Definition:
Emphysema is a lung condition where the air spaces in the lung are abnormally permanently enlarged with no elasticity to shrink. There are three types: centriacinar (starts in bronchioles and moves to periphery and is associated to cigarette smoking), panacinar (destroys all alveoli/air spaces in lower half of lungs and is associated with alpha-1-antitrypsin deficiency), and distal acinar (creating bullae that may rupture). Other risk factors include: intravenous drug use, autoimmune deficiency (i.e. HIV), vasculitis, certain connective tissue disorders.
Symptoms:
- Longstanding cigarette smoking history
- Productive cough that is usually worse in AM
- Breathlessness
- Wheezing
- Cyanosis (bluish lips - severe)
- Asthma
Diagnosis:
- Physical Exam - use of accessory muscles and increased breathing rate, elevated jugular vein pressure, barrel chest, prolonged expiration
- Lab test - alpha-1-antitrypsin level low, increased blood count, sputum showing macrophages or WBCs
- Chest X-Ray - hyperinflation
- CT Scan - can see lung anatomy for air pockets (bullae)
- PFTs - to show breathing capacity
Treatment:
- Stop smoking!
- For alpha-1-antitrypsin, quit smoking with gene therapy/tamoxifen/danazol
- Bronchodilators
- Inhaled corticosteroids
- Antibiotics with infections
- Surgery
