COPD

• What is the difference between emphysema and chronic bronchitis?

• Emphysema and chronic bronchitis are both types of COPD. Many people
have them both at the same time.
• Emphysema is a lung disease that damages the alveoli in your lungs. The
primary symptom of emphysema is shortness of breath.
• Chronic bronchitis is a lung condition that destroys the cilia in your airways.
Cilia are hair-like parts (organelles) of cells that move germs and other
debris out of your airways. The primary symptom of chronic bronchitis is
mucus production, including a wet cough that produces thick, discolored
(yellow, green or yellow-grey) mucus from your lungs (productive cough).
Emphysema has more symptoms, including shortness of breath and cough.
• Emphysema is a lung disease that results from damage to the walls of
the alveoli in your lungs. A blockage (obstruction) may develop, which
traps air inside your lungs. If you have too much air trapped in your
lungs, your chest may appear fuller or have a barrel-chested
appearance. With fewer alveoli, less oxygen moves into your
bloodstream.
• Alveoli are small, thin-walled, fragile air sacs arranged in clusters at
the end of the bronchial tubes (airways) deep inside your lungs. In a
typical set of lungs, there are about 300 million alveoli. As you
breathe in air (inhale), the air travels through the bronchial tubes until
it reaches the alveoli. Once the air gets there, the alveoli stretch, draw
in oxygen and transport oxygen to your blood. As you breathe out air
(exhale), your alveoli shrink and force carbon dioxide out of your
body.
• Think of your lungs as bubble wrap. The alveoli are like individual
bubbles in bubble wrap. If you have emphysema, your alveoli
eventually break. Instead of many tiny bubble wrap bubbles, you
develop a large air pocket, like a big shipping air pillow. This damage
causes your lungs’ overall surface area to shrink, and it makes it hard
to get fresh air in and out of your lungs. This makes your breathing
difficult and makes you short of breath.
• Emphysema usually develops after many years of smoking. However,
emphysema has other causes. These include:
• Genetic (inherited) factors such as alpha-1 antitrypsin deficiency.
• Respiratory infections.
• Toxins in your home or workplace.
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).
• The fourth subtype is known as paracicatricial emphysema or
irregular emphysema, involves the acinus irregularly and is associated
with fibrosis.[17]
• Centrilobular (Centriacinar) Emphysema:
• This is the most common type, and is strongly associated with
smoking. It primarily affects the respiratory bronchioles in the center
of the lung lobule, while the surrounding tissue is relatively spared.

• Panlobular (Panacinar) Emphysema:

• This type involves the entire lung lobule, from the bronchioles to the
alveoli, and is often associated with alpha-1 antitrypsin deficiency. It
tends to be more prevalent in the lower lung zones
• Paraseptal (Distal Acinar) Emphysema:
• This type primarily affects the periphery of the lung lobule, near the
pleura (membrane surrounding the lungs), and can lead to
spontaneous pneumothorax (collapsed lung) in some cases.

• Irregular (Paracicatricial) Emphysema:

• This type is associated with scarring and fibrosis, often in areas of pre-
existing lung damage or inflammation.
• What are the stages of emphysema?
• The Global Initiative for Chronic Obstructive Lung Disease (GOLD) categorizes
COPD in four stages. Emphysema is a cause of COPD, but not all patients with
emphysema have COPD. Healthcare providers use the COPD stages to help
describe emphysema. The stages are:
• Stage 1. This is the mildest stage of emphysema. Your lungs operate at least 80%
as well as the healthy lungs of someone who’s the same age, height and sex.
• Stage 2. This is moderate emphysema. Your lungs operate between 50% and 79%
as well as the healthy lungs of someone who’s the same age, height and sex.
• Stage 3. This is severe emphysema. Your lungs operate between 30% and 49% as
well as the healthy lungs of someone who’s the same age, height and sex.
• Stage 4. This is very severe emphysema. Your lungs operate less than 30% as well
as the healthy lungs of someone who’s the same age, height and sex.
• What is the main cause of emphysema?
• Smoking is the main cause of emphysema.
• Cigarette smoke destroys your lung tissue, and it also irritates your airways. Cigarette
smoke causes inflammation and damages your cilia. Irritation and damaged cilia cause
swollen airways, mucus production and difficulty clearing your airways. All of these
changes can cause shortness of breath.
• Though smoking is the main cause of emphysema, there are other causes. These
include:
• Marijuana
• Vaping and e-cigarettes.
• Cigar smoke.
• Toxins in the air.
• Dust.
• Chemical fumes.
Diagnosis and Tests
• Your healthcare provider can diagnose emphysema. However, they
can’t diagnose emphysema solely from your symptoms.
• Your healthcare provider will perform a physical examination. During
the physical exam, they’ll listen to your lung sounds with a stethoscope
(auscultation). A stethoscope is a medical device that features a small,
metal disc (diaphragm) that connects to earpieces with rubber tubing.
• With their stethoscope pressed against your chest, your healthcare
provider will tap on your chest and listen for a hollow sound. If they
hear a hollow sound, that means your lungs are trapping air. They’ll
then order tests to confirm emphysema.
• Chest X-ray. Your healthcare provider will take X-rays of your chest to look at your lungs. They’ll
compare your lungs to X-rays of healthy lungs. X-rays are usually not helpful in detecting the
early stages of emphysema. They’re more useful in diagnosing moderate or severe emphysema.
• CT scan. A CT scan creates a 3D image of your lungs. It provides more detailed images than an
X-ray.
• Pulmonary function testing. Pulmonary function tests measure how well your lungs inhale and
exhale air. Testing may include spirometry. Spirometry uses a spirometer machine to measure
the flow of air through your lungs. It also estimates the amount of air in your lungs.
• Arterial blood gas (ABG). An ABG measures the amount of oxygen and carbon dioxide in the
blood from an artery (arterial blood). An artery is a tube that carries blood away from your
heart. Your healthcare provider may order an ABG if your emphysema gets worse. It can help
determine if you need extra oxygen.
• Electrocardiogram (EKG). An EKG checks your heart function. Your healthcare provider may
order an EKG to rule out heart disease as a cause of shortness of breath.
• Blood tests and genetic tests. Your healthcare provider may order blood tests and genetic tests
to confirm alpha-1 antitrypsin deficiency as a cause of emphysema.
• Management and Treatment
• Can your lungs heal from emphysema?
• No, your lungs can’t heal from emphysema. However, treatments can
help reduce your symptoms and improve your quality of life. Other
interventions can help prevent further damage from occurring.
• How is emphysema treated?
• Emphysema can worsen over time, so treatment focuses on slowing
emphysema down and maximizing the function of your remaining
healthy lung. The type of treatment depends on the severity of your
emphysema.
• Treatment options may include:
• Quitting smoking.
• Bronchodilators.
• Inhaled corticosteroids. Inhaled corticosteroids reduce swelling in your airways and mucus production
• Oral corticosteroids. A provider often prescribes short courses of oral corticosteroids when you’re having an
exacerbation or “flare” of your emphysema.
• Antibiotics. Antibiotics help treat bacterial infections, including pneumonia, bronchitis and other lung infections.
• Anti-inflammatory medications. Anti-inflammatories reduce inflammation in your airways.
• Oxygen therapy. If your lungs aren’t getting enough oxygen to your blood (hypoxemia), oxygen therapy can help.

• Lung volume reduction surgery (LVRS). During LVRS, your healthcare provider removes a portion of your
diseased lung tissue and joins the remaining tissue together. Removing the damaged tissue may relieve pressure
on your breathing muscles and help improve your lungs’ ability to stretch. LVRS results are usually promising.
However, not all people with emphysema are candidates for this surgery.
• Bronchoscopic lung volume reduction. During bronchoscopic lung volume reduction, a provider places a one-
way valve into your airways. The valve allows air to leave those sections of your lungs, but not enter. This helps
decrease the amount of “trapped” air that’s in your lungs and makes it easier to breathe. Not all people with
emphysema are candidates for this procedure.
• Lung transplant. If you have severe emphysema and your lungs don’t respond to other treatment options, a lung
transplant replaces your damaged lungs with a donor’s healthy lungs.