What is Emphysema?

Emphysema is a type of COPD (chronic obstructive pulmonary disease) which involves the permanent dilation of air spaces distal to the terminal bronchioles and the destruction of the walls of the dilated air spaces that leads to damage to alveoli(air sacs).

emphysema 1

Epidemiology of Emphysema?

The prevalence of emphysema is approximately 14 includes the 14% of white male smokers and 3% of the white male non smokers. The major cause for the emphysema is found to be cigarette smoking and environmental pollution. A contributing factor for the decreased mortality from the other causes is cardiovascular and infectious diseases.

Ethiopathogenesis of Emphysema?

The mechanism of alveolar wall destruction in emphysema by the elastolytic action is based on the imbalances between the proteases and the anti-proteases.

By the decrease in the anti elastase activity or by increase elastase activity i.e. increase in the neutrophilic infiltration in lungs causing the excessive elaboration of neutrophil elastase. Smoking promotes emphysema by both decreases in the amount of anti-elastase as well as by increase in the elastolytic protease in the lungs.


ICD 10 codes for Emphysema:

Unilateral pulmonary emphysema – J43.0

Panlobular emphysema( Panacinar emphysema) – J43.1

Centrilobular emphysema – J43.2

Other emphysema – J43.8

Emphysema unspecified – J43.9

Signs and Symptoms of Emphysema

  • Produce a lot of mucus
  • Continuous lung infections
  • Wheezing and difficulty breathing
  • Weight loss
  • anxiety 
  • depression
  • Headache and sleep disturbance



1. Centriacinar Emphysema:

Centriacinar Emphysema is one of the most commonly seen type of emphysema. Centriacinar Emphysema is characterized by initial involvement of the respiratory bronchioles i.e. the central or the proximal part of the acinus. It predominantly occurs in smoker and in coal mines.

centrilobar emphysema

2. Panacinar Emphysema

In this type, all the portions of acinus are effected but not the entire lung. Panacinar Emphysema is often associated with the alpha-1 antitrypsin deficiency in the middle aged smokers.

3. Paraseptal Emphysema (distal acinar):

Paraseptal Emphysema involves the distal part of acinus while the proximal part is normal and it also involves the upper part of lungs more severely than the lower part of the lungs i.e. the sub pleural portion of the lung shows air filled cysts which are about 0.5-2 cm in diameter.

4. Irregular Emphysema/Para-cicatriacial emphysema: The involvement is irregular as regards the portion of acinus involved as well as within the lung as a whole. This type of emphysema is usually asymptomatic.

5. Mixed Emphysema/unclassified emphysema:

In this type, the same lung may show more than 1 type of emphysema which is due to more severe involvement resulting in the loss of clear cut distinction between 1 types of emphysema.

Morphology of the types of over-inflation:

1. Compensatory Emphysema:

When a part or lobes of the lung are surgically removed, the residual lung parenchyma undergoes compensatory hyperinflation so as to fill the pleural cavity.

2. Senile hyperinflation/ageing lung:

In the old people, the lungs become voluminous due to the loss of the elastic tissue thinning and atrophy of the alveolar ducts and alveoli.

3. Obstructive overinflation:

Partial obstruction to the bronchial tree such as by a tumor or a foreign body causes over inflation of the region supplied by the obstructed bronchus.

4. Unilateral translucent lung:

This is a form of over inflation in which one lung or one of its lobes or segments of a lobe are radiolucent.

5. Interstitial emphysema:

The entry of air into the connective tissue frame work of the lung is called the intestinal surgical emphysema.

Clinical features for Emphysema:

  • Long history of slowly increased severe exertional dyspnea (shortness of breath).
  • Distressed
  • Chest is barrel shaped and hyper resonant.
  • Cough occurs late after dyspnea starts and is associated with scanty mucoid sputum.
  • Patients who are suffering with emphysema are called ‘pink puffers’ as they remain well
  • oxygenated and have tachypnea.
  • Weight loss is common.
  • The chest x-ray shows small heart with hyper inflated lungs.Treatment:The emphysema can’t be cured but the treatments help to relieve the symptoms and will slow the progression of the disease.
    1. Bronchodialtors:
    These bronchodilators will help in relieve coughing, shortness of breath and thereby relaxes the constricted airways.
    2. Inhaled steroids:
    The Corticosteroid drugs inhaled as the aerosol sprays will reduce the inflammation and will also help in the shortness of breath.
    3. Antibiotics:
    This is a better choice of drug if you have a bacterial infection.
    1. Pulmonary rehabilitation:
    A pulmonary rehabilitation program will teach you the breathing exercises and techniques which will help to reduce the breathlessness and improve your ability to do exercise.
    2. Nutrition therapy:
    In the early stages of emphysema, most of the people need to lose weight, but the people with late stage of emphysema need to gain weight.
    3. Supplemental oxygen:
    If you are suffering with the severe emphysema with low blood oxygen levels, then you need to use oxygen therapy regularly at home. It’s usually administered through the narrow tubing which fits into your nostrils.


Depending on the severity, the doctor may suggest either one or more different types of surgery, which includes:

1. Lung volume reduction surgery:

In this, the surgeons will remove the small wedges of the damaged lung tissue. The removal of the diseased tissue will help the remaining lung tissue to expand and work more efficiently and also improves breathing.

2. Lung transplant:

It is the last option when there is a severe lung damage and all the other options have failed. The chest x-ray shows small heart with hyper inflated lungs.

                                                                            Presented by

                                                               Keerthi kumari,  Deepthi kumari