Pulmonology
Emphysema
폐기종
Irreversible alveolar wall destruction with hyperinflation
- How common
- Common subtype of COPD
- Typical age
- Smokers ≥50 yrs
What is it?
Imbalance between elastase and antielastase destroys alveolar walls.
Commonly affected: Alveoli (upper lobes in smokers)
How it develops
- Smoke exposureRecruits neutrophils/macrophages
- Excess elastaseWorse with α1-antitrypsin deficiency
- Alveolar destructionAlveolar coalescence into bullae
- Reduced gas exchangeDecreased DLCO and elastic recoil
Symptoms
- Severe dyspneaEven with minimal activity
- Pursed-lip breathingIncreases expiratory resistance
- Weight loss/cachexiaIncreased work of breathing
- Barrel chestIncreased AP diameter
How it is examined
- Reduced DLCOHallmark of emphysema
- SpirometryReduced FEV1, increased RV/TLC
Imaging
Hyperinflation, decreased lung markings, flat diaphragms.
- Hyperinflation
- Decreased vascularity
Chest CT distinguishes centrilobular vs panlobular emphysema.
- Centrilobular emphysema
- Giant bullae
Non-surgical care
- Quit smoking + bronchodilatorsLAMA/LABA are standard
- Pulmonary rehabImproves exercise tolerance
- LTOTFor PaO2 ≤55 mmHg
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Severe upper-lobe emphysema, giant bullae
Procedures that may be discussed
- Lung volume reduction surgery
- Endobronchial valve placement
- Lung transplant
Outlook
Quit + treatment slows progression; avg survival 10–15 yrs from diagnosis.