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Emphysema is the destruction of interalveolar septa. The disease occurs in the distal or terminal airways and involves both airways and lung parenchyma.

Chronic obstructive pulmonary disease (COPD) encompasses several diffuse pulmonary diseases including chronic bronchitis, asthma, cystic fibrosis, bronchiectasis, and emphysema. The term usually refers to a mixture of chronic bronchitis and emphysema.

Chronic bronchitis is defined clinically by increased mucus production and recurrent cough present on most days for at least three months during at least two consecutive years.

Signs include: dyspnea, tachypnea, and increased AP chest diameter - Òbarrel chestÓ. Emphysema patients are which is referred to as Òpink puffersÓ.


Causes of emphysema include: cigarette smoking, air pollution, occupational exposure (i.e., firefighters), and infection possibly (viral)

A rare form of emphysema, antiprotease deficiency (due to alpha 1-antitrypsin deficiency), is an inherited disorder that is an expression of two autosomal codominant alleles.

Risk factors include: Passive smoking (especially adults whose parents smoked), Severe viral pneumonia early in life, Aging, Ethel alcohol (EtOH) consumption, and Airway hyperactivity

Conventional Labs

Normal serum hemoglobin or polycythemia

PFTs - reduced FEV1, reduced FVC in severe disease

PFTs - Normal PaCO2; unless FEV1 < 1 L/sec, then can be elevated

Mild hypoxia

Chest x-ray (CXR) shows hyperexpanded lungs, a small heart, flat diaphragms and possibly bullous changes .

sputum - exacerbation shows Strep pneumoniae or H. influenza

EKG - sinus tachycardia

ABG - compensatory respiratory acidosis in advanced disease

secondary polycythemia in advanced COPD




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