Centrilobular emphysema is a form of chronic obstructive pulmonary disease. It differs from other forms of emphysema due to its location in the lungs.
The term centrilobular means that the disease occurs in the center of the functional units of the lungs, called the secondary pulmonary lobules. In a different type of emphysema, called panlobular emphysema, the damage begins in tissues throughout the lungs simultaneously.
In this article, we take a look at the symptoms and stages of centrilobular emphysema as well as its diagnosis and treatment.
Centrilobular emphysema causes damage in the respiratory passages, and mainly affects the upper lobes in the centers of the functioning lung units. This damage can obstruct the flow of air from the lungs and make it difficult to breathe.
Symptoms of centrilobular emphysema can vary depending on the overall health of a person, but may include:
- shortness of breath
- difficulty performing regular tasks
- persistent coughing
- producing a lot of extra mucus or phlegm
- tightness in the chest
- blueness in the lips and fingernails
Symptoms can be more apparent if there are additional complications, and they may get worse as the condition progresses.
To accurately diagnose centrilobular emphysema, doctors will often begin by looking at the progression of the disease to date.
The severity of emphysema varies from person to person.
Some people may retain good lung function and have only very mild, infrequent symptoms. Others may have moderate or severe symptoms that occur more often and are accompanied by poorer lung function.
A doctor will use a variety of tests to help them make their diagnosis. These may include:
- Spirometry testing. To check the lung function, a doctor may use a spirometer, which is a device that measures how much air a person can push out of their lungs and at what speed.
- Plethysmography. This is a way of measuring lung capacity and involves a person sitting or standing in an airtight box and breathing through a mouthpiece to measure the amount of air inside the lungs.
- A pulse oximetry test. The amount of oxygen in the blood can indicate the efficiency of the lungs. A doctor may order a pulse oximetry test, where a clip is attached to the ear or finger to pick up the level of oxygen in the blood.
- An imaging test. Another option is an imaging test such as an X-ray or computed tomography (CT) scan of the chest to check for other complications of chronic obstructive pulmonary disease (COPD), such as lung enlargement, enlarged arteries, or other physical changes.
A proper diagnosis is essential to create an effective treatment plan for each individual.
It is not currently possible to reverse the damage that centrilobular emphysema does to the lung tissue. Treatment instead focuses on managing the symptoms as best as possible and slowing the progression of the disease.
Acute flares can cause the progression of emphysema to accelerate over time. These flares may be life-threatening and require hospitalization for treatment. Controlling the symptoms and preventing acute flares is essential in the treatment of emphysema.
Medical treatments vary based on the severity of the case but can include a few different options. Anyone needing treatment should discuss these options with a doctor.
Doctors may prescribe corticosteroids in an inhaler. These steroids work to relieve symptoms by reducing inflammation in the lungs. They help prevent acute flares and make it easier to breathe.
A doctor may also prescribe bronchodilators. These medicines relax the bronchial muscles to dilate the airways and improve airflow in the lungs. They can be used for short-term relief but are also suitable for daily use as a long-term management option.
In some cases, people may need to take an inhaled medicine containing both a bronchodilator and a corticosteroid.
Some people may need to use a device to supplement the amount of oxygen they are getting into their body. An oxygen concentrator is a machine that takes in air and concentrates the oxygen in it before delivering it to the person via a cannula or mask. If this is still not enough, a doctor may recommend that a person uses an oxygen tank.
Other treatment options include:
Centrilobular emphysema is most often seen in people over 50, while panlobular emphysema is often seen in younger people who smoke cigarettes. Centrilobular emphysema may overlap with COPD, while panlobular emphysema is almost exclusively present in severe COPD.
A person's lungs absorb the chemicals in cigarette smoke. These chemicals cause inflammation, destroy the small air sacs, and weaken the ability of the lungs to fight off infections. Secondhand smoking can have similar effects.
Other toxic inhalants may also pose a risk, and are likely to be more common in certain lines of work. People who work around coal or charcoal may be at risk if they frequently inhale coal dust or other toxic fumes. Regular exposure to exhaust fumes from vehicles or machinery and fumes from fuel may also increase the risk.
People with centrilobular emphysema may be at a higher risk of other medical conditions. These include:
- Bronchitis or other respiratory tract infections.
- Difficulties with the heart, as the pressure in the arteries can build up and cause the heart to swell and weaken.
- Bullae, which are holes inside the lungs caused by abnormal air pockets. These holes can drastically reduce the space that a lung has to expand, and may even lead to lung collapse.
- A collapsed lung, which occurs when air enters the space between the chest wall and lungs called the pleural space. This happens as a result of damage to lung tissue and may be a life-threatening complication.
In many cases, it is possible to prevent centrilobular emphysema by reducing exposure to toxins such as tobacco smoke and environmental pollutants, but there is no cure for the disease.
It is not possible to repair the damage that is already present, but treatment can help slow the progression of the condition and allow a person to use their existing lung capacity more efficiently.
Medical treatment should always be the priority following a centrilobular emphysema diagnosis. Catching the condition early on may improve a person's outlook and make it easier to manage their symptoms.