Emphysema
Published Oct 1, 1969 · M. Dunnill
Journal of the Royal Society of Medicine
29
Citations
1
Influential Citations
Abstract
Emphysema is defined on an anatomical basis as a disease characterized by structural changes in the lung causing increase, beyond the normal range, in the size of air spaces distal to terminal bronchioles. This anatomical abnormality is commonly found to be associated with increased resistance to airflow in the lungs, varying little either spontaneously or in response to treatment; but this finding is not a defining characteristic. Knowledge of the causation both of chronic * bronchitis and of emphysema is sadly incomplete. There is strong evidence that chronic bronchitis is usually a response to air pollution, both private in the form of cigarette smoking and public in the form of smoke and fumes from domestic and commercial fuel-burning. To what extent and in what way these factors may be concerned also in the pathogenesis of emphysema remains uncertain. Can they directly damage alveoli and cause emphysema? Do the recurrent episodes of infection that commonly occur in the course of chronic bronchitis cause emphysema among other structural changes? Does chronic bronchitis accelerate the progression of emphysema in individuals predisposed to it by some other factor? One form of emphysema is known to be related to exposure to dust. Another form is now known to be associated with a deficiency of a,-globulin and of the antitryptic activity which resides in this globulin fraction. This deficiency is inherited as a mendelian recessive characteristic (Eriksson 1965). It is rare, and can account for only a small proportion of cases of emphysema; but nevertheless it confirms the suspicion, long held on clinical grounds, that emphysema may in some cases be genetically determined. In this difficult field, the physician needs to know what the morbid-anatomist can tell him about the anatomical classification and quantification of emphysema. He must be familiar with the pattern of functional defect associated with emphysema, with methods of quantifying it and distinguishing it from the patterns associated with other diseases causing airways obstruction. He must be aware of the contribution which radiology can make, especially of correlations between radiographic appearances and morbid anatomy. His own contribution consists in the integration of all these, and of the evidence derived from long-term clinical and epidemiological studies, to the understanding of the clinical course of the disease and to the problems of individual patients.