What is Emphysema? Types of Emphysema, symptom ,risk factor, diagnosis, and treatment of Emphysema.

DEFINITION :

“Permanent enlargement of the air spaces of the lung distal to terminal bronchioles accompanied by destruction of their walls is called emphysema “

(enlargement proximal to terminal bronchioles is called bronchioles is called bronchiectasis )

                          “ OR “

“Emphysema is a destructive disease of the lung in which the alveoli (small sacs) that promote oxygen exchange between the air and the bloodshed.                              

OVERINFLATION / HYPERINFLATION :the enlargement of  air spaces , unaccompanied by destruction of the walls is called over inflation or hyperinflation.

TYPES OF EMPHYSEMA :

1.CENTRILOBULAR EMPHYSEMA ;

·        This is the most common type of emphysema , it involves the proximal acinus  (respiratory bronchioles ) and sparing the more distal air spacesin early stages .

·        This case is mostly seen in cigarette smokers , the lesions are more common in upper lobes.

2.PANACINAR EMPHYSEMA :

·        In this type the acinus are uniformal enlarge from the level of respiratory bronchiole to the alveoli .

·        The panacinar emphysema is associated with alpha 1 antitrypsin deficiency .

·        It tends to occur more commonly in lower lobes.

3.DISTAL ACINAR EMPHYSEMA :

·        Also known as “ paraseptal emphysema ”.

·        In this type the proximal portion of the acinar is normal but the distal part is dominantly involved.

4. IRREGULAR EMPHYSEMA :

·        In this type the acinus irregularly involved.

·        Irregularly emphysema is almost associated with scarring .

CAUSES :

The main cause of emphysema is long-term exposure to airborne irritants, including:

·         Tobacco smoke

·         Marijuana smoke

·         Air pollution

·         Chemical fumes and dust

Rarely, emphysema is caused by an inherited deficiency of a protein that protects the elastic structures in the lungs. It's called alpha-1-antitrypsin deficiency emphysema.

 RISK FACTORS :

Factors that increase your risk of developing emphysema include:

Smoking :

·         Emphysema is most likely to develop in cigarette smokers, but cigar and pipe smokers also are susceptible.

·         The risk for all types of smokers increases with the number of years and amount of tobacco smoked.

Age. :

·         Although the lung damage that occurs in emphysema develops gradually, most people with tobacco-related emphysema begin to experience symptoms of the disease between the ages of 40 and 60.

Exposure to secondhand smoke. :

·         Secondhand smoke, also known as passive or environmental tobacco smoke, is smoke that you inadvertently inhale from someone else's cigarette, pipe or cigar.

·         Being around secondhand smoke increases your risk of emphysema.

Occupational exposure to fumes or dust :

 If you breathe fumes from certain chemicals or dust from grain, cotton, wood or mining products, you're more likely to develop emphysema.

 This risk is even greater if you smoke.

Exposure to indoor and outdoor pollution :

 Breathing indoor pollutants, such as fumes from heating fuel, as well as outdoor pollutants — air exhaust, for instance — increases your risk of emphysema.

COMPLICATIONS :

people who have emphysema are also more likely to develop:

Collapsed lung (pneumothorax):

·         A collapsed lung can be life-threatening in people who have severe emphysema, because the function of their lungs is already so compromised.

·         This is uncommon but serious when it occurs.

Heart problems :

·        Emphysema can increase the pressure in the arteries that connect the heart and lungs. this can cause a condition called cor pulmonale, in which a section of the heart expands and weakens.

Large holes in the lungs (bullae) :

·        Some people with emphysema develop empty spaces in the lungs called bullae.

·        They can be as large as half the lung. in addition to reducing the amount of space available for the lung to expand, giant bullae can increase your risk of pneumothorax.

PREVENTION :

to prevent emphysema :

·        Don't smoke

·        avoid breathing secondhand smoke.

·        wear a mask to protect your lungs if you work with chemical fumes or dust.

DIAGNOSIS :

To determine if you have emphysema, your doctor will ask about your medical history and do a physical exam. Your doctor may recommend a variety of tests.

IMAGING TESTS :

·        A chest X-ray can help support a diagnosis of advanced emphysema and rule out other causes of shortness of breath.

·        But the chest X-ray can also show normal findings if you have emphysema.

·        Computerized tomography (CT) scans combine X-ray images taken from many different directions to create cross-sectional views of internal organs.

·        CT scans can be useful for detecting and diagnosing emphysema.

·        You may also have a CT scan if you're a candidate for lung surgery.

LAB TESTS :

·        Blood taken from an artery in your wrist can be tested to determine how well your lungs transfer oxygen into, and remove carbon dioxide from, your bloodstream.

LUNG FUNCTION TESTS :

·        These noninvasive tests measure how much air your lungs can hold and how well the air flows in and out of your lungs.

·        They can also measure how well your lungs deliver oxygen to your bloodstream. One of the most common tests uses a simple instrument called a spirometer, which you blow into.

TREATMENT :

Emphysema and COPD can't be cured, but treatments can help relieve symptoms and slow the progression of the disease.

MEDICATIONS :

Depending upon the severity of your symptoms, your doctor might suggest:

Bronchodilators :

·          These drugs can help relieve coughing, shortness of breath and breathing problems by relaxing constricted airways.

Inhaled steroids:

·          Corticosteroid drugs inhaled as aerosol sprays reduce inflammation and may help relieve shortness of breath.

Antibiotics :

·         If you have a bacterial infection, like acute bronchitis or pneumonia, antibiotics are appropriate.

References :

https://www.mayoclinic.org/diseases-conditions/emphysema/symptoms-causes/syc-20355555

https://www.mayoclinic.org/diseases-conditions/emphysema/symptoms-causes/syc-20355555

https://www.emedicinehealth.com/emphysema/article_em.htm

Textbook  of pathology , Ihsaan Danish , page 166 4/9/2020