Centrilobular emphysema, or centriacinar emphysema, is a long-term, progressive lung disease. It’s considered to be a form of chronic obstructive pulmonary disease (COPD).
Centrilobular emphysema primarily affects the upper lobes of the lungs. It’s characterized by damage to your respiratory passageways. Known as bronchioles, these passageways allow airflow from your mouth and nose to your lungs.
The damage typically begins in the center of your lungs and gradually spreads outward.
The condition typically affects people who smoke or used to smoke cigarettes. People who’ve had coal workers' pneumoconiosis (CWP) are also at risk.
Symptoms of centrilobular emphysema include:
- tightness in the chest
- shortness of breath while performing day-to-day tasks (dyspnea)
- chronic cough
- producing excess mucus, also referred to as sputum or phlegm
- blueness of lips and fingernail beds
These symptoms can worsen as the condition progresses. Lung function will decrease from above 80 percent in stage 1 of centrilobular emphysema to below 30 percent in the advanced stages of the disease. Centrilobular emphysema is often accompanied by chronic bronchitis.
Smoking is the main cause of centrilobular emphysema. Smoking cigarettes causes 85 to 90 percent of all COPD cases.
The toxic chemicals released by cigarettes:
- irritate and weaken the lungs
- narrow your respiratory passageways
- destroy the air sacs (alveoli) of the lungs
- cause inflammation
These effects can also occur if you frequently inhale toxic fumes, such as charcoal dust. This is why centrilobular emphysema can be seen with CWP.
Severe exposure to pollution and secondhand smoke can also lead to centrilobular emphysema.
The risk factors for centrilobular emphysema increase with age. These factors include:
Smoking: Cigarette smokers are at the highest risk for centrilobular emphysema. However, people who smoke pipes and cigars can also develop the condition. Your risk of developing the disease depends on how long and how much tobacco you smoke.
Work-related exposure to fumes or dusts: Coal miners can develop centrilobular emphysema because of the charcoal dust they inhale. This is also true of workers who inhale fumes from grain, cotton, or wood. This type of exposure combined with smoking compounds your likelihood of developing the disease.
Contact with secondhand smoke or air pollution: Constant exposure to secondhand cigarette, cigar, or pipe smoke can increase your risk of centrilobular emphysema. Frequent exposure to air pollutants, including heating fuel fumes or car exhaust, can also cause the condition.
People who develop centrilobular emphysema are at a higher risk for:
Collapsed lung: This is also known as pneumothorax. A collapsed lung is an uncommon, but serious condition that can be life-threatening for people in advanced stages of emphysema.
Large holes in the lungs: Holes in the lungs, known as bullae, can become as big as half of the lung. Giant bullae can reduce the space available for lung expansion, as well as increase the risk for your lung to collapse.
Heart problems: Pressure in the arteries connecting the lungs and heart builds when emphysema is present. This can cause the heart to swell and deteriorate.
Your doctor will diagnose centrilobular emphysema by evaluating your smoking and work histories, and performing certain tests.
Your doctor may order a chest X-ray to see if your lungs are enlarged, or if you’ve developed any other physical symptoms. A CT scan can also identify physical changes, such as enlarged arteries, that are associated with COPD.
To measure oxygen levels in your blood, your doctor may perform a noninvasive pulse oximetry test. To do this, they’ll place a clip-like device called a probe on your finger or ear lobe. The probe uses light to determine how much oxygen is present in your blood.
In some cases, an arterial blood gas (ABG) test may be necessary. An AGB requires a small blood sample. This blood may be taken from an artery in your wrist, arm, or groin.
Lung function tests are also known as pulmonary function tests. These tests help determine how well your lungs are working. There are two methods for doing this: spirometry and plethysmography.
In spirometry, your doctor will use a spirometer, a small device attached to a mouthpiece. This will measure how much air you can push out of your lungs and how quickly you can push it out.
In plethysmography, your doctor will have you sit or stand inside an air-tight box similar to a telephone booth. This booth is called a plethysmograph. Once inside, you’ll breathe into a mouthpiece. This can show your doctor how much air is inside your lungs.
Your treatment will depend on the severity of your symptoms and how well your lungs are functioning.
While there isn’t a cure for centrilobular emphysema, there are treatments that can help manage your symptoms, prevent complications, and slow the progression of the disease.
Treatment often involves inhaled beta-agonists. This medication can relieve some symptoms and help you breathe better.
The most common short-acting beta-agonist is an albuterol inhaler, which provides quick relief for asthma symptoms.
Inhaled anticholinergics are another type of treatment. This drug blocks acetylcholine, a neurotransmitter that causes skeletal muscle contraction and regulates the endocrine system.
Short-acting anticholinergics include ipratropium.
Formoterol is a long-acting beta2-agonist (LABA). It’s typically paired with an inhaled corticosteroid. It’s not a good idea to use a LABA as the sole therapy for asthma or COPD.
Ipratropium is a short-acting anticholinergic that’s often paired with albuterol. Albuterol is a short-acting beta2-agonist.
Long-acting anticholinergics, such as tiotropium (Spiriva), are becoming more common as treatment options.
Other treatment options
Roflumilast (Daliresp), a long-acting phosphodiesterase-4 (PDE4) inhibitor, is newer on the market. It’s been shown to help decrease flare-ups and inflammation in the lungs. The medication, however, has not been proven to improve lung function.
Additional treatment options include:
- oxygen therapy to assist with labored breathing
- flu vaccine and pneumonia shot to prevent infections
- antibiotics to fight respiratory infections
- protein therapy to slow the progression of lung damage
- surgery or a lung transplant
Inhaled steroids are also an option. Inhaled steroids may lead to certain side effects over time. These may include:
- high blood pressure in the eye (ocular hypertension)
- weakened bones
Talk to your doctor about the specific treatment options available to you. Your doctor can help you understand the potential risks and benefits of each treatment.
Although there isn’t a cure for centrilobular emphysema, there are plenty of treatment options that can help you manage your symptoms.
Life expectancy can shorten as the condition advances. It’s important to start a treatment regime right away in order to slow down the progression of the disease.
If you smoke, quitting can help reduce your symptoms and reduce your risk of further damage. Reducing your exposure to other harmful chemicals is also crucial.
Centrilobular emphysema is absolutely preventable. The condition is typically caused by external factors that are often in your control. For example, avoiding or quitting smoking greatly reduces your risk of developing this condition.
Try to limit your exposure to dusts or fumes. If you’re exposed to these pollutants at work, talk to your employer about wearing a protective mask over your mouth.