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BMJ 2011; 343 doi: (Published 02 November 2011) Cite this as: BMJ 2011;343:d7056

Time to rethink the definition of emphysema

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We have long thought that emphysema was a disease of the lung parenchyma, whereby alveoli became permanently enlarged and subsequently destroyed. A new study suggests though that it is not the alveoli that are primarily affected in emphysema, but rather the terminal bronchioles, which become narrowed and destroyed as a result of inflammation. It seems that alveolar walls only collapse and fold as a consequence.

The study used multidetector and microdectector computed tomography to examine the lungs of 78 volunteers with various stages of chronic obstructive pulmonary disease (COPD), as judged by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) scale, as well as lungs removed from four dead people without lung disease, four people with centrilobular emphysema, and eight people with panlobular emphysema.

Compared with lungs of people without COPD, the lungs of those with COPD showed a decrease in the number of small airways (measuring 2.0-2.5 mm in diameter), as well as a reduction in the total cross sectional area of terminal bronchioles. For people with the most severe COPD, these reductions were up to 99.7% and 89%, respectively. Moreover, an analysis according to various stages of emphysematous disease suggested that the loss of terminal bronchioles preceded alveolar disease.

It may be time to rethink the definition of emphysema, writes the editorialist (p 1637). The new definition needs to include information on what happens in the bronchioles—that is, inflammation and destruction—rather than defining emphysema as enlargement and destruction of alveoli without obvious fibrosis.

CT screening for lung cancer may help diagnose COPD

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Chronic obstructive pulmonary disease (COPD) is underdiagnosed despite being common in people who smoke. Early cessation and treatment are known to improve prognosis substantially.

Men participating in a lung cancer screening trial underwent spirometry …

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