Related Subjects:
|Emphysema
|Chronic Bronchitis
🧾 Emphysema is a pathological diagnosis defined by permanent enlargement of airspaces distal to the terminal bronchioles with destruction of alveolar walls.
It commonly occurs as part of COPD, alongside chronic bronchitis.
📌 In UK practice, NICE guidance is framed around COPD diagnosis and management, rather than emphysema in isolation.
📖 About
- Emphysema and chronic bronchitis are both recognised components of COPD.
- Emphysema represents a structural phenotype within COPD, characterised by alveolar destruction and loss of elastic recoil.
🔬 Pathological Definition
- Alveolar wall destruction + loss of elastic recoil → expiratory airway collapse, air trapping, and hyperinflation.
- Centriacinar emphysema is classically associated with smoking and tends to affect the upper lobes.
- Panacinar emphysema is classically associated with alpha-1 antitrypsin deficiency and tends to affect the lower lobes.
- Bullae are enlarged airspaces, often defined radiologically as >1 cm 🎈.
⚠️ Aetiology
- 🚬 Smoking is the major cause.
- 🧬 Alpha-1 antitrypsin deficiency should be considered in early-onset disease, limited smoking history, or a strong family history.
🩺 Clinical Features
- Progressive dyspnoea is often the dominant symptom.
- Reduced exercise tolerance.
- Weight loss may occur in advanced disease.
- 🫁 Hyperinflation: barrel chest, hyperresonance, reduced breath sounds.
- Prolonged expiration and pursed-lip breathing.
- Late disease may be complicated by cor pulmonale or chronic respiratory failure.
🔍 Differentials
- COPD with mixed phenotype
- Asthma
- Bronchiectasis
- Heart failure
🧪 Investigations
- 📉 Spirometry: used to support the diagnosis of COPD in the appropriate clinical setting; post-bronchodilator FEV1/FVC <0.7 supports airflow obstruction.
- 🫁 CT chest can demonstrate emphysema pattern and bullous disease, but emphysema remains a pathological diagnosis.
- 🩸 FBC may show secondary polycythaemia in chronic hypoxia.
- 🧬 Check alpha-1 antitrypsin if onset is early or smoking history is limited.
- 🩺 Blood gas assessment may be needed in advanced disease or exacerbations to assess hypoxia/hypercapnia.
💊 Management
- 🚭 Smoking cessation is the most important disease-modifying intervention.
- 🏋️ Pulmonary rehabilitation is a core NICE recommendation for appropriate people with COPD.
- 💨 Inhaled therapy is guided by COPD symptoms and exacerbation history:
- SABA or SAMA for symptom relief
- LABA or LAMA for maintenance
- LABA + LAMA ± ICS in selected patients with persistent symptoms or exacerbations
- 💊 Exacerbations of COPD: NICE recommends prednisolone 30 mg once daily for 5 days.
- 🫁 Oxygen during exacerbations: prescribe to the person’s target saturation range; 88–92% is commonly used in those at risk of hypercapnic respiratory failure.
- 🏠 LTOT should be assessed when stable, and may be indicated if PaO₂ ≤7.3 kPa, or ≤8 kPa with complications.
📚 References
