GetWiki

{{cs1 config|name-list-style=vanc}}

factoids

| complications =| onset = Over 40 years old| duration = Long term| causes = Tobacco smoking, air pollution, genetics| risks =Spirometry{{sfn>Gold Reportpp=20-23|loc=Chapter 2: Diagnosis and initial assessment}} Asthma, congestive heart failure, bronchiectasis, tuberculosis, obliterative bronchiolitis, diffuse panbronchiolitis{{sfn>Gold Reportpp=33–35|loc=Chapter 2: Diagnosis and initial assessment}}Smoking cessation, improving indoor and outdoor air quality, tobacco control measures{{sfn>Gold Reportpp=40–46|loc=Chapter 3: Evidence supporting prevention and maintenance therapy}}Pulmonary rehabilitation, oxygen therapy>long-term oxygen therapy, lung volume reduction{{sfn2021loc=Chapter 3: Evidence supporting prevention and maintenance therapy}}bronchodilators and corticosteroids{{sfn>Gold Reportpp=40–46|loc=Chapter 3: Evidence supporting prevention and maintenance therapy}}| prognosis =| frequency =| deaths =| alt =}}Emphysema is any air-filled enlargement in the body’s tissues.WEB, Definition of Emphysema,www.merriam-webster.com/dictionary/emphysema, Merriam-Webster, 10 April 2023, en, Most commonly emphysema refers to the enlargement of air spaces (alveoli) in the lungs, and is also known as pulmonary emphysema.Emphysema is a lower respiratory tract disease,WEB, ICD-11 – ICD-11 for Mortality and Morbidity Statistics,icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1948124976, icd.who.int, 9 August 2021, characterised by enlarged air-filled spaces in the lungs, that can vary in size and may be very large. The spaces are caused by the breakdown of the walls of the alveoli, which replace the spongy lung tissue. This reduces the total alveolar surface available for gas exchange leading to a reduction in oxygen supply for the blood.BOOK, Saladin, K, Human anatomy, 2011, McGraw-Hill, 9780071222075, 650, 3rd, Emphysema usually affects the middle aged or older population because it takes time to develop with the effects of tobacco smoking, and other risk factors. Alpha-1 antitrypsin deficiency is a genetic risk factor that may lead to the condition presenting earlier.WEB,radiopaedia.org/articles/pulmonary-emphysema?lang=gb, Pulmonary emphysema, Murphy, Andrew, Danaher, Luke, radiopaedia.org, 16 August 2019, When associated with significant airflow limitation, emphysema is a major subtype of chronic obstructive pulmonary disease (COPD), a progressive lung disease characterized by long-term breathing problems and poor airflow.BOOK, Algusti, Alvar G., etal, Global Strategy for the Diagnosis, Management and Prevention of COPD, 2017, Global Initiative for Chronic Obstructive Lung Disease (GOLD), 6–17, Definition and Overview,goldcopd.org/download/326/, JOURNAL, Roversi, Sara, Corbetta, Lorenzo, Clini, Enrico, GOLD 2017 recommendations for COPD patients: toward a more personalized approach, 5 May 2017, COPD Research and Practice, 3, 10.1186/s40749-017-0024-y,flore.unifi.it/bitstream/2158/1119012/1/s40749-017-0024-y.pdf, free, Without COPD, the finding of emphysema on a CT lung scan still confers a higher mortality risk in tobacco smokers.WEB,www.medscape.com/viewarticle/836650, Emphysema on CT Without COPD Predicts Higher Mortality Risk, Diedtra Henderson, 2014-12-16, Medscape, In 2016 in the United States there were 6,977 deaths from emphysema – 2.2 per 100,000 of the population.WEB, FastStats – Chronic Lower Respiratory Disease,www.cdc.gov/nchs/fastats/copd.htm, www.cdc.gov, 30 May 2019, 23 May 2019, Globally it accounts for 5% of all deaths.JOURNAL, Martini, K., Frauenfelder, T., Advances in imaging for lung emphysema., Annals of Translational Medicine, November 2020, 8, 21, 1467, 10.21037/atm.2020.04.44, 33313212, 7723580, free, A 2018 review of work on the effects of tobacco and cannabis smoking found that a possibly cumulative toxic effect could be a risk factor for developing emphysema, and spontaneous pneumothorax.JOURNAL, Underner, M, Urban, T, Perriot, J, etal, REVUE GÉNÉRALE – Pneumothorax spontané et emphysème pulmonaire chez les consommateurs de cannabis, fr, Spontaneous pneumothorax and lung emphysema in cannabis users, Revue de pneumologie clinique, December 2018, 74, 6, 400–415, 10.1016/j.pneumo.2018.06.003, 30420278, 59233744, WEB, Coffey, Donavyn, Buzz Kill: Lung Damage Looks Worse in Pot Smokers, Medscape, 15 November 2022,www.medscape.com/viewarticle/984059, There are four types of emphysema, three of which are related to the anatomy of the lobules of the lung – centrilobular or centriacinar, panlobular or panacinar, and paraseptal or distal acinar emphysema – and are not associated with fibrosis (scarring).{{sfn|Kumar|2018|pp=498–501}} The fourth type is known as paracicatricial emphysema or irregular emphysema that involves the acinus irregularly and is associated with fibrosis.{{sfn|Kumar|2018|pp=498–501}} Though the different types can be seen on imaging they are not well-defined clinically. There are also a number of associated conditions including bullous emphysema, focal emphysema, and Ritalin lung. Only the first two types of emphysema – centrilobular and panlobular – are associated with significant airflow obstruction, with that of centrilobular emphysema around 20 times more common than panlobular. Centrilobular emphysema is the only type associated with smoking.{{sfn|Kumar|2018|pp=498–501}}Osteoporosis is often a comorbidity of emphysema. The use of systemic corticosteroids for treating exacerbations is a significant risk factor for osteoporosis, and their repeated use is recommended against.WEB,goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-v1.7-FINAL-14Nov2018-WMS.pdf, COPD and comorbidities, 133, 24 September 2019,

Signs and symptoms

(File:Blausen 0343 Emphysema.png|thumb|300px|Diagram of alveoli with emphysema)Emphysema is a respiratory disease of the lower respiratory tract. It is commonly caused by tobacco smoking but a significant number of people are affected who either do not smoke, or have never smoked. The presence of emphysema is a clear risk factor for the development of lung cancer, made stronger in those who smoke.BOOK, Global Strategy for Prevention, Diagnosis and Management of COPD: 2021 Report, 25 November 2020, 123,goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf, 3 October 2021, Early symptoms of emphysema may vary from person to person. Symptoms can include a cough (with or without sputum), wheezing, a fast breathing rate, breathlessness on exertion, and a feeling of tightness in the chest. There may be frequent cold or flu infections. Other symptoms may include anxiety, depression, fatigue, sleep problems and weight loss. These symptoms could also relate to other lung conditions or other health problems;WEB, Pulmonary Emphysema,www.hopkinsmedicine.org/health/conditions-and-diseases/pulmonary-emphysema, www.hopkinsmedicine.org, 19 November 2019, 3 October 2021, therefore, emphysema is often underdiagnosed.{{cn|date=January 2024}} The shortness of breath caused by emphysema can increase over time and develop into chronic obstructive pulmonary disease.A sign of emphysema in smokers is the finding of a higher number of alveolar macrophages sampled from the bronchoalveolar lavage (BAL) in the lungs. The number can be four to six times greater in those who smoke than in non-smokers.JOURNAL, Naeem, Ahmed, Rai, Sachchida N., Pierre, Louisdon, Histology, Alveolar Macrophages,www.ncbi.nlm.nih.gov/books/NBK513313/, StatPearls, StatPearls Publishing, 22 October 2021, 2021, 30020685, Emphysema is also associated with barrel chest.

Types

There are four main types of emphysema, three of which are related to the anatomy of the lobules of the lung – centrilobular or centriacinar, panlobular or panacinar, and paraseptal or distal acinar and are not associated with fibrosis (scarring).{{sfn|Kumar|2018|pp=498–501}} Although fibrosis is not a normal feature of these subtypes, repair strategies in end-stage emphysema may lead to pulmonary fibrosis. The fourth subtype is known as paracicatricial emphysema or irregular emphysema, involves the acinus irregularly and is associated with fibrosis.{{sfn|Kumar|2018|pp=498–501}}Only the first two types of emphysema – centrilobular and panlobular – are associated with significant airflow obstruction, with that of centrilobular emphysema around 20 times more common than panlobular.{{sfn|Kumar|2018|pp=498–501}} The subtypes can be seen on imaging but are not well-defined clinically.There are also a number of associated conditions including bullous emphysema, focal emphysema, and Ritalin lung.

Centrilobular

(File:Emphysema H and E.jpg|thumb|Stained lung tissue from end-stage emphysema)Centrilobular emphysema, also called centriacinar emphysema, affects the centre of a pulmonary lobule (centrilobular) in the lung, the area around the terminal bronchiole and the first respiratory bronchiole, and can be seen on imaging as an area around the tip of the visible pulmonary artery. Centrilobular emphysema is the most common type usually associated with smoking, and with chronic bronchitis.{{sfn|Kumar|2018|pp=498–501}} The disease progresses from the centrilobular portion, leaving the lung parenchyma in the surrounding (perilobular) region preserved.JOURNAL, Takahashi, M, Fukuoka, J, 2008, Imaging of pulmonary emphysema: a pictorial review., International Journal of Chronic Obstructive Pulmonary Disease, 3, 2, 193–204, 18686729, 2629965, 10.2147/COPD.S2639, free, Usually the upper lobes of the lungs are affected.{{sfn|Kumar|2018|pp=498-501}}

Panlobular

Panlobular emphysema, also called panacinar emphysema, affects all of the alveoli in a lobule, and can involve the whole lung or mainly the lower lobes.ENCYCLOPEDIA, Panlobular emphysema, Radiopaedia,radiopaedia.org/articles/panlobular-emphysema?lang=us, Weerakkody, Yuranga, 2013, 10.53347/rid-21965, 239605521, 22 May 2019, free, This type of emphysema is associated with alpha-1 antitrypsin deficiency (A1AD or AATD), and Ritalin lung, and is not related to smoking.

Complications

Likely complications of centrilobular and panlobular emphysema, some of which are life-threatening, include: respiratory failure, pneumonia, respiratory infections, pneumothorax, interstitial emphysema, pulmonary heart disease, and respiratory acidosis.JOURNAL, Pahal, Parul, Avula, Akshay, Sharma, Sandeep, Emphysema,www.ncbi.nlm.nih.gov/books/NBK482217/, StatPearls, StatPearls Publishing, 26 August 2021, 2021, 29489292,

Paraseptal

Paraseptal emphysema, also called distal acinar emphysema, relates to emphysematous change next to a pleural surface, or to a fissure.JOURNAL, Smith, B, January 2014, Pulmonary emphysema subtypes on computed tomography: the MESA COPD study., Am J Med, 127, 1, 94.e7–23, 24384106, 3882898, 10.1016/j.amjmed.2013.09.020, WEB,www.radiologyassistant.nl/en/p42d94cd0c326b/lung-hrct-basic-interpretation.html#i458119136dc3b, Chest, Radiology assistant, 20 June 2019, The cystic spaces known as blebs or bullae that form in paraseptal emphysema typically occur in just one layer beneath the pleura. This distinguishes it from the honeycombing of small cystic spaces seen in fibrosis that typically occurs in layers. This type of emphysema is not associated with airflow obstruction.JOURNAL,emedicine.medscape.com/article/297664-overview#a3, Chronic Obstructive Pulmonary Disease (COPD), Mosenifar, Zab, April 2019, emedicine.medscape, 25 July 2019,

Bullous

File:Bullus emphasemaCT.png|thumb|CT scan of bullous emphysemabullous emphysemaWhen the subpleural bullae are significant, the emphysema is called bullous emphysema. Bullae can become extensive and combine to form giant bullae. These can be large enough to take up a third of a hemithorax, compress the lung parenchyma, and cause displacement. The emphysema is now termed giant bullous emphysema, more commonly called vanishing lung syndrome due to the compressed parenchyma.JOURNAL, Sharma, N., Justaniah, A. M., Vanishing lung syndrome (giant bullous emphysema):CT findings in 7 patients and a literature review, J Thoracic Imaging, August 2009, 24, 3, 227–230, 19704328, 10.1097/RTI.0b013e31819b9f2a, 882767, A bleb or bulla may sometimes rupture and cause a pneumothorax.{{sfn|Kumar|2018|pp=498-501}}

Paracicatricial

Paracicatricial emphysema, also known as irregular emphysema, is seen next to areas of fibrosis (scarring) as large spaces. The scarring is most often a result of silicosis, granulomatous infection, tuberculosis, or pulmonary infarction. It can be difficult to differentiate from the honeycombing of pulmonary fibrosis.WEB, Weerakkody, Yuranga, Paracicatricial emphysema {{!, Radiology Reference Article {{!}} Radiopaedia.org |url=https://radiopaedia.org/articles/paracicatricial-emphysema?lang=gb |website=Radiopaedia |access-date=28 July 2021}}

HIV associated

Classic lung diseases are a complication of HIV/AIDS with emphysema being a source of disease. HIV is cited as a risk factor for the development of emphysema and COPD regardless of smoking status.JOURNAL, Kumar, A, Mahajan, A, Salazar, EA, Pruitt, K, Guzman, CA, Clauss, MA, Almodovar, S, Dhillon, NK, Impact of human immunodeficiency virus on pulmonary vascular disease, Global Cardiology Science & Practice, 30 June 2021, 2021, 2, e202112, 10.21542/gcsp.2021.12, 34285903, 8272407, Around 20 percent of those with HIV have increased emphysematous changes. This has suggested that an underlying mechanism related to HIV is a contributory factor in the development of emphysema. HIV associated emphysema occurs over a much shorter time than that associated with smoking; an earlier presentation is also seen in emphysema caused by alpha-1 antitrypsin deficiency. Both of these conditions predominantly show damage in the lower lungs, which suggests a similarity between the two mechanisms.JOURNAL, Stephenson SE, Wilson CL, Crothers K, Attia EF, Wongtrakool C, Petrache I, Schnapp LM, Impact of HIV infection on α1-antitrypsin in the lung, Am J Physiol Lung Cell Mol Physiol, 314, 4, L583–L592, April 2018, 29351445, 5966776, 10.1152/ajplung.00214.2017,

Alpha-1 related

Emphysema may develop in some people with alpha-1 antitrypsin deficiency, the only genotype of chronic obstructive pulmonary disease. This usually occurs a lot earlier (as does HIV associated emphysema) than other types.WEB, Alpha-1 antitrypsin deficiency: MedlinePlus Genetics,medlineplus.gov/genetics/condition/alpha-1-antitrypsin-deficiency/, medlineplus.gov, 26 August 2021,

Ritalin lung

The intravenous use of methylphenidate, commonly marketed as Ritalin and widely used as a stimulant drug in the treatment of attention deficit hyperactivity disorder, can lead to emphysematous changes known as Ritalin lung. The mechanism underlying this link is not clearly understood. Ritalin tablets are not intended to be injected. They contain talc as a filler, and must be crushed and dissolved to make injection possible. It has been suggested that the talc exposure causes granulomatosis leading to alveolar destruction. However, other intravenous drugs also contain talc, and no emphysematous change is associated with those. High resolution CT scanning shows the emphysema to be panlobular.WEB,radiopaedia.org/articles/ritalin-lung?lang=gb, Ritalin lung, Sharma, R., radiopaedia.org, 9 July 2019,

CPFE

Combined pulmonary fibrosis and emphysema (CPFE) is a rare syndrome that shows upper-lobe emphysema, together with lower-lobe interstitial fibrosis. This is diagnosed by CT scan.JOURNAL, Wand, O, Kramer, MR, January 2018, Harefuah, 157, 1, 28–33, 29374870, The Syndrome of Combined Pulmonary Fibrosis and Emphysema – CPFE, This syndrome presents a marked susceptibility for the development of pulmonary hypertension.JOURNAL, Seeger, W, December 2013, Pulmonary hypertension in chronic lung diseases, J Am Coll Cardiol, 62, 25 Suppl, 109–116, 24355635, 10.1016/j.jacc.2013.10.036, free, 11585/534482, free,

SRIF

Smoking-related interstitial fibrosis (SRIF) is another type of fibrosis that occurs in emphysematous lungs and can be identified by pathologists. Unlike CPFE, this type of fibrosis is usually clinically occult (i.e., does not cause symptoms or imaging abnormalities). Occasionally, however, some patients with SRIF present with symptoms and radiologic findings of interstitial lung disease.JOURNAL, Vehar SJ, Yadav R, Mukhopadhyay S, Nathani A, Tolle LB, Smoking-Related Interstitial Fibrosis (SRIF) in Patients Presenting With Diffuse Parenchymal Lung Disease, Am J Clin Pathol, 159, 2, 146–157, December 2022, 36495281, 10.1093/ajcp/aqac144, 9891418,

Congenital lobar

Congenital lobar emphysema (CLE), also known as congenital lobar overinflation and infantile lobar emphysema,WEB, UpToDate: Congenital lobar emphysema,www.uptodate.com/contents/congenital-lobar-emphysema, 10 July 2016, is a neonatal condition associated with enlarged air spaces in the lungs of newborn infants. It is diagnosed around the time of birth or in the first 6 months of life, occurring more often in boys than girls. CLE affects the upper lung lobes more than the lower lobes, and the left lung more often than the right lung. CLE is defined as the hyperinflation of one or more lobes of the lung due to the partial obstruction of the bronchus. This causes symptoms of pressure on the nearby organs. It is associated with several cardiac abnormalities such as patent ductus arteriosus, atrial septal defect, ventricular septal defect, and tetralogy of Fallot.JOURNAL, Demir, Omer, May 2019, Congenital lobar emphysema: diagnosis and treatment options, International Journal of Chronic Obstructive Pulmonary Disease, 14, 921–928, 31118601, 6507121, 10.2147/COPD.S170581, free, Although CLE may be caused by the abnormal development of bronchi, or compression of airways by nearby tissues, no cause is identified in half of cases.JOURNAL, Guidry, Christopher, McGahren, Eugene D., Pediatric Chest I, Surgical Clinics of North America, June 2012, 92, 3, 615–643, 10.1016/j.suc.2012.03.013, 22595712, CT scan of the lungs is useful in assessing the anatomy of the lung lobes and status of the neighbouring lobes on whether they are hypoplastic or not. Contrast-enhanced CT is useful in assessing vascular abnormalities and mediastinal masses.

Focal

(File:Pneumot rax bullae.JPG|thumb|A large bulla and a smaller bleb illustrated)Focal emphysema is a localized region of emphysema in the lung that is larger than alveoli, and often associated with coalworker’s pneumoconiosis.BOOK, Weinberger, S, Cockrill, B, Mandel, J, Principles of pulmonary medicine, 2019, 9780323523714, 147, Elsevier, Seventh, This is also known as localized pulmonary emphysema.WEB, Weerakkody, Yuranga, Localised pulmonary emphysema {{!, Radiology Reference Article {{!}} Radiopaedia.org |url=https://radiopaedia.org/articles/localised-pulmonary-emphysema?lang=gb |website=Radiopaedia |access-date=2 August 2021}} Blebs and bullae may also be included as focal emphysema. These can be differentiated from the other type of enclosed air space known as a lung cyst by their size and wall thickness. A bleb or bulla has a wall thickness of less than 1 mm, and are smaller.WEB, Gaillard, Frank, Pulmonary bullae {{!, Radiology Reference Article {{!}} Radiopaedia.org |url=https://radiopaedia.org/articles/pulmonary-bullae?lang=gb |website=Radiopaedia |access-date=16 June 2019}}

Occupational

A number of occupations are associated with the development of emphysema due to the inhalation of varied gases and particles. In the US uranium mining that releases radon gas and particles has been shown to be a cause of emphysema deaths; the figures in the study included some miners who also smoked. Uranium mining and milling was found to create environmental pollution.WEB, Worker Health Study Summaries – Uranium Miners {{!, NIOSH {{!}} CDC |url=https://www.cdc.gov/niosh/pgms/worknotify/uranium.html |website=www.cdc.gov |access-date=29 July 2021 |date=15 June 2020}}The inhalation of coal mine dust that can result in coalworker’s pneumoconiosis is an independent risk factor for the development of emphysema. Focal emphysema is associated with the coal macule, and this extends into progressive centrilobular emphysema. Less commonly a variant of panlobular emphysema develops.WEB, Pathology Basis of Occupational Lung Disease, Pneumoconiosis {{!, NIOSH {{!}} CDC |url=https://www.cdc.gov/niosh/learning/b-reader/pathology/pneumoconiosis/1.html |website=www.cdc.gov |access-date=31 July 2021 |date=5 August 2020}}Silicosis results from the inhalation of silica particles, and the formation of large silica nodules is associated with paracicatricial emphysema, with or without bullae.WEB, Pathology Basis of Occupational Lung Disease, Silicosis {{!, NIOSH {{!}} CDC |url=https://www.cdc.gov/niosh/learning/b-reader/pathology/silicosis/1.html |website=www.cdc.gov |access-date=31 July 2021 |date=5 August 2020}}

Ozone-induced emphysema

Ozone is another pollutant that can affect the respiratory system. Long-term exposure to ozone can result in emphysema.JOURNAL, Mumby S, Chung KF, Adcock IM, Transcriptional Effects of Ozone and Impact on Airway Inflammation, Front Immunol, 10, 1610, 2019, 31354743, 6635463, 10.3389/fimmu.2019.01610, free,

Osteoporosis

Osteoporosis is a major comorbidity of emphysema. Both conditions are associated with a low body mass index.JOURNAL, Martinez, CH, Han, MK, Contribution of the environment and comorbidities to chronic obstructive pulmonary disease phenotypes., The Medical Clinics of North America, July 2012, 96, 4, 713–27, 10.1016/j.mcna.2012.02.007, 22793940, 4629222, There is an association between treating emphysema, and osteoporosis; the use of systemic corticosteroids for treating exacerbations is a significant risk factor for osteoporosis, and their repeated use is not recommended.

Other terms

{{Further|Pneumatosis}}Compensatory emphysema is overinflation of part of a lung in response to either removal by surgery of another part of the lung or decreased size of another part of the lung.BOOK, Han, Xinwei, Wang, Chen, Airway Stenting in Interventional Radiology, 2018, Springer, 9789811316197, 27,books.google.com/books?id=oQ92DwAAQBAJ&pg=PA27, Pulmonary interstitial emphysema (PIE) is a collection of air inside the lungs but outside the normal air space of the alveoli, found as pneumatoses inside the connective tissue of the peribronchovascular sheaths, interlobular septa, and visceral pleura.

Lung volume reduction

Lung volume reduction may be offered to those with advanced emphysema. When other treatments fail, and the emphysema is located in the upper lobes, a surgical option may be possible. A number of minimally invasive bronchoscopic procedures are increasingly used to reduce lung volume.JOURNAL, Duffy S, Marchetti N, Criner GJ, Surgical Therapies for Chronic Obstructive Pulmonary Disease, Clin Chest Med, 41, 3, 559–566, September 2020, 32800206, 10.1016/j.ccm.2020.06.011, 221145423,

Surgical

Where there is severe emphysema with significant hyperinflation that has proved unresponsive to other therapies, lung volume reduction surgery (LVRS) may be an option.{{sfn|Gold Report|2021|p=96|loc=Chapter 4: Management of stable COPD}}JOURNAL, et al., van Geffen, WH, Slebos, DJ, Herth, FJ, Surgical and endoscopic interventions that reduce lung volume for emphysema: a systemic review and meta-analysis., The Lancet. Respiratory Medicine, April 2019, 7, 4, 313–324, 10.1016/S2213-2600(18)30431-4, 30744937, 73428098,pure.rug.nl/ws/files/81829213/1_s2.0_S2213260018304314.pdf, LVRS involves the removal of tissue from the lobe most damaged by emphysema, which allows the other lobes to expand and give improved function. The procedure appears to be particularly effective if the emphysema primarily involves the upper lobes; however, the procedure increases the risk of adverse events and early death in people who have diffuse emphysema.JOURNAL, van Agteren JE, Carson KV, Tiong LU, Smith BJ, Lung volume reduction surgery for diffuse emphysema, The Cochrane Database of Systematic Reviews, 2016, CD001001, October 2016, 10, 27739074, 10.1002/14651858.CD001001.pub3, 6461146,

Bronchoscopic

{{Further|Bronchoscopic lung volume reduction}}Minimally invasive bronchoscopic procedures may be carried out to reduce lung volume. These include the use of valves, coils, or thermal ablation.{{sfn|Gold Report|2021|pp=60–65|loc=Chapter 3: Evidence supporting prevention and maintenance therapy}}WEB, 1 Recommendations {{!, Endobronchial valve insertion to reduce lung volume in emphysema {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/ipg600/chapter/1-Recommendations |website=www.nice.org.uk |date=20 December 2017 |access-date=7 July 2021}} Endobronchial valves are one-way valves that may be used in those with severe hyperinflation resulting from advanced emphysema; a suitable target lobe and no collateral ventilation are required for this procedure. The placement of one or more valves in the lobe induces a partial collapse of the lobe that ensures a reduction in residual volume that improves lung function, the capacity for exercise, and quality of life.JOURNAL, Klooster K, Slebos DJ, Endobronchial Valves for the Treatment of Advanced Emphysema, Chest, 159, 5, 1833–1842, May 2021, 33345947, 8129734, 10.1016/j.chest.2020.12.007, The placement of endobronchial coils made of nitinol, instead of valves is recommended where there is collateral ventilation that would prevent the use of valves.JOURNAL, Slebos, DJ, Ten Hacken, NH, Hetzel, M, Herth, FJF, Shah, PL, Endobronchial Coils for Endoscopic Lung Volume Reduction: Best Practice Recommendations from an Expert Panel., Respiration; International Review of Thoracic Diseases, 2018, 96, 1, 1–11, 10.1159/000490193, 29991060, 6530543, JOURNAL, Welling JB, Slebos DJ, Lung volume reduction with endobronchial coils for patients with emphysema, J Thorac Dis, 10, Suppl 23, S2797–S2805, August 2018, 30210833, 6129816, 10.21037/jtd.2017.12.95, free, Nitinol is a biocompatible shape-memory alloy.Both of these techniques are associated with adverse effects, including persistent air leaks and cardiovascular complications. Bronchoscopic thermal vapor ablation has an improved profile. Heated water vapor is used to target affected lobe regions, which leads to permanent fibrosis and volume reduction. The procedure is able to target individual lobe segments, can be carried out regardless of collateral ventilation, and can be repeated with the natural advance of emphysema.JOURNAL, Valipour, Arschang, Bronchoscopic Thermal Vapour Ablation: Hot Stuff to Treat Emphysema Patients!,www.archbronconeumol.org/en-bronchoscopic-thermal-vapour-ablation-hot-articulo-S1579212916302725, Archivos de Bronconeumología (English Edition), 3 July 2021, 1–2, 10.1016/j.arbr.2016.11.009, 1 January 2017, 53, 1, 27916315, 78181696,

Other surgeries

Lung transplantation – the replacement of either a single lung or both (bilateral) – may be considered in end-stage disease. A bilateral transplant is the preferred choice as complications can arise in a remaining single native lung; complications can include hyperinflation, pneumonia, and the development of lung cancer.JOURNAL, Inci I, Lung transplantation for emphysema, Ann Transl Med, 8, 21, 1473, November 2020, 33313218, 7723607, 10.21037/atm-20-805, free, Careful selection as recommended by the National Emphysema Treatment Trial (NETT) for transplant surgeries is needed as in some cases there will be an increased risk of mortality.JOURNAL, Marchetti N, Criner GJ, Surgical Approaches to Treating Emphysema: Lung Volume Reduction Surgery, Bullectomy, and Lung Transplantation, Semin Respir Crit Care Med, 36, 4, 592–608, August 2015, 26238644, 10.1055/s-0035-1556064, 12014757, Several factors including age, and poor exercise tolerance, using the BODE index need to be taken into account. A transplant is only considered where there are no serious comorbidites. A CT scan or a ventilation/perfusion scan may be useful in surgery considerations to evaluate cases for surgical interventions, and also to evaluate post-surgery responses.JOURNAL, Lung Scintigraphy in COPD, Seminars in Nuclear Medicine, 16–21, 10.1053/j.semnuclmed.2018.10.010, 1 January 2019, Mortensen, Jann, Berg, Ronan M.G., 49, 1, 30545511, 56486118, free, A bullectomy may be carried out when a giant bulla occupies more than a third of a hemithorax.

In other tissues

Trapped air can also develop in other tissues such as under the skin, known as subcutaneous emphysema. Orbital emphysema is the trapping of air in the orbit; a type of this is palpebral emphysema that affects just the eyelids.JOURNAL, Zimmer-Galler, Ingrid E., Bartley, George B., Orbital Emphysema: Case Reports and Review of the Literature,www.mayoclinicproceedings.org/article/S0025-6196(12)61036-2/fulltext, Mayo Clinic Proceedings, 10 April 2023, 115–121, English, 10.1016/S0025-6196(12)61036-2, 1 February 1994, 69, 2, 8309261, free, Emphysematous gastritis is the presence of air in the stomach wall, usually caused by a bacterial infection. This is a rare occurrence but has a high mortality rate.JOURNAL, Azer, Samy A., Awosika, Ayoola O., Akhondi, Hossein, Gastritis,www.ncbi.nlm.nih.gov/books/NBK544250/, StatPearls, StatPearls Publishing, 5 December 2023, 2023, 31334970,

History

File:Giambattista morgagni.gif|thumb|upright=0.6|Giovanni Battista MorgagniGiovanni Battista MorgagniThe terms emphysema and chronic bronchitis were formally defined in 1959 at the CIBA guest symposium, and in 1962 at the American Thoracic Society Committee meeting on Diagnostic Standards. The word emphysema is derived from Ancient Greek ἐμφύσημα ‘inflation, swelling’WEB, Greek Word Study Tool – ἐμφύσημα,www.perseus.tufts.edu/hopper/morph?l=%E1%BC%90%CE%BC%CF%86%CF%8D%CF%83%CE%B7%CE%BC%CE%B1&la=greek#lexicon, 2021-08-25, www.perseus.tufts.edu, (referring to a lung inflated by air-filled spaces), itself from emphysao ‘to blow in, to inflate’,WEB, Greek Word Study Tool,www.perseus.tufts.edu/hopper/morph?l=%E1%BC%90%CE%BC%CF%86%CF%85%CF%83%CE%AC%CF%89&la=greek#lexicon, 2021-08-25, www.perseus.tufts.edu, composed of ἐν en, meaning ”in”, and φυσᾶ physa,WEB, Greek Word Study Tool,www.perseus.tufts.edu/hopper/morph?l=%E1%BC%90%CE%BC%CF%86%CF%8D%CF%83%CE%B7%CE%BC%CE%B1&la=greek#lexicon, 2021-08-25, www.perseus.tufts.edu, meaning ”wind, blast{{-“}}.{{sfn||Klein|1971|p=245}}WEB, Emphysema,dictionary.reference.com/browse/emphysema, Dictionary.com, 21 November 2013, live,dictionary.reference.com/browse/emphysema," title="web.archive.org/web/20131124023213dictionary.reference.com/browse/emphysema,">web.archive.org/web/20131124023213dictionary.reference.com/browse/emphysema, 24 November 2013, René Laennec, the physician who invented the stethoscope, used the term emphysema in his book A Treatise on the Diseases of the Chest and of Mediate Auscultation (1837) to describe lungs that did not collapse when he opened the chest during an autopsy.JOURNAL, Petty TL, The history of COPD, International Journal of Chronic Obstructive Pulmonary Disease, 1, 1, 3–14, 2006, 18046898, 2706597, 10.2147/copd.2006.1.1.3, free, He noted that they did not collapse as usual because they were full of air and the airways were filled with mucus. Early descriptions of probable emphysema include: in 1679 by T. Bonet of a condition of “voluminous lungs” and in 1769 by Giovanni Morgagni of lungs which were “turgid particularly from air”.{{sfn|Wright|Churg|2008|pp=693–705}} In 1721 the first drawings of emphysema were made by Ruysh.{{sfn|Wright|Churg|2008|pp=693–705}} These were followed the illustrations of Matthew Baillie in 1789 and descriptions of the destructive nature of the condition.

References

{{Reflist}}

Bibliography

• BOOK, Klein, Ernest,books.google.com/books?id=CWUYAAAAIAAJ, A Comprehensive Etymological Dictionary of the English Language, 1971, Elsevier Publishing Company, 978-0-444-40930-0,
• BOOK, Robbins Basic Pathology, Kumar, Vinay, Elsevier, 2018, 9780323353175,
• BOOK, Joanne L., Wright, Andrew, Churg, Pathologic Features of Chronic Obstructive Pulmonary Disease: Diagnostic Criteria and Differential Diagnosis,www.mhprofessional.com/downloads/products/0071457399/0071457399_chap40.pdf, Alfred, Fishman, Jack, Elias, Jay, Fishman, Michael, Grippi, Robert, Senior, Allan, Pack, 2008, Fishman’s Pulmonary Diseases and Disorders, 4th, McGraw-Hill, 978-0-07-164109-8, 2021-08-14, 2016-03-03,www.mhprofessional.com/downloads/products/0071457399/0071457399_chap40.pdf," title="web.archive.org/web/20160303202744www.mhprofessional.com/downloads/products/0071457399/0071457399_chap40.pdf,">web.archive.org/web/20160303202744www.mhprofessional.com/downloads/products/0071457399/0071457399_chap40.pdf, dead,
• WEB, {{harvid, Gold Report, 2021, |url=https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.0-11Nov20_WMV.pdf |title=Gold report 2021 |date=2021 |publisher=Global Initiative for Chronic Obstructive Lung Disease}}

External links

• EB9, Emphysema, VIII, 180–181, 1,

{{Medical resourcesJ43}}, {{ICD10|P25.0}}}}{{Authority control}}