Emphysema : Definition, Classification, Pathogenesis, Symptoms, Treatment And MCQs for NEET, GPAT, CSIR NET JRF

‘’Emphysema is a condition of the lung characterized by abnormal permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls, and without obvious fibrosis.’’

CLASSIFICATION OF EMPHYSEMA :-

There are four types of emphysema :

• Centriacinar emphysema : The central or proximal part of the acini, formed by respiratory bronchioles, are affected, whereas distal alveoli are spared.
• Panacinar emphysema : In this type the acini are uniformly enlarged from the levels of respiratory bronchiole to the terminal blind alveoli.
• Paraseptal emphysema : In this type the proximal portion of the acinus is normal, but the distal part is dominantly involved.
• Irregular emphysema : Irregular emphysema, so maned because the acinus is irregularly involved is almost invariably associated with scarring. Thus, it may be the most common form of emphysema.

PATHOGENESIS :-

Pathologically, COPD is characterized by diffuse inflammation of lung parenchyma and airways. This inflammatory response in emphysema typically shows evidence of the activation of innate and acquired inflammatory components contributes to the lung injury in these patients and serves as a self – perpetuating stimulus for further immune activation. The mobilization of inflammatory cells to the lungs lead to the release of potentially  destructive mediators, includes tissue proteases and cytokinesis, which directly contribute to tissue remodelling and destruction. These mediators include chemo attractant factors, most notably chemo kines, which serve to attract additional inflammatory cells. In addition to inflammation, oxidative stress caused by cigarette smoke inhalation plays a significant role in generating emphysema. Therefore, oxidation injury and lung inflammation act in concrete to increase alveolar destruction or to compromise maintenance and repair of alveolar structure.

SYMPTOMS :-

In early stage of emphysema, commonly two symptoms are observed – shortness of breath and chronic cough.

Other symptoms of emphysema includes :-

• Lung infection become frequent
• A lot of mucus
• Wheezing
• Reduced appetite and weight loss
• Fatigue
• Due to the lack of oxygen cyanosis occur, nails become blue
• Anxiety and depression
• Breathing at night become difficult
• Headache happen due to the lack of the oxygen
• Sleep problems due to the difficulty in breathing

TREATMENT :-

Medication of emphysema include :

MULTIPLE CHOICE QUESTIONS :-

1.] True about alpha – 1 antitrypsin deficiency is / are ?

a. Pulmonary emphysema

b. Diastase resistance hepatic cells

c. Both (a) and (b)

d. None of the above

2.] Moat common type of emphysema clinically is ?

a. Panacinar

b. Centriacinar

c. Paraseptal

d. Segmental

3.] In a heavy smoker with chronic bronchiolitis which of the following is likely to be seen ?

a. Centrilobular emphysema

b. Panacinar emphysema

c. Paraseptal emphysema

d. None of the above

4.] Alpha – 1 – antitrypsin deficiency occur in ?

a. Asthma

b. Bronchiectasis

c. Emphysema

d. Bronchogenic carcinoma

5.] Which of the following disease is included in the umbrella term COPD ?

a. Emphysema

b. Chronic bronchitis

c. Lung cancer

d. Both (a) and (b)

6.] People in what age group are most likely to say they have symptoms of COPD ?
a. 15 – 24

b. 25 – 34

c. 35 – 39

d. 40 and older

7.] Long term exposure to which of the following can increase the risk of COPD ?
a. Airborne chemicals

b. Pollutants

c. Lung irritants

d. All of the above

8.] Which of the following can help improve your health if you have COPD ?
a. Not smoking

b. Exercising regularly

c. Drinking alcohol

d. Both (a) and (b)

9.] How is COPD treated ?
a. Bronchodilators

b. Inhaled corticosteroids

c. Supplemental oxygen

d. All of the above

10.] Which of the following steps help to prevent respiratory infection ?

a. Annual flee shots

b. Pneumonia shot

c. Avoiding drafts

d. Both (a) and (b)

SOLUTIONS :-

1.] (c)

2.] (b) Centriacinar

3.] (a) Centrilobular emphysema

4.] (c) Emphysema

5.] (d)

6.] (d) 40 and older

7.] (d)

8.] (d)

9.] (d)

10.] (d)

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REFERENCES :-

1.] Textbook Of Pathology By Harsh Mohan; 7th edition; Page no. 459 – 463.

2.] Robbin’s Basic Pathology; 5th edition; Page no. 683 – 688.