Introduction:
Emphysema is a condition in which there is the destruction of alveolar sacs and simultaneous enlargement of the lung parenchyma distal to the terminal bronchiole. The most significant risk factor for emphysema is cigarette smoking. Smoking stimulates inflammatory cells, such as macrophages and polymorphonuclear cells, which release elastase and cause elastolysis and emphysema. A characteristic feature of emphysema is the barrel chest which is a rounded and enlarged chest appearance due to hyperinflation. Typically, the anteroposterior to transverse ratio is 5:7 or 1:2, but in the case of emphysema, it becomes 1:1 due to hyperinflation. Depending on the zonal distribution, there are two types of emphysema: centrilobular emphysema and pan-lobular emphysema.
What Is Panlobular Emphysema?
Panlobular emphysema is an irreversible chronic disease that keeps worsening daily. It typically affects the acini, which can cause obstruction and hence, make it difficult to breathe. It is the end portion of the tracheobronchial tree, including alveolar ducts, alveolar sacs, and alveoli. It affects the lower lobe of the lungs more severely. It evenly distributes the disease and uniformly destroys the acinus and the secondary pulmonary lobules.
What Are the Signs and Symptoms of Panlobular Emphysema?
The signs and symptoms include:
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Chest tightness.
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Wheezing.
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Shortness of breath.
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Recurrent respiratory infections.
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Persistent cough.
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Excess sputum production.
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Difficulty in performing daily activities.
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Fatigue.
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Weight loss.
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Anxiety or depression.
The signs and symptoms may vary from person to person, the patient's history, and the disease's severity.
What Are the Causes of Panlobular Emphysema?
It can be caused by :
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Deficiency of Alpha- 1 Antitrypsin.
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Aging.
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Ritalin lung.
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Obliterative bronchiolitis.
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Swyer- James syndrome.
Alpha-1 Antitrypsin Deficiency: It is a rare congenital genetic disorder in which the body does not produce the alpha -1 antitrypsin enzyme. This enzyme is produced by the liver and secreted into the bloodstream to protect the lungs. The enzyme helps inhibit the elastase enzyme; therefore, all the elastin is broken down, resulting in emphysema.
Ritalin Lung: It is seen in intravenous Ritalin (methylphenidate) abusers. It is also known as excipient lung disease. Methylphenidate is commonly used in cases of attention deficit hyperactivity disorder (ADHD) in children and narcolepsy in adults. It is a structural analog of Amphetamine. Exposure to the talc-containing methylphenidate causes alveolar damage via talc granulomatosis, or there is a secondary infection relating to talc exposure resulting in the production of elastases, thereby causing alveolar destruction.
Obliterative Bronchiolitis: It is a rare condition caused by inhalation of chemicals, exposure to a respiratory virus, or an autoimmune disorder. It is also known as obliterative bronchiolitis or constrictive bronchiolitis. It is a type of bronchial inflammation with submucosal peribronchial fibrosis. It can also be associated with graft versus host disease following a lung or bone marrow transplant. It is characterized by concentric luminal narrowing of membranous and respiratory bronchioles due to submucosal and peribronchial inflammation and fibrosis without any intraluminal granulation tissue or polyps/ polyposis. Diffuse parenchymal inflammation is absent. It is also known as a popcorn lung since workers of a microwave popcorn plant had inhaled diacetyl, a chemical compound used for flavoring, and developed obliterative bronchiolitis.
Swyer-James Syndrome: It is a rare lung condition that involves either the entire lung or a portion of the lung that can get affected. It retards the growth of the affected lung compared to the other lung. The condition typically follows a viral respiratory infection such as adenovirus or Mycoplasma pneumonia infection in infancy or early childhood. The typical feature of a CT (computed tomography) scan is the affected lung being hyperlucent with diminished vascularity.
What Are the Lab Investigations to Be Carried Out?
The following factors can make the diagnosis:
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Radiographic Imaging: Such as a chest X-ray or a computed tomography (CT) scan.
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Pulse Oximetry: To measure the oxygen saturation levels in the blood.
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Arterial Blood Gas Analysis: It measures the amount of oxygen and carbon dioxide dissolved within the blood. It helps in evaluating how effectively the lungs are able to bring in oxygen and remove carbon dioxide from the body.
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Pulmonary Function Test or Spirometry: To measure the lung volume and capacities.
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Electrocardiogram: To check the heart function.
Although these tests help identify a case of emphysema, pan-lobular emphysema can be diagnosed with a CT scan. The most common characteristic features seen in a CT are:
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Decreased lung attenuation.
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Few visible pulmonary vessels in abnormal areas.
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Bullae or cysts are usually absent.
What Is the Treatment Modality for Panlobular Emphysema?
The treatment of pan lobular emphysema aims to reduce the symptoms and slow the disease progression.
The treatment may vary depending on the cause. Still, the treatment protocol remains the same:
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Bronchodilators: Drugs that relax the tubules' muscles and dilate the airways, such as short and long-acting beta-agonists and anticholinergics.
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Corticosteroids: Drugs that help to reduce the inflammation of the airways.
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Combined Inhalers: Bronchodilators and corticosteroids combined as one inhaler.
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Antibiotics: Drugs to fight against bacterial infection.
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Flu or Pneumonia Vaccine: To reduce the chances of developing a respiratory illness.
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Mucolytics: Helps in lysis or breaking down the secretions such as Guaiphenesin.
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Pulmonary Rehabilitation includes exercise, disease management, and proper counseling to stay healthy and active.
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Lung Transplant: May be required in severe cases.
What Are the Complications of Panlobular Emphysema?
The complications include
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Respiratory insufficiency.
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Respiratory tract infection.
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Respiratory failure.
How Is Panlobular Emphysema Different From Centrilobular Emphysema?
Pan lobular emphysema typically affects the secondary pulmonary lobules, particularly the lower lobes, whereas centrilobular emphysema affects the upper lobes. Also, pan-lobular emphysema can occur from various causes, but centrilobular emphysema is most commonly caused by smoking.
Conclusion:
Panlobular emphysema is a type of emphysema. In emphysema, the alveoli are destroyed and ruptured with a decreased exchange of gasses during respiration. As a result, emphysema is commonly associated with difficulty breathing, sputum production, and wheezing. The potential causes are alpha-1 antitrypsin deficiency and aging. Although there is no cure for pan lobular emphysema, only symptomatic relief can be provided to slow down the disease progression and improve the patient's quality of life. Bronchodilators can be helpful for anti-inflammatories such as corticosteroids, antibiotics, and mucolytics. A lung transplant remains the last resort in very severe cases of emphysema.
