**4.2.2 Panacinar emphysema**

122 Chronic Obstructive Pulmonary Disease – Current Concepts and Practice

are found in upper lobes of cocaine or heroin abusers whereas basilar and panacinar

Human immunodeficiency virus (HIV) infection was found to be a risk factor for COPD, independent of confounding variables(Crothers et al.,2006 as cited in Shapiro SD,2010). Apical and cortical bullous lung damage occurs in autoimmune deficiency syndrome and

Hypocomplementemic vasculitis urticaria syndrome (HVUS) and other associated conditions include angioedema, nondeforming arthritis, sinusitis, conjunctivitis, and

Several connective disorders have been implicated in causation of or co-existence with emphysema and poor lung function. Cutis laxa is a congenital disorder of elastintropoelastin that is characterized by premature aging and occasionally emphysema. Marfan syndrome (autosomal dominant inherited disease of type I collagen), Ehlers-Danlos syndrome,Salla disease (autosomal recessive storage disorder with intralysosomal accumulation of sialic acid), Birt-Hogg-Dube' syndrome and familial spontaneous pneumothorax syndrome(mutations in folliculin gene) have been associated with poor lung

Chronic bronchitis is a clinical entity defined by a chronic productive cough for three months in each of two successive years in a patient in whom other causes of chronic cough have been excluded. It is characterised by an overlapping pathologic process of bronchial wall inflammation. The submucosal glands show dilated ducts and hypertrophy and hyperplasia. Reid index (the ratio of glandular to bronchial wall thickness) as well as goblet cell frequency and airway smooth muscle thickness is increased in chronic bronchitis(Reid,1960). The airway wall contains inflammatory cells predominated by macrophages and CD8+T lymphocytes. Bronchus-associated lymphoid tissue(BALT) is also present in late GOLD stages(Hogg & Timens,2009 as cited in Shapiro SD,2010). Increased numbers of neutrophils are found in the airway lumen and in the glands during episodes of

exacerbations(Saetta et al.,1997;Thompson et al.,1989 as cited in Shapiro SD,2010).

Pulmonary emphysema, a pathological entity defined as destruction and enlargement of air spaces distal to the terminal bronchiole involving respiratory bronchioles, alveolar ducts, and alveoli. Cigarette smoking, inhaled irritants, recurrent infections and proteinase-

emphysema are associated with methadone and methylphenidate injections.

pericarditis may be associated with obstructive lung disease.

function, blebs, pneumothorax and emphysema(ATS,2010).

**3.1.11 Immune deficiency syndromes** 

*Pneumocystis carinii* infection.

**3.1.12 Vasculitis syndrome** 

**4. Pathology** 

**4.2 Emphysema** 

**4.1 Chronic bronchitis** 

**3.1.13 Connective-tissue disorders** 

Involves the entire alveolus uniformly and is predominant in the lower half of the lungs(Snider et al.,1962;Thurlbeck,1963,1976 as cited in Shapiro SD,2010). It is observed in patients with homozygous A1PI deficiency.
