COPD: Emphysema Pathophysiology & Schematic Diagram

Emphysema is an abnormal, irreversible enlargement of air spaces distal to terminal bronchioles due to destruction of alveolar walls, resulting in decreased elastic recoil properties of lungs.

Causes of Emphysema

• Cigarette smoking and congenital deficiency of alpha-antityrpsin
• Recurrent inflammation associated with release of proteolytic enzymes from cells in lungs causes bronchiolar and alveolar wall damage and ultimately destruction.

COPD: Emphysema Pathophysiology & Schematic Diagram

Pathophysiology of Emphysema

Emphysema is a pathological diagnosis defined by permanent enlargement of airspaces distal to the terminal bronchioles. This leads to a dramatic decline in the alveolar surface area available for gas exchange. Furthermore, loss of alveoli leads to airflow limitation by 2 mechanisms. First, loss of the alveolar walls results in a decrease in elastic recoil, which leads to airflow limitation. Second, loss of the alveolar supporting structure leads to airway narrowing, which further limits airflow.

Emphysema commonly presents with chronic bronchitis. Chronic bronchitis leads to obstruction by causing narrowing of both the large and small (< 2 mm) airways. In the large airways, an increase in Goblet cells, squamous metaplasia of ciliary epithelial cells, and loss of serous acini can be seen. In the small airways, Goblet cell metaplasia, smooth muscle hyperplasia, and subepithelial fibrosis can be seen. In healthy individuals, small airways contribute little to airway resistance; however, in COPD patients, these become the main site of airflow limitation. (PubMed.gov)

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