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Pseudophysiologic emphysema resulting from severe small-airways disease

A F Gelb1, N Zamel, J C Hogg

  • 1Departments of Medicine and Radiology, Lakewood Regional Medical Center, University of California Los Angeles, School of Medicine, Los Angeles, California, USA. afgelb@msn.com

American Journal of Respiratory and Critical Care Medicine
|September 10, 1998
PubMed
Summary

Severe small airways disease without emphysema can mimic emphysema's lung mechanics. This study shows it causes hyperinflation, reduced lung elastic recoil, and falsely low diffusing capacity, impacting expiratory airflow.

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Area of Science:

  • Pulmonary Medicine
  • Respiratory Physiology
  • Lung Mechanics

Background:

  • Emphysema is characterized by lung elastic recoil loss, hyperinflation, and reduced airflow.
  • Small airways disease can also affect lung mechanics and airflow.

Purpose of the Study:

  • To investigate lung mechanics in patients with severe airflow limitation but minimal emphysema.
  • To determine if small airways disease can cause physiological changes mimicking emphysema.

Main Methods:

  • Studied lung mechanics in 10 patients with fixed, severe expiratory airflow limitation and minimal emphysema (CT grade <= 20).
  • Measured total lung capacity (TLC), functional residual capacity (FRC), residual volume (RV), diffusing capacity of carbon monoxide (DLCO), and lung pressure-volume curves.
  • Assessed transdiaphragmatic pressure (Pdi) in a subset of patients.

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Main Results:

  • All patients exhibited marked hyperinflation (TLC 140%, FRC 177%, RV 242% predicted).
  • Reduced diffusing capacity of carbon monoxide (DLCO) was observed (61% predicted).
  • Lung pressure-volume curves showed significant abnormalities, with reduced elastic recoil (Pst(L) at TLC 11.6 cm H2O) and decreased Pdi.

Conclusions:

  • Severe small airways disease, even without significant emphysema, can lead to substantial loss of lung elastic recoil.
  • This condition results in marked hyperinflation, increased TLC, and reduced expiratory airflow.
  • The observed reduction in DLCO may be spurious, reflecting small airways disease rather than emphysema-related destruction.