emfysem

Emphysema, sometimes spelled emfysem in some languages, is a chronic lung disease characterized by damage to the walls of the air sacs (alveoli) in the lungs, leading to enlargement of air spaces and reduced surface area for gas exchange.

It is a form of chronic obstructive pulmonary disease (COPD). Emphysema can be categorized as centriacinar (affecting the upper lobes and around respiratory bronchioles) or panacinar (more uniform involvement, often linked to alpha-1 antitrypsin deficiency).

Causes include long-term exposure to cigarette smoke and other inhaled irritants, air pollution, and genetic deficiency of alpha-1 antitrypsin. These factors lead to progressive destruction of alveolar walls and loss of elastic recoil.

Symptoms are typically progressive shortness of breath, reduced exercise tolerance, chronic cough, and occasional wheeze. On examination, patients may have diminished breath sounds, hyperresonance, and a barrel-shaped chest. The disease often coexists with chronic bronchitis, another form of COPD.

Diagnosis relies on spirometry showing an obstructive pattern with reduced FEV1 and FEV1/FVC ratio, alongside a reduced diffusing capacity (DLCO). Imaging with high-resolution CT reveals emphysematous changes, and chest X-ray may show hyperinflation.

Management focuses on stopping exposure to irritants, notably smoking cessation, and using inhaled bronchodilators and, when indicated, inhaled corticosteroids. Pulmonary rehabilitation, vaccinations, and supplemental oxygen for hypoxemia are important. Surgical options include bullectomy or lung volume reduction in selected cases, and lung transplantation for end-stage disease.

Prognosis varies with disease severity and comorbidity; emphysema is typically progressive but can be stabilized with treatment and lifestyle changes. Epidemiologically, it is a major component of COPD, more common in older adults and smokers, with risk increased by genetic factors.