Patients with emphysema are often referred to as “pink puffers.” This is because individuals with emphysema must compensate for poor gas exchange by hyperventilation (the puffer part) and often have a pink complexion. Eventually, people afflicted with this disease often develop weight loss and muscle wasting due to low cardiac output.
Individuals with emphysema often exhale through pursed lips, which helps keep their airways open during exhalation.
Collapse of the small airways during exhalation leads to air trapping in the lungs. This can lead to increased anteroposterior diameter of the chest, also referred to as a barrel chest.
Emphysema is a form of obstructive lung disease with airways closing prematurely at high lung volumes, resulting in increased residual volume and decreased functional vital capacity. Patients with obstructive lung disease have decreased FEV1/FVC ratio.
Destruction of the alveolar walls and increased elastase activity leads to increased lung compliance. Other effects of elastic fiber loss include decreased recoil and enlarged air spaces. Lung compliance is calculated by the change in volume over the change in pleural pressure.
Centriacinar emphysema is characterized by damage to the respiratory bronchiole, including the proximal and central part of the acinus, while the distal acinus or alveoli are relatively unchanged. Centriacinar emphysema is more commonly associated with a history of cigarette smoking and more commonly affects the upper lungs.
Panacinar emphysema is characterized by expansion of the entire respiratory lobule from the respiratory bronchiole to alveoli. It is associated with alpha-1 antitrypsin deficiency and more commonly affects the lower lungs, and can lead to hepatic cirrhosis.
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