Serdar Balcı

Chronic Obstructive Pulmonary Diseases Emphysema and Chronic Bronchitis

Serdar BALCI, MD

Obstructive Lung Diseases

Airway disease

Increase in resistance to airflow

Partial or complete obstruction

Trachea, Larger bronchi, Terminal and respiratory bronchioli

Restrictive Lung Diseases

Reduced expansion of lung parenchyma

Decreased total lung capacity

Chest wall disorders

Chronic interstitial and infiltrative diseases

Robbins Basic Pathology

Chronic Obstructive Pulmonary Diseases

Robbins Basic Pathology



Abnormal permanent enlargement of the air spaces distal to the terminal bronchioles

Destruction of alveoli walls without significant fibrosis

Types of Emphysema



Distal acinar


distention of all the peripheral structures; later extends to respiratory bronchioles

dilation that initially affects the respiratory bronchioles

Robbins Basic Pathology

Centriacinar emphysema

Upper two thirds, apical segments

Dilation of air spaces and destruction of alveolar parenchyma

Autopsy Pathology: A Manual and Atlas

Centriacinar emphysema

Autopsy Pathology: A Manual and Atlas

Centriacinar emphysema: Central areas show marked emphysematous damage, surrounded by relatively spared alveolar spaces

Centriacinar (Centrilobular) Emphysema

Central, proximal parts of the acini

Respiratory bronchioles are affected

Distal alveoli are spared

Both emphysematous and normal air spaces exist within the same acinus and lobule

Cigarette smoking

Panacinar (Panlobular) emphysema

Autopsy Pathology: A Manual and Atlas

Panacinar emphysema: involving the entire pulmonary lobule

Panacinar (Panlobular) Emphysema

Distal Acinar (Paraseptal) Emphysema

Proximal portion is normal

Distal part is primarily involved

More striking adjacent to the pleura, along the lobular connective tissue septa, and at the margins of the lobules

Occurs adjacent to areas of fibrosis, scarring, or atelectasis

More severe in the upper half of the lungs

Multiple, contiguous, enlarged air spaces

0.5 mm - >2.0 cm

Cystic structures

Progressive enlargement


Cause is unknown

Most often in spontaneous pneumothorax in young adults

Irregular Emphysema

Pathogenesis of Emphysema


Elastin degradation products increase the inflammation

80% of patients with congenital α1-antitrypsin (antielastase) deficiency develop symptomatic panacinar emphysema

Earlier age and with greater severity if the affected person smokes

TGFB gene polymorphisms influence susceptibility to COPD

MMP-9 and MMP-12

Robbins Basic Pathology


Fibrosing lung diseases

Airway obstruction in emphysema

Macroscopic appearance

Histologic examination

Robbins Basic Pathology

Bullous emphysema with large apical and subpleural bullae

Robbins Basic Pathology

Emphysematous bullae

Autopsy Pathology: A Manual and Atlas

Interstitial pulmonary emphysema

Autopsy Pathology: A Manual and Atlas


Chronic Bronchitis

Clinical definition: Persistant cough with sputum, at least 3 months, at least 2 consecutive years, absence of any identifiable cause

Cigarette smokers

Urban, smog-ridden cities

20-25% of men in 40-65-year-old age have the disease

Chronic bronchitis: Marked thickening of the mucous gland layer (approximately twice-normal) and squamous metaplasia of lung epithelium

Robbins Basic Pathology