Emphysema is a type of chronic obstructive pulmonary disease. This presentation quickly throws light on its subtypes, etiology, pathophysiology, clinical manifestations, diagnostic procedures, treatment, and complications.

1. ©
BY DR. SARAH D’SOUZA
BDS

2. INTRODUCTION
WHAT IS EMPHYSEMA ?
Emphysema is pathologically defined as an abnormal permanent enlargement
of air spaces distal to the terminal bronchioles, accompanied by the
destruction of alveolar walls and without obvious fibrosis.
This process leads to reduced gas exchange, changes in airway dynamics that
impair expiratory airflow, and progressive air trapping

3. ETIOLOGY
▸Tobacco smoke
▸Marijuana smoke
▸Air pollution
▸Manufacturing fumes
▸α1-antitrypsin deficiency (AATD)

4. • Bronchioles lose their stabilizing function
and therefore causing a collapse in the
airways resulting in gas to be trapped
distally.
• Erosion in the alveolar septa causing there
to be an enlargement of the available air
space in the alveoli.
• Sometimes, there is a formation of bullae
with their thin walls of diminished lung
tissue.
PATHOPHYSIOLOGY

5. PATHOPHYSIOLOGY
Smoking activates the inflammatory process.
Inflammatory cells are released from polymorphonuclear leukocytes and alveolar
macrophages to move into the lungs.
Inflammatory cells are known as proteolytic enzymes, which the lungs are usually
protected against due to the action of antiproteases such as the alpha1-
antitrypsin.
However, the irritants from smoking will have an effect on the alpha1-antitrypsin,
reducing its activity.

6. PATHOPHYSIOLOGY
Production and activity of antiprotease are
not sufficient to counter the harmful effects
of excess protease production.
Destruction of the alveolar walls and the
breakdown of elastic tissue and collagen.
Reduction in the surface area for gas
exchange, which increases the rate of
blood flow through the pulmonary capillary
system.

7. TYPES OF EMPHYSEMA
▸Centriacinar (centrilobular) emphysema
▸ Panacinar (panlobar) emphysema
▸Distal acinar (paraseptal) emphysema
▸Irregular emphysema

8. TYPES OF EMPHYSEMA
Centriacinar (centrilobar) emphysema
Most common; >20%
Central or proximal parts of the acini, formed by respiratory bronchioles, are
affected, while distal alveoli are spared
Severe type affects the distal alveoli as well
Seen in cigarette smokers

9. TYPES OF EMPHYSEMA
Panacinar (panlobar) emphysema
Lower lung zone
Acini are uniformly enlarged, from the level of the respiratory
bronchiole to the terminal blind alveoli
Usually seen in α1-antitrypsin deficiency

10. TYPES OF EMPHYSEMA
Distal acinar (paraseptal) emphysema
The proximal portion of the acinus is normal but the distal part is
primarily involved
Unknown cause -> spontaneous pneumothorax in young adults
Characteristic finding: multiple, contiguous, enlarged air spaces
ranging in diameter from <0.5 mm to >2.0 cm
Sometimes forming cystic structures that, with progressive
enlargement, are referred to as bullae

11. TYPES OF EMPHYSEMA
Irregular emphysema
Acinus is irregularly involved
Almost invariably associated with scarring
Clinically asymptomatic

12. CLINICAL MANIFESTATIONS
Difficult/laboured
breathing Reduced exercise capacity
Chest pain
Bluish fingers/lips

13. DIAGNOSTIC PROCEDURES
HISTORY AND PHYSICAL
‣ Risk factors - smoking, secondhand smoke, and home and
occupational exposures to chemicals
‣ Family history - alpha-1-antitrypsin deficiency
‣ Examination -
Abnormal breath sounds
A barrel chest (Rounding of the chest)
• Muscle wasting
• Weight loss
• Clubbing of nails
• The use of accessory muscles

14. DIAGNOSTIC PROCEDURES
CHEST X-RAY
‣ On an x-ray, emphysematous lungs look
hyperlucent with normal markings from blood
vessels being less prominent.
‣ The diaphragms also appear flattened due to
the hyperinflation of the lungs (which pushes
down on the diaphragm.)
‣ Unfortunately, changes on x-ray are not usually
seen until the disease is quite extensive.

15. DIAGNOSTIC PROCEDURES
OTHER INVESTIGATIONS
‣ PULMONARY FUNCTION TESTS
‣ SPIROMETRY
‣ LUNG PLETHYSMOGRAPHY
‣ ARTERIAL BLOOD GASES
‣ COMPLETE BLOOD COUNT

16. COMPLICATIONS
Complication of emphysema
‣ Pulmonary failure with respiratory acidosis
‣ Hypoxia
‣ Coma
‣ Right-sided heart failure (cor pulmonale)

17. TREATMENT
Complication of emphysema
No treatment can reverse or stop emphysema.
But treatment can help to:
•Relieve symptoms
•Treat complications
•Minimize disability
People with AAT deficiency may be candidates for
replacement therapy.

18. TREATMENT
Complication of emphysema
A. Bronchodilators Inhalers.
◦ Tiotropium (Spiriva)
◦ Ipratropium (Atrovent)
◦ Albuterol (Proventil, Ventolin, others
B. Corticosteroids
C. Combination Corticosteroid/ Long-Acting Bronchodilator Inhalers.
◦ Budesonide and formoterol (Symbicort)
◦ Fluticasone and salmeterol (Advair)
◦ Mometasone and formoterol (Dulera)

19. TREATMENT
Complication of emphysema
‣ Antibiotics
‣ Oxygen therapy
‣ Pulmonary rehabilitation
‣ Lung volume reduction surgery
‣ Lung transplant