symptoms and radiologic findings of interstitial lung disease.[36]
Congenital lobar
Congenital lobar emphysema (CLE), also known as congenital lobar overinflation and infantile lobar emphysema,
Focal
Focal emphysema is a localized region of emphysema in the lung that is larger than alveoli, and often associated with
Occupational
A number of occupations are associated with the development of emphysema due to the inhalation of varied gases and particles. In the US
The inhalation of
Ozone-induced emphysema
Ozone is another pollutant that can affect the respiratory system. Long-term exposure to ozone can result in emphysema.[46]
Osteoporosis
Other terms
Compensatory emphysema is overinflation of part of a lung in response to either removal by surgery of another part of the lung or decreased size of another part of the lung.[48]
Lung volume reduction
Lung volume reduction may be offered to those with advanced emphysema. When other treatments fail, and the emphysema is in the upper lobes, a surgical option may be possible.
Surgical
Where there is severe emphysema with significant hyperinflation that has proved unresponsive to other therapies,
Bronchoscopic
Minimally invasive bronchoscopic procedures may be carried out to reduce lung volume. These include the use of valves, coils, or thermal ablation.[54][55] Endobronchial valves are one-way valves that may be used in those with severe hyperinflation resulting from advanced emphysema; a suitable target lobe and no collateral ventilation are required for this procedure. The placement of one or more valves in the lobe induces a partial collapse of the lobe that ensures a reduction in residual volume that improves lung function, the capacity for exercise, and quality of life.[56]
The placement of endobronchial coils made of
Both of these techniques are associated with adverse effects, including persistent air leaks and cardiovascular complications. Bronchoscopic thermal vapor ablation has an improved profile. Heated water vapor is used to target affected lobe regions, which leads to permanent fibrosis and volume reduction. The procedure is able to target individual lobe segments, can be carried out regardless of collateral ventilation, and can be repeated with the natural advance of emphysema.[59]
Other surgeries
Lung transplantation – the replacement of either a single lung or both (bilateral) – may be considered in end-stage disease. A bilateral transplant is the preferred choice as complications can arise in a remaining single native lung; complications can include hyperinflation, pneumonia, and the development of lung cancer.[60] Careful selection as recommended by the National Emphysema Treatment Trial (NETT) for transplant surgeries is needed as in some cases there will be an increased risk of mortality.[49] Several factors, including age and exercise tolerance using the BODE index need to be taken into account.[60] A transplant is considered only when there are no serious comorbidites.[50] A CT scan or a ventilation/perfusion scan may be useful to evaluate cases for surgical interventions and to evaluate post-surgery responses.[61] A bullectomy may be carried out when a giant bulla occupies more than a third of a hemithorax.[50]
In other tissues
Trapped air can also develop in other tissues such as under the skin, known as
History

The terms emphysema and chronic bronchitis were formally defined in 1959 at the CIBA guest symposium, and in 1962 at the American Thoracic Society Committee meeting on Diagnostic Standards.[65] The word emphysema is derived from Ancient Greek ἐμφύσημα 'inflation, swelling'[66] (referring to a lung inflated by air-filled spaces), itself from ἐμφυσάω emphysao 'to blow in, to inflate',[67] composed of ἐν en, meaning "in", and φυσᾶ physa,[68] meaning "wind, blast".[69][70]
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- ^ Gold Report 2021, pp. 20–23, Chapter 2: Diagnosis and initial assessment.
- ^ Gold Report 2021, pp. 33–35, Chapter 2: Diagnosis and initial assessment.
- ^ a b c Gold Report 2021, pp. 40–46, Chapter 3: Evidence supporting prevention and maintenance therapy.
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- "Gold report 2021" (PDF). Global Initiative for Chronic Obstructive Lung Disease. 2021.
External links
- Encyclopædia Britannica. Vol. VIII (9th ed.). 1878. pp. 180–181. .