Scenario 5:  COPD A 66-year-old female with a 50 pack/year history of cigarette smoking had a CT scan and was diagnosed with emphysema.  He asks if this means he has chronic obstructive pulmonary disease (COPD). Question: There is a clear relationship between emphysema and COPD, explain the pathophysiology of emphysema and the relationship to COPD.

 

Emphysema is characterized by two significant changes: loss of lung elasticity and hyperinflation of the lung. It occurs when protein-degrading enzymes called proteases are at higher-than-normal levels. They damage the alveoli and the small airways by breaking down elastin (Rodrigues et al., 2021). High protease levels make the alveolar sacs lose their elasticity, and the small airways collapse or narrow. Some alveoli get destroyed, and others become large and flaccid with reduced area for effective gas exchange. An increased amount of air is trapped in the lungs due to loss of elastic recoil in the alveolar walls, overstretching and enlargement of the alveoli into air-filled spaces, and collapse of small airways (Rodrigues et al., 2021). Emphysema is linked to COPD since oxygenation is affected by the loss of alveolar tissue and the increased work of breathing. Usually, inhalation begins before exhalation is completed, causing an uncoordinated breathing pattern.

References

Chindamo, M. C., & Marques, M. A. (2019). Role of ambulation to prevent venous thromboembolism in medical patients: where do we stand?. Jornal Vascular Brasileiro, 18. https://doi.org/10.1590/1677-5449.180107

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