Affects more than 2 million Americans.

Characterized by abnormal permanent enlargement of airspaces distal to the terminal bronchiole, accompanied by destruction of their walls and without significant fibrosis.

Characterized by lung tissue inelasticity, air trapping, hyperinflation, associated with dyspnea, exercise limitation ability and impaired quality of life.

Classification based on anatomic distribution within the lobule.

Four major types: centriacinar, panacinar, paraseptal, and irregular.

Centriacinar constitutes more than 95% of cases.

Centriacinar type associated with involvement of central or proximal parts of the acini, whereas distal alveoli are spared, meaning that emphysematous and normal airspaces are present within the same acinus and lobule.

Centriacinar lesions more common and severe in the upper lobes of the lung.

Occurs predominantly in heavy smokers, but up to 20% of people with emphysema never smoked.

Can be measured quantitatively on CT imaging and can be observed without spirometric COPD.

The percentage of emphysema-like lung on CT scan is associated with the degree of lung function impairment and symptoms as well as mortality in patients with COPD.

Percent emphysema is associated with shortness of breath and disease exacerbations independent of lung function among smokers and with incident COPD and all cause mortality among individuals without COPD in the general population.

In severe disease centriacinar disease may involve the distal acinus and be difficult to differentiate from panacinar emphysema.

Panacinar type disease associated with acini which are uniformly enlarged throughout the acinus and tends to occur on the lower and anterior margins of the lung with most severe involvement in the lung bases.

Panacinar type disease associated with alpha1-antitrypsin deficiency.

Related to an i,balance between protease and anti-protease activity due to lung infiltration by activated neutrophils, reduced into a protease activity or both (alpha1-antitrypsin deficiency) plus additional factors including enhanced apoptosis, lung maintenance failure, oxidative stress, auto immunity, malnutrition, or a combination of these factors.

In addition the abnormal alveolarization during long development in early life due to maternal smoking, prematurity can contribute to the lifetime burden of emphysema.

Distal acinar type associated with a normal proximal acinus, but the distal aspect is predominantly involved.

Distal acinar type associated with areas adjacent to the pleura, along lobular septae, and at margins of lobules.

Distal acinar type usually more severe in the upper lungs.

Distal acinar type occurs near areas of atelectasis and fibrosis.

Distal acinar type characteristically associated with multiple enlarged airspaces from 0.5-2.0cm diameter lesions.

Distal acinar type of emphysema underlies many cases of spontaneous pneumothorax in young adult patients.

Distal acinar type characteristically associated with multiple enlarged airspaces from 0.5-2.0cm diameter lesions.

Distal acinar type of emphysema underlies many cases of spontaneous pneumothorax in young adult patients.

Irregular emphysema, airspace enlargement with fibrosis, refers to a process of irregular involvement of the acinus associated with scarring.

May be the most common type of emphysema because most lung have scars from healed inflammatory process, but these foci are symptomatic and clinically insignificant.

Three surgical treatments include emphysematous bullectomy, lung reduction surgery and lung transplantation.

Giant bullous emphysema rare and can be as large as the affect 80-90% of lung.

Surgical intervention indicated for giant bullae with progressive respiratory insufficiency, recurrent pneumothorax, hemoptysis or infection of the bullae.

Lung volume reduction surgery has significant morbidity and mortality

Endobronchial valves significantly improve predominant emphysema.

Bronchoscopic treatment with nitinol coils compared with usual care results in improved exercise capacity at 6 months (REVOLENS Study Group).

Screening tests for lung cancer using low-dose CT scans has revealed that changes associated with emphysema, may be the single most powerful predictor of lung cancer risk.

Never smokers with emphysema have a 6 fold increase in lung cancer risk compared with never smokers without emphysema.

Long-term exposure to ambient air pollutants is significantly associated with increasing emphysema as assessed quantitatively using CT imaging and lung function.

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