What is Centrilobular Emphysema?

What is Centrilobular Emphysema? In short, Centrilobular Emphysema, or Secondary Pulmonary Emphysema is an Emphysema that occurs in the pulmonary area in contact with the terminal bronchi, so in the center of the pulmonary lobe. It is a complication of Chronic Bronchoobstructive diseases.

But to better answer this question we should first understand the concept of emphysema and other particularly important notions regarding the diagnosis of emphysema, its symptoms, and complications.

To start of, Emphysema is a diffuse lung disease that is characterized by a distension of the alveoli with the destruction of their walls.

As for the causes, these are often unknown, but older age is a favored factor, happening at around 40 years of age.

This form of Emphysema is caused by an abnormality of the proportions of enzymes present in the lungs. Centrolobular Emphysema is a complication of chronic bronchitis which usually happens as a consequence of excessive smoking.

Professional emphysema is caused by some lung diseases: tuberculosis, pneumoconiosis (silicosis, for example).

The most frequent causes of Emphysema

By far, the most common cause of lung emphysema is smoking and although the pulmonary damage specific to emphysema is progressive, most people with smoker emphysema begin to show symptoms of this disease between 50 and 60 years of age.

Cylinders in the respiratory tract mucosa are designed to clean the airways and prevent air, germs, irritants, microscopic pollutants from entering the alveoli. In the absence of healthy cilia, irritants remain in the airways and a part penetrate into the alveoli, generating inflammation.

Other risk factors for pulmonary emphysema are:

  • Passive exposure to cigarette smoke,
  • Occupation exposure to various chemicals,
  • Heredity – inherited deficiency of alpha 1 antitrypsin is a cause of emphysema, especially before the age of 50, even if the person is a non smoker,
  • HIV infection – HIV infected smokers have an additional risk of emphysema comparing to the uninfected,
  • And some other connective tissue diseases are associated with emphysema.

What is Centrilobular Emphysema?

Emphysema CentrilobularSecondary pulmonary emphysema, or centrilobular emphysema occurs in the pulmonary area in contact with the terminal bronchi, so in the center of the pulmonary lobe (acin).

Lung parenchyma and vessels are destroyed in the central portion of the lobe, leaving the alveoli and vessels in the rest of the lobe unaffected.

It is a complication of Chronic Bronchoobstructive diseases.

The most common cause is Chornic Obstructive Bronchitis, followed by asthma.

The pathophysiological disturbances are predominantly caused by bronchoobstructive syndrome. Bronchial obstruction causes decreased alveolar ventilation, deterioration of ventricular/infusion ratio, chronic airway failure with hypoxemia and hypercapnia.

Symptoms of centrilobular emphysema

Insidious onset of chronic bronchoobstructiv maladia (chronic obstructive bronchitis, bronchial asthma, etc.) with expiratory drowsiness (with protruding lips), progressing slowly and irreversibly, accentuating stress and decreasing remission.

Another symptom of centrilobular emphysema is represented by cough with expectoration (the sputum depends of the inflammatory process in the bronchi).

Other symptoms are:

  • An increase of all chest parameters, lowering of the pulmonary bases, limiting the movements of the chest in deep breath,
  • Whistling of the tympanic sound,
  • Reduction of the vesicular murmur,
  • Prolonged respiration
  • Dry rallies.

Digital hypocratism is possible (clubbing of the fingertips).

Diffuse pronounced cyanosis: sick blue bloaters (cyanotics, buhaites).

How is Centrilobular Emphysema diagnosed?

The diagnosis of pulmonary emphysema is based on insidious onset, with dyspnea and periodic bronchial episodes, and the aspect of the chest fixed in an inspiring position and on the radiological examination.

Pulmonary radiography highlights indirect signs of emphysema:

  • horizontal ribbons,
  • intercostal space latency,
  • flattening the diaphragm with reduced breathing movements,
  • larger transparency of the lungs on the radiographic film.

Spirometry measures the volume of gas that interferes with breathing and functional parameters, which strengthens the diagnosis and facilitates a precise classification of the disease.

Treatment of Centrilobular Emphysema

Changes in pulmonary parenchyma resulting from an emphysema are irreversible, so the treatment is aimed at slowing down disease progression and making more effective use of existing reserves.

The therapy of pulmonary emphysema includes:

  1. Bronchodilators
  2. Inhaled steroids
  3. Supplement with oxygen
  4. Antibiotics
  5. Vaccines to avoid infections

In some cases surgical treatment is required to remove the pulmonary areas destroyed by emphysema and emphysema bubbles.

It is advisable to avoid irritant susceptibility and consistently and timely treatment of respiratory infections. The strengthening of respiratory muscles done through physiotherapy.

As for prevention, the best method for preventing pulmonary emphysema is to avoid cigarette smoke.

Infections that can occur in chronic obstructive diseases can be prevented by two vaccinations:

  • Flu vaccine
  • Antipneumococcal vaccine.

Oxygen therapy is used to correct hypoxemia, avoiding hypercapnia and respiratory acidosis by increasing the inspiratory oxygen fraction. The two methods are:

  • Controlled Oxyhenotherapy – administer to the nasal mask or probe for 15-20 minutes with breaks at a rate of 2-4 L /minute.
  • Long-term Oxygenation (18h/day continuously) at a concentration of 24-28% and at a rate of 1-2 L /min is indicated when PaO2 < mmHg or SaO2 < 80% at rest, during sleep as well as in the presence of pulmonary hypertension, pulmonary heat or neuropsychiatric disorders secondary to respiratory insufficiency.

Oxygen therapy reduces pulmonary arterial hypertension and chronic lung decompensation, decreases hospitalizations and increases the life span of patients.

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