Pulmonary emphysema is a progressive condition that is part of the disease known as chronic obstructive pulmonary disease, or COPD. It primarily affects the alveoli in the lungs. These are tiny air sacs that are necessary for proper breathing. In cases of pulmonary emphysema, these sacs are damaged in various ways whether enlarged, narrowed, stretched or otherwise permanently destructed. Smoking is the single biggest and most common cause of emphysema, although there are cases of non smokers developing the condition. Most of these occurrences are related to occupational or environmental hazards such as exposure to second hand smoke, toxins or fumes or working in places like mines. Emphysema can occur in various parts of the lung, and thus can be further classified based on location. There are two main types of emphysema based on this distinction, centrilobular emphysema (also known as centriacinar emphysema) and panlobular emphysema (also known as panacinar emphysema).
The lungs are big organs, and emphysema can affect different parts of it differently. When the lung disease is present throughout the lung but concentrated in the lower portions, it is referred to as panlobular emphysema. When the opposite is true and the lung disease is more predominant in the upper parts of the lungs, it is referred to as centrilobular emphysema.
Emphysema causes between these two types can vary. In the case of panlobular emphysema for instance, the condition is thought to be more common in people with a homozygous alpha1-antitrypsin (AAT) deficiency. Additionally, in smokers who have this form of the condition, it is thought to commonly coexist with the centriacinar form of the disease. Conversely, centrilobular emphysema, while also intimately related to smoking, is also more associated with chronic bronchitis. In addition, it is also the type of emphysema more likely to be caused by occupational exposures, such as in people who work in mines or deal with pollutants regularly.
The two types of the condition are different in terms of physical location and sometimes, causes. However, when it comes to emphysema symptoms, there is little differentiation between the two. Both types lead to a decreased ability to breathe, excess mucus production and a persistent or chronic cough (sometimes even coughing up blood in later stages). These symptoms worsen over time through each of the four stages of emphysema, where lung function becomes more and more reduced and thusly, emphysema symptoms are intensified. In stage one, lung function maintains above 80%. Stage two refers to decreased lung function at between a 50% and 80% capacity. Stage three refers to lung function between 30% and 50% and the final and most advanced stage refers to lung function below 30%. Emphysema symptoms become worse the later the stage becomes. And, similarly, emphysema life expectancy decreases as the lung disease advances as well.
With one minor exception, the treatment for both centrilobular emphysema and the panlobular form of the condition is the same as well. Quitting smoking is the single biggest contributing factor to both symptoms management and slowing the progression of the disease. Unfortunately, however, there is no cure for emphysema or COPD. Some medications are used however for symptom relief. Steroids are sometimes implemented and some COPD medications like mucolytic agents to reduce the viscosity of mucus may be used as well. Oxygen therapy is very common due to the decreased breathing capacity. Other medications like bronchodilators may also be utilized as well. The one difference between panlobular emphysema treatment and that for centrilobular emphysema has to do with the former’s deficiency. In some cases of panlobular emphysema, medicines may be used to correct the homozygous alpha1-antitrypsin (AAT) deficiency by increasing its production in the liver.
Emphysema is a serious and life long illness. Chronic obstructive pulmonary disease, of which emphysema belongs, is one of the most common causes of death in the United States. In part, this is because it is not often found until later stages of illness. It also may be because smoking habits are not ceased while the disease is present. Regardless of where in the lungs the damage has occurred, and whether centrilobular emphysema or panlobular emphysema is present, it is irreversible, and breathing will forever be impacted. However, lifestyle changes like smoking cessation, increasing physical activity and improving health in other ways can lead to a dramatically halted progression of both symptoms and disease, leading to a more normal life with fewer and less aggressive symptoms.