Emphysema Pathophysiology

Tobacco smoke, Air Pollution Inherited α-1 Anti-trypsin Deficiency Inflammation of the Airway Epithelium Inhibition of Normal Endogenous AntiProteases

Infiltration of Inflammatory Cells & Release of Cytokines (Neutrophils, Macrophages, Lymphocytes, Leukotrines, Interleukins)

Increased Protease Activity with Breakdown of Elastin in Connective Tissue of Lungs (Elastases, Cathepsins, etc.)

Irreversible Enlargement of the Air Spaces distal to the Terminal Bronchioles

Destruction of Alveolar Walls & Septa and Loss of Elastic Recoil of Bronchial Walls (EMPHYSEMA)

Loss of Fibrous & Muscle Tissue Breakdown of Alveolar Elasticity

Alveoli cannot support the airways to keep them open Dyspnea on Exertion Amount of air that can be expired is diminished

A Portion of the Capillary Bed of an Alveolus has been eliminated. Increased Air Volume in the Acinus

Change in Airway Size

Decreased Tactile Fremitus on Palpation

Inability of the Alveoli to recoil normally after expanding

Lungs become less Compliant

Chest X-Ray Air Trapping Pulmonary Function Test

Crackles & Wheezing Barrel Chest, Hyperresonance on Chest Percussion Overdistended Lungs Hyperinflation of the Alveoli

Bronchiolar Collapse on Expiration

Inability of the Lungs to Circulate Sufficient Air

Increased Pulmonary Vascular Resistance ECG Pulmonary Hypertension

Airway Calibration is Decreased

Increased Total Lung Capacity And Residual Volume

Bullae (air spaces) will be formed adjacent to the Pleura (blebs)

Ruptured Bullae and Blebs Part of Each Inspiration is Trapped Arterial Blood Gas Spontaneous Pneumothorax

Right Ventricular Hypertrophy (Cor Pulmonale)


Decreased Oxygenation

Prolonged Hypoxia Chest X-Ray


Chest X-Ray

Decreased Chest Expansion


Clubbing of Fingers & Toes

LEGEND: Black Text – usual pathway Square Dotted Line – Clinical Manifestations Gray Text – Complications Dash Dot Line with Diamond Arrow – Laboratory & Diagnostic Tests

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