Emphysema is a chronic lung disease characterized by abnormal enlargement of the airspaces in the lungs. It is caused by destruction of the walls of the alveoli, the tiny air sacs in the lungs. There are several types of emphysema including centriacinar, panacinar, and paraseptal. The main symptoms of emphysema include shortness of breath, cough, and wheezing. Smoking is the leading cause of emphysema and it can also be caused by air pollution and genetic conditions like alpha-1 antitrypsin deficiency. Emphysema is a component of chronic obstructive pulmonary disease (COPD) along with chronic bronchitis,

1. Emphysema
KHAWAJA TAIMOOR SHAHID
M.Phil Zoology, M.Ed
Department of Zoology
Superior College M.B.DiN

2. Emphysema
Definition: Abnormal permanent
enlargement of the airspaces distal to the
terminal bronchiole, accompanied by
destruction of their walls and without
obvious fibrosis.
Spaces in parenchyma > 1mm =Abnormal

3. Emphysema
Emphysema causes dilation of air
spaces by destruction of alveolar wall,
leading to collapse of alveoli during
expiration

4. Emphysema & Overinflation
• Emphysema: Increased air space with
destruction
• Overinflation: Increased air space without
destruction

5. Classification: Types of emphysema
1. Centriacinar
2. Panacinar
3. Paraseptal [Distal acinar]
4. Mixed & unclassified [Irregular]

6. Centriacinar :
[ centrilobular, Proximal acinar ]
• Dilatation of Respiratory Bronchiole
• Upper lobes - severely involved
• Can coexist with chronic bronchitis
• Invariably occurs in smokers
• Coal mine workers [carbon, dust]

7. Panacinar Emphysema:
• Whole of Acinus uniformly affected
• Lower lobes severely involved
• Association:
… A1AT deficiency
… Cigarette smokers
A1AT= Alpha-1 antitrypsin deficiency (AAT
deficiency) is an inherited condition that raises
your risk for lung and liver disease

8. Paraseptal (Distal Acinar)
• Localized along pleura - peripheral part
of the acinus; a region of the lung
supplied with air from one of the terminal
bronchioles.
• Predisposes to spontaneous peumothorax
• Adjacent to foci of fibrosis ; represent
microscopic zones of acute lung injury
• Least common

9. Mixed – IRREGULAR EMPHYSEMA:
• MOST COMMON
• LEAST SIGNIFICANT
• COMMON AROUND SCAR TISSUE
• COMBINATION OF TYPES
• Scar tissue is a collection of cells and
collagen that covers the site of the injury.

10. Etiology
• Cigarette smoking [20 - 40% smokers]
• Air pollution
• Alpha-1-antitrypsin deficiency

11. Clinical picture
• Dysponea
• Cough with or without expectoration
• Wheezing
• Loss of weight
• Peptic ulceration
• Hypercapnia > changes in central
nervous system
• Barrel chest

12. Barrel chest

13. Obstructive Pulmonary diseases
• Disorders Associated with Airflow
Obstruction
• Chronic bronchitis, Emphysema, Asthma,
Bronchiectasis & Bronchiolitis come under
this category

14. Venn diagram of chronic obstructive pulmonary disease (COPD).
Chronic obstructive lung disease is a disorder in which subsets of
patients may have dominant features of chronic bronchitis,
emphysema, or asthma. The result is irreversible airflow obstruction.

15. COPD
• COPD: Comprises Emphysema and chronic
bronchitis
• Many patients have overlapping features of
damage at both the acinar level (emphysema) and
bronchial level (bronchitis)
• Common extrinsic trigger— cigarette smoking —
is implicated in both the diseases

16. Figure 15-9 Schematic representation of evolution of
chronic bronchitis (left) and emphysema (right).

18. “Pink Puffer”
Emphysema
Thin
Dysponea
< Vital capacity
> Lung volume

19. “Blue Bloater” – Chronic bronchitis

20. Table 15-4 -- Emphysema and Chronic Bronchitis
Predominant Bronchitis Predominant Emphysema
Age (yr) 40–45 50–75
Dyspnea Mild; late Severe; early
Cough Early; copious sputum Late; scanty sputum
Infections Common Occasional
Respiratory insufficiency Repeated Terminal
Cor pulmonale Common Rare; terminal
Airway resistance Increased Normal or slightly increased
Elastic recoil Normal Low
Chest radiograph Prominent vessels; large heart Hyperinflation; small heart
Appearance Blue bloater Pink puffer

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