II. Definitions

  1. Emphysema
    1. Subtype of Chronic Obstructive Pulmonary Disease
    2. "Lung Dry Rot"
      1. Alveolar distention
      2. Destruction of alveolar septae

III. Pathophysiology

  1. High Alveolar Dead Space
    1. Wasted ventilation to diseased alveoli that have poor gas exchange
  2. Progressively more limited Ventilatory response to pCO2 (as Emphysema progresses)
    1. Increased airway resistance requires increased work of breathing
    2. Increased work of breathing generates higher CO2 that is poorly excreted in severe COPD
    3. Increased airway resistance causes hyperinflation due to air trapping
      1. Hyperinflation results in diaphragm flattening, shorter Muscle fibers that are inefficient
      2. Shorter Muscles are unable to generate adequate negative pressure to increase air flow past obstruction
    4. Overall weakness, Asthenia and wasting results in further muscle Fatigue and decreased work of breathing

IV. Type

  1. Panacinar
    1. Affects both central and peripheral portions acinus
  2. Centriacinar
    1. Affects primarily Bronchioles and alveolar ducts
    2. Minimal involvement of peripheral acini

V. Symptoms

  1. Scant Sputum production
  2. Exertional Dyspnea

VI. Signs

  1. "Pink Puffer"
    1. Thin, dyspneic patient with mild Hypoxia
    2. Increased respiratory drive to maintain a normal pCO2
      1. Contrast with "Blue Bloater" of Chronic Bronchitis
  2. Tachypnea
  3. Prolonged expiration
  4. Hyperresonant chest
  5. Diminished breath sounds

VII. Labs

  1. Arterial Blood Gas (ABG)
    1. Slightly decreased arterial pO2
    2. Slightly decreased arterial pCO2
  2. Pulmonary Function Tests
    1. FEV1 reduced
    2. Diffusion capacity (DLCO) reduced

VIII. Staging

IX. Imaging: Chest XRay

  1. Hyperinflated lungs

X. Management

  1. SEE COPD Management
  2. Lung reduction surgery
    1. Removal of most severely damaged lung (n=20)
    2. Increased mean lung elastic recoil by 27%
    3. Increased FEV1
    4. Increased FVC
    5. Reduced FRC and RV
    6. Improved walking capacity
  3. References
    1. Sciurba (1996) N Engl J Med, 334:1095-9 [PubMed]

XI. Complications

XII. References

  1. Wilson (1991) Harrison IM, McGraw-Hill, p.1074-82
  2. Martinez (1998) Postgrad Med 103(4):112-25 [PubMed]

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Related Studies

Ontology: Pulmonary Emphysema (C0034067)

Definition (MSH) Enlargement of air spaces distal to the TERMINAL BRONCHIOLES where gas-exchange normally takes place. This is usually due to destruction of the alveolar wall. Pulmonary emphysema can be classified by the location and distribution of the lesions.
Definition (CHV) an abnormal increase in the size of the air spaces, resulting in breathing difficulty and an increased sensitivity to infection
Definition (CHV) an abnormal increase in the size of the air spaces, resulting in breathing difficulty and an increased sensitivity to infection
Definition (CHV) an abnormal increase in the size of the air spaces, resulting in breathing difficulty and an increased sensitivity to infection
Definition (MSHCZE) Zvětšení vzduchových prostor distálně od terminálních bronchiolů (BRONCHIOLY) - průdušinek, v nichž normálně dochází k výměně plynů. K tomu obvykle dochází při zničení alveolární stěny. Plicní emfyzém může být klasifikován podle místa a rozložení lézí.
Definition (MEDLINEPLUS)

Emphysema is a type of chronic obstructive pulmonary disease (COPD) involving damage to the air sacs (alveoli) in the lungs. As a result, your body does not get the oxygen it needs. Emphysema makes it hard to catch your breath. You may also have a chronic cough and have trouble breathing during exercise.

The most common cause is cigarette smoking. If you smoke, quitting can help prevent you from getting the disease. If you already have emphysema, not smoking might keep it from getting worse. Treatment is based on whether your symptoms are mild, moderate or severe. Treatments include inhalers, oxygen, medications and sometimes surgery to relieve symptoms and prevent complications.

Definition (NCI_NCI-GLOSS) Pulmonary emphysema is a disorder affecting the alveoli (tiny air sacs) of the lungs. The transfer of oxygen and carbon dioxide in the lungs takes place in the walls of the alveoli. In emphysema, the alveoli become abnormally inflated, damaging their walls and making it harder to breathe. People who smoke or have chronic bronchitis have an increased risk of emphysema.
Definition (NCI) A subcategory of chronic obstructive pulmonary disease (COPD). It occurs in people who smoke and suffer from chronic bronchitis. It is characterized by inflation of the alveoli, alveolar wall damage, and reduction in the number of alveoli, resulting in difficulty breathing.
Definition (NCI_FDA) A condition of the lung characterized by increase beyond normal in the size of air spaces distal to the terminal bronchioles, either from dilatation of the alveoli or from destruction of their walls.
Definition (CSP) subcategory of chronic obstructive pulmonary disease; characterized by anatomic alterations of the lungs, such as the enlargement of airspaces and destruction of alveolar walls.
Concepts Disease or Syndrome (T047)
MSH D011656
ICD9 492
ICD10 J43 , J43.9
SnomedCT 155573002, 87433001
English Emphysema, Emphysema, Pulmonary, Emphysemas, Pulmonary, Pulmonary Emphysema, Pulmonary Emphysemas, EMPHYSEMA, Emphysema pulmonary, Emphysema NOS, Emphysema, unspecified, EMPHYSEMAS PULM, EMPHYSEMA PULM, PULM EMPHYSEMAS, PULM EMPHYSEMA, emphysema, emphysema (diagnosis), Emphysema (lung)(pulmonary) NOS, Pulmonary Emphysema [Disease/Finding], lung emphysema, pulmonary emphysema, Emphysema (disorder), EMPHYSEMA, PULMONARY, PULMONARY EMPHYSEMA, Pulmonary emphysema, Emphysema of lung, Pulmonary emphysema (disorder), Emphysema of lung, NOS, Pulmonary emphysema, NOS, Emphysema (Pulmonary)
French EMPHYSEME, Emphysème, Emphysème pulmonaire
Portuguese ENFISEMA, Enfisema pulmonar, Enfisema, Enfisema Pulmonar
Spanish ENFISEMA, Enfisema pulmonar, enfisema de pulmón (trastorno), enfisema de pulmón, enfisema pulmonar, Enfisema, Enfisema Pulmonar
German EMPHYSEM, Emphysem, nicht naeher bezeichnet, Emphysem, Emphysem, pulmonales, Lungenemphysem, Pulmonales Emphysem, Emphysem, Lungen-
Italian Enfisema, Enfisemi polmonari, Enfisema polmonare
Dutch longemfyseem, Emfyseem, niet gespecificeerd, emfyseem, Emfyseem, Emfyseem, long-, Emfyseem, pulmonaal, Longemfyseem
Japanese 肺気腫症, ハイキシュショウ, ハイキシュ, 気腫-肺, 肺気腫
Swedish Lungemfysem
Finnish Keuhkolaajentuma
Czech Emfyzém, Plicní emfyzém, plicní emfyzém, rozedma plic, emfyzém plic, plíce - emfyzém
Korean 폐기종, 상세불명의 폐기종
Polish Rozedma płuc
Hungarian Pulmonalis emphysema, Emphysema
Norwegian Lungeemfysem