COPD- Emphysema

Question 1

Emphysema Etiology?

Answer 1

Associated with smoking and hereditary α1-antitrypsin deficiency

Question 2

Emphysema Pathogenesis?

Answer 2

Enzymes (elastase) destroy elastin in alveolar wall, unless neutralized by α1
antitrypsin;

smoking inactivates α1-antitrypsin and attracts neutrophils (source of elastase)

Question 3

Emphysema Gross FX?

Answer 3

Enlargement of air spaces; destruction of alveolar wall

Question 4

4 gross patterns seen in emphysema?

Answer 4

(1) Centriacinar—respiratory bronchioles dilated especially in upper lobes, seen in smokers;
(2) Panacinar—entire acinus is dilated in entire lung, seen with α1-antitrypsin deficiency;
(3) Paraseptal—distal alveoli dilated near pleura and interlobar septa, may see large blebs;
(4) Irregular—acinus is irregularly involved, associated with scarring and inflammation

Question 5

Emphysema clinical signs?

Answer 5

“Pink puffers” (slowing of forced expiration through pursed lips); 
dyspnea; cyanosis; 
tachycardia;
barrel-shaped chest; 
use of accessory respiratory muscles

Question 6

Emphysema Complications?

Answer 6

pneumothorax caused by bullae rupture, chronic bronchitis;

and cor pulmonale

Question 7

Emphysema Imaging?

Answer 7

CXR: Hyperinflation and bullae with flattened diaphragm

Question 8

Emphysema Lab findings?

Answer 8

Hypoxia,

increased residual volume and TLC, decreased FEV1/FVC ratio

Question 9

Emphysema Treatment?

Answer 9

Smoking cessation;
oxygen;
bronchodilators (anticholinergics, beta-agonist);
inhaled steroids

Question 10

Hereditary α1-antitrypsin deficiency also causes?

Answer 10

hepatic cirrhosis