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https://www.mayoclinic.org/diseases-conditions/emphysema/symptoms-causes/syc-20355555#:~:text=Emphysema%20is%20a%20lung%20condition,instead%20of%20many%20small%20ones.

https://www.lung.org/lung-health-diseases/lung-disease-lookup/emphysema

L12 Lecture Notes

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Overview

Emphysema is a lung condition that causes shortness of breath. In people with emphysema, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture - creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.

When you exhale, the damaged alveoli don't work properly and old air becomes trapped, leaving no room for fresh, oxygen-rich air to enter.

Most people with emphysema also have chronic bronchitis. Chronic bronchitis is inflammation of the tubes that carry air to your lungs (bronchial tubes), which leads to a persistent cough.

Emphysema and chronic bronchitis are two conditions that make up chronic obstructive pulmonary disease (COPD). Smoking is the leading cause of COPD. Treatment may slow the progression of COPD, but it can't reverse the damage.

Symptoms

You can have emphysema for many years without noticing any signs or symptoms. The main symptom of emphysema is shortness of breath, which usually begins gradually.

You may start avoiding activities that cause you to be short of breath, so the symptom doesn't become a problem until it starts interfering with daily tasks. Emphysema eventually causes shortness of breath even while you're at rest.

When to see a doctor

See your doctor if you've had unexplained shortness of breath for several months, especially if it's getting worse or it's interfering with your daily activities. Don't ignore it by telling yourself it's because you're aging or out of shape. Seek immediate medical attention if:

You're so short of breath, you can't climb stairs

Your lips or fingernails turn blue or gray with exertion

You're not mentally alert

Causes

The main cause of emphysema is long-term exposure to airborne irritants, including:

Tobacco smoke

Marijuana smoke

Air pollution

Chemical fumes and dust

Rarely, emphysema is caused by an inherited deficiency of a protein that protects the elastic structures in the lungs. It's called alpha-1-antitrypsin deficiency emphysema.

Risk factors

Factors that increase your risk of developing emphysema include:

Smoking. Emphysema is most likely to develop in cigarette smokers, but cigar and pipe smokers also are susceptible. The risk for all types of smokers increases with the number of years and amount of tobacco smoked.

Age. Although the lung damage that occurs in emphysema develops gradually, most people with tobacco-related emphysema begin to experience symptoms of the disease between the ages of 40 and 60.

Exposure to secondhand smoke. Secondhand smoke, also known as passive or environmental tobacco smoke, is smoke that you inadvertently inhale from someone else's cigarette, pipe or cigar. Being around secondhand smoke increases your risk of emphysema.

Occupational exposure to fumes or dust. If you breathe fumes from certain chemicals or dust from grain, cotton, wood or mining products, you're more likely to develop emphysema. This risk is even greater if you smoke.

Exposure to indoor and outdoor pollution. Breathing indoor pollutants, such as fumes from heating fuel, as well as outdoor pollutants - car exhaust, for instance - increases your risk of emphysema.

Complications

People who have emphysema are also more likely to develop:

Collapsed lung (pneumothorax). A collapsed lung can be life-threatening in people who have severe emphysema, because the function of their lungs is already so compromised. This is uncommon but serious when it occurs.

Heart problems. Emphysema can increase the pressure in the arteries that connect the heart and lungs. This can cause a condition called cor pulmonale, in which a section of the heart expands and weakens.

Large holes in the lungs (bullae). Some people with emphysema develop empty spaces in the lungs called bullae. They can be as large as half the lung. In addition to reducing the amount of space available for the lung to expand, giant bullae can increase your risk of pneumothorax.

Prevention

To prevent emphysema, don't smoke and avoid breathing secondhand smoke. Wear a mask to protect your lungs if you work with chemical fumes or dust.

Show references

1. What is COPD? National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/health-topics/topics/copd/#. Accessed Jan. 9, 2017.

2. Mason RJ, et al. COPD: Pathogenesis and natural history. In: Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Jan. 11, 2017.

3. Goldman L, et al., eds. Chronic obstructive pulmonary disease. In: Goldman-Cecil Medicine. 25th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Jan. 12, 2017.

4. AskMayoExpert. Chronic obstructive pulmonary disease. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.

5. Longo DL, et al., eds. Chronic obstructive pulmonary disease. In: Harrison's Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill Education; 2015. http://www.accessmedicine.com. Accessed Jan. 11, 2017.

6. Weiss ST. Chronic obstructive pulmonary disease: Risk factors and risk reduction. http://www.uptodate.com/home. Accessed Jan. 11, 2017.

7. Han MK, et al. Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging. http://www.uptodate.com/home. Accessed Jan. 11, 2017.

8. Ferguson GT, et al. Management of stable chronic obstructive pulmonary disease. http://www.uptodate.com/home. Accessed Jan. 11, 2017.

9. What is bronchitis? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/brnchi. Accessed Jan. 9, 2017.

10. Jong EC, et al. Travel with chronic medical conditions. In: Travel and Tropical Medicine Manual. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2008.

11. Gautret P, et al. Travel-associated illness in older adults (>60 y). Journal of Travel Medicine. 2012;19:169.

12. Fishwick D, et al. Occupational chronic obstructive pulmonary disease: A standard of care. Occupational Medicine. 2015;65:270.

13. Support and community. American Lung Association. http://www.lung.org/support-and-community/. Accessed Jan. 23, 2017.

14. COPD treatment options. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/educational/copd/breathing-better/treatment-options.htm. Accessed Jan. 23, 2017.

# data[].attributes.attachment_link.description
Emphysema is a lung condition that causes shortness of breath. In people with emphysema, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture - creating larger air spaces instead of many small ones.

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Troubled breathing
shortness of breath (e.g: when walking / climbing stairs)

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More likely to develop acute bronchitis and other lung infection if treatment not given or delayed

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Sleeplessness

Confusion

Weakness (due to lack of O2)

Appetite loss

Blue-toned skin (due to lack of O2, hypoxia？）

Unequal chest expansion （Barrel Chest）

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Progressively shortness of breathe
Cough with sputum or heavy phlegm
Wheezing
Weight loss

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1. Decrease in recoil --> Narrowing of bronchioles --> trapping air in alveoli --> difficulty to breathe

2. Alveoli damaged -->less alveoli -->lesser O2 in blood --> affect normal organ function

3. Unable to support bronchioles -->insufficient surfactant proteins (Clara Cells) --> Collapsing of bronchioles

4. Obstruction of airflow --> O2 get trapped in the lungs --> Barrel Chest

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1. Smoking introduces harmful particles like tar --> activates inflammatory process (e.g: NK cells / dendric cells / CD4 T cells /CD8 T cells)
2. Neutrophils (PMN) and Macrophages move to the lungs
3. Release of proteolytic enzymes (e.g: elastase)
4. Destruction of elastin by proteolytic enzyme elastase

*Lungs are usually protected against this enzyme elastase by antiproteases AAT

5. Till all elastin get destroyed --> nothing to protect alveolar walls --> alveolar damaged --> Emphysema develop
6. Reduced surface area for gaseous exchange
7. Increase the rate of blood flow through the pulmonary capillary system
8. Cardiovascular system may be affected
9. Increase RBC to compensate for lack of O2, increase WBC to fight harmful smoking particles

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Bullectomy --> Remove giant bullae -->removal of large air sacs with destroyed alveoli / removal of damage alveoli

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Lack of O2 in blood -->Supplement O2 -->Relieve shortness of breathe

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Cannot be cured / Only temporary symptomatic relief / with reduce risk factors 

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Cannot be cured / Only temporary symptomatic relief / with reduce risk factors 

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Help minimise complications
Slow progression throughout treatment

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Bronchodilator --> e.g: Tiotropium/Albuterol --> relax airway muscles --> opening of the airways towards the lungs --> more O2 flowing into lungs --> Reduce discomfort

steroids -->e.g: fluticasone -->   reduce swelling of the lungs

Anti-cough / Anti-mucus medicine --> reduce buildup of mucus --> opening up of the airway --> more O2 flowing into the lungs

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Normal lungs -->  blow out most of the air in their lungs in 1  sec.
Emphysema --> take longer to empty the lungs -->more than 10sec --> due to difficulty in breathing

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Infections --> due to smoking/air pollutants --> WBC increase
Lack of O2 for gaseous exchange --> increase RBC to compensate

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Chest X-ray --> show abnormally large lungs
Note:
1) In early emphysema --> chest X-ray film shows usually normal.
2)Diagnosing emphysema can't be done with an X-ray alone.

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Reduced surface area for gas exchange --> increase rate of blood flow through pulmonary capillary system --> Heart/Cardiovasular issues

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If Emphysema is cause by asthma such as buildup of mucus in the alveoli air sacs --> under CT scan may be seen as consolidation

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CT scan with emphysema --> show small pockets of air throughout the lungs. --> those damaged lungs are where air becomes trapped --> forceful exhalation

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AAT deficiency --> unable to inhibit neutrophil elastase --> upon trigger (e.g: smoking) neutrophils will produce elastase uncontrollably--> elastase not only break down elastin at the membrane of alveoli but also break down the walls of alveoli --> increase lung damage over time --> emphysema

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AAT inhibits neutrophil elastase (produced by the activation of the immune system)
Those neutrophils upon a trigger (e.g: smoking)--> release inflammatory cells (e.g: cytokines) --> release elastase -->break down elastin at the membrane of alveoli

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Deficiency of a protein alpha 1-antitrypsin (AAT).

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Asthma (e.g: due to buildup of Mucus in airways) --> constant deep-cough--> alveoli may be injured

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Allergy  (e.g: Cats/ Dogs / Dusts/ Peanuts)

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secondhand smoke or vaping --> increased risk of emphysema

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Environmental pollutants (e,g: Pollutants, Chemical dust, fumes, coal, wood smoke, BBQ smoke)

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Cigarette smoke --> Chronic Lung Damage

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damage to the lung parenchyma

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Destruction of Alveoli by breaking down the elastic fibers by proteases secluded by immune cells

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lungs --> become floppy --> over-expanded --> difficulty in breathing

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alveoli may be narrow and collapse or stretch out of shape become abnormally large

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Walls of the alveoli are damaged --> become less elastic --> less able to exchange carbon dioxide for oxygen.

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a type of COPD

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Example used: Cigarette Smoking.