Emphysema (Centriacinar) “Pink Puffers”


Summary 1) Robbins Basic Pathology by Vinay Kumar

Emphysema is characterized by abnormal permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls without significant fibrosis.

Pathophysiology 2) Wikipedia

Xray – Hyperinflation of lungs (Radiopaedia)

Emphysema is one of the diseases that make up chronic obstructive pulmonary disease (COPD). This is a set of diseases where the flow of air in the lungs is obstructed. Emphysema is most often caused by smoking but can be caused by other diseases or have no known cause at all.

It occurs when the very small air sacs (called the alveoli) at the ends of the airways in the lungs start to break down from many sacs to form much bigger sacs. The alveoli are the areas of the lung where oxygen and carbon dioxide are exchanged into and out of the blood. Emphysema makes it hard for people to blow air out of the lungs because air gets trapped inside the broken alveoli due to the collapse of the walls.

Causes 3) Robbins Basic Pathology by Vinay Kumar

  • Smoking 
  • Inhaled pollutants

Symptoms 4) Fundamentals of Pathology by Hussain Sattar

  • Lung involvement – dyspnea and cough with minimal sputum, prolonged expiration with pursed lips 
  • Skin changes – pink skin complexion (pink puffer) 

Enlarged Airspace (Yale Med)

Diagnosis 5) First Aid: USMLE Step 1 by Tao Le

  • Physical exam – thin or cachectic, leaning forward on extended arms (“tripoding”), using accessory muscles of respiration, increased anteroposterior (AP) diameter of the chest, due to hyperinflation of the lungs
  • Chest X-ray Hyperinflated lungs, flattened diaphragm, and increased AP diameter, paucity of vascular markings (arterial deficiency) in the upper lobes with or without bullae
  • Pulmonary function testing decreased FEV1 and FEV1:FVC ratio, FVC, air trapping leads to increased TLC, FRC, and RV
  • Diffusing capacity – surface area for gas exchange decreased, so DLCO decreased 
  • Arterial blood gas testing – both PaO2 and PaCO2 are normal or slightly decreased

Treatment 6) First Aid: USMLE Step 1 by Tao Le

  • Inhaled bronchodilators – B-agonists (albuterol, salmeterol), anticholinergics (ipratropium, tiotropium), can reduce airflow obstruction. IV or PO 
  • Corticosteroids – used during acute exacerbations and are given longterm via inhaler for chronic disease. 
  • Supplemental O2 – useful in patients with hypoxemia

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