Emphysema and Chronic Airways Disease

  • Philip C. Pratt


Pulmonary emphysema is among the most prevalent of all diseases. On the basis of examination of properly inflation-fixed lungs from consecutive autopsy series, it is present in at least one-third of the adult male population and in half or more of those men who smoke.1-5 This high prevalence is partly the result of the gradual evolution and progression of the lesions, which on average probably take some 30 or more years from the asymptomatic onset to the final lethal episode of respiratory failure. The prolonged course also gives many individuals the opportunity to die of other diseases so that the death rate from emphysema is far lower than the prevalence rate. Therefore, the major societal impact of the disease results not so much from total prevalence or deaths, as from the many years of disability and loss of productivity experienced by the many cases who become symptomatic in their late forties and survive with impairment throughout their fifties and sixties. The disease is less common in women, but the incidence in women has increased in recent years.5

Fig. 24-1

The regression of the correlation between age at death and percentage of lung involvement by centrilobular emphysema, detemined by point-counting, in the 173 autopsies of smokers who had the disease. The slope represents progression of the disease at the rate of 7% per 10 years. The correlation coefficient is .27 and the probability that this trend might have occurred by. chance is less than .001. The equation for the regression line is: Emphysema extent = .69 × age — 13.2. Values in parentheses represent number of cases seen in each 10-year age group. Horizontal bars represent average extent of emphysema per group.


Chronic Bronchitis Lower Lobe Airway Disease Small Airway Airflow Obstruction 
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  1. 1.
    Thurlbeck WM. The incidence of pulmonary emphysema: with observations on the relative incidence and spatial distribution of various types of emphysema. Am Rev Respir Dis 1963; 87: 206 – 215.PubMedGoogle Scholar
  2. 2.
    Boushy SF, Greenberg SD, Jenkins DE. The prevalence of emphysema in 67 unselected male necropsies. Dis Chest 1968; 53: 497 – 501.PubMedCrossRefGoogle Scholar
  3. 3.
    Ishikawa S, Bowden DH, Fisher V, et al. The “emphysema profile” in two midwestern cities in North America. Arch Environ Health 1969; 18: 660 – 666.PubMedGoogle Scholar
  4. 4.
    Mitchell RS, Walker SH, Silvers VW, et al. Frequency and severity of anatomic emphysema in men over 40 dying in two Denver hospitals. Arch Environ Health 1969; 18: 667 – 670PubMedGoogle Scholar
  5. 5.
    Thurlbeck WM. Chronic airflow obstruction in lung disease. Philadelphia: WB Saunders, 1976.Google Scholar
  6. 6.
    World Health Organization Report. Chronic cor pulmonale: report of an expert committee. WHO Tech. Rep. Ser. 213, 1961: 15.Google Scholar
  7. 7.
    American Thoracic Society. Chronic bronchitis, asthma and pulmonary emphysema: A statement by the committee on diagnostic standards for nontuberculous respiratory diseases. Am Rev Respir Dis 1962; 85: 762 – 768.Google Scholar
  8. 8.
    Reid L. Pathology of chronic bronchitis. Proc R Soc Med 1956; 49: 771 – 773.PubMedGoogle Scholar
  9. 9.
    Reid L. Measurement of the bronchial mucous gland layer. A diagnostic yardstick on chronic bronchitis. Thorax 1960; 15: 132 – 141.PubMedCrossRefGoogle Scholar
  10. 10.
    Matsuba K, Thurlbeck WM. Disease of the small airways in chronic bronchitis. Am Rev Respir Dis 1973; 167: 552 – 558.Google Scholar
  11. 11.
    Krahl V. Microstructure of the lung. Arch Environ Health 1963; 6: 37 – 42.PubMedGoogle Scholar
  12. 12.
    Karpick RJ, Pratt PC, Asmundsson T, Kilburn KH. Pathologic findings in respiratory failure: goblet cell metaplasia 30. alveolar damage and myocardial infarction. Ann Intern Med 1970; 72: 189 – 197.PubMedCrossRefGoogle Scholar
  13. 13.
    Fletcher CM, Pride NB. Definitions of emphysema, chronic bronchitis, asthma, and airflow obstruction: 25 31. years on from the Ciba symposium. Thorax 1984; 39: 81 – 85.PubMedCrossRefGoogle Scholar
  14. 14.
    Peto R, Speizer FE, Cochrane AL, et al. The relevance 32. in adults of air-flow obstruction, but not of mucus hyper-secretion, to mortality from chronic lung disease. Am 33. Rev Respir Dis 1983; 128: 491 – 500.Google Scholar
  15. 15.
    Atsushi N, West WW, Thurlbeck WM. The National Institutes of Health intermittent positive-pressure breathing trial: pathology studies. II. Correlation between morphologic findings, clinical findings, and evidence of 34. expiratory air-flow obstruction. Am Rev Respir Dis 1985; 132: 946 – 953.Google Scholar
  16. 16.
    Ciba Guest Symposium Report: Terminology, definitions and classification of chronic pulmonary emphysema and 35. related conditions. Thorax 1959; 14: 286 – 299.CrossRefGoogle Scholar
  17. 17.
    Miller WS. The lung. 2d ed. Springfield: Thomas, 1947.Google Scholar
  18. 18.
    Lichter L, Gwynne JF. Spontaneous pneumothorax in young subjects. A clinical and pathological study. Thorax 1971; 26: 409–417. 37.Google Scholar
  19. 19.
    Miller JA, Pratt PC, Capp MP, Human bronchial and bronchiolar compressibility measured by postmortem bronchography. Lab Invest 1973; 29: 465 – 477.PubMedGoogle Scholar
  20. 20.
    Radford EP. Static mechanical properties of mammalian 38. lungs. In: Fenn WO, Balen H, eds. Handbook of physiology. Sect. 3, Respiration. Vol. 1. Washington DC: Ameri- 39. can Physiological Society, 1964: 429 – 449.Google Scholar
  21. 21.
    Mead J, Whittenberger JL, Radford EP. Surface tension as a factor in pulmonary volume-pressure hysteresis. J 40. Appl Physiol 1957; 10: 191 – 196.Google Scholar
  22. 22.
    Hartroft WD, Macklin CC. Intrabronchial fixation of the human lung for purposes of alveolar measurements, us- 41. ing 25 µ microsections made therefrom. Trans R Soc Can (Biol) 1943; 37: 75 – 80.Google Scholar
  23. 23.
    Blumenthal BJ, Boren HG. Lung structure in three dimensions after inflation and fume fixation. Am Rev Res- 42. pir Dis 1959; 79: 165 – 171.Google Scholar
  24. 24.
    Pratt PC, Klugh GA. A technique for the study of ventilatory capacity, compliance, residual volume of excised lungs and for fixation, drying and serial sectioning in 43. the inflated state. Am Rev Respir Dis 1961; 83: 690 – 696.PubMedGoogle Scholar
  25. 25.
    Weibel ER, Vidone RA. Fixation of the lung for formalin 44. steam in a controlled state of air inflation. Am Rev Respir Dis 1961; 84: 856 – 862.PubMedGoogle Scholar
  26. 26.
    Sills B. A multidisciplinary method for study of lung 45. structure and function. Am Rev Respir Dis 1962; 86: 238 – 243.PubMedGoogle Scholar
  27. 27.
    Boren HG. Alveolar fenestrae: relationship to pathology 46. and pathogenesis of pulmonary emphysema. Am Rev Respir Dis 1962; 85: 328 – 344.PubMedGoogle Scholar
  28. 28.
    Pratt PC, Hague A, Klugh GA. Correlation of postmor- 47. tern function and structure in normal and emphysematous lungs. Am Rev Respir Dis 1961; 83: 856 – 865.PubMedGoogle Scholar
  29. 29.
    Pratt PC, Kilburn KH. A modern concept of the emphysemas. Hum Pathol 1970; 1: 443 – 463.PubMedCrossRefGoogle Scholar
  30. 30.
    Takaro T, Gaddy LR, Pirra S. Thin alveolar epithelial partitions across connective tissue gaps of the human lung: ultrastructural observations. Am Rev Respir Dis 1982; 126: 328 – 331.Google Scholar
  31. 31.
    Heard BE, Esterly JR, Wootliff JS. A modified apparatus for fixing lungs to study the pathology of emphysema. Am Rev Respir Dis 1967; 95: 311 – 312.PubMedGoogle Scholar
  32. 32.
    Weibel ER. Morphometry of the human lung. New York: Academic Press, 1963.Google Scholar
  33. 33.
    Pratt PC, Jutabha O, Klugh GA. Quantitative relationship between structural extent of centrilobular emphysema and postmortem volume and flow characteristic of lungs. Proceedings of the Seventh Aspen Conference on Research in Emphysema. Med Thorac 1965; 22: 197 – 208.PubMedGoogle Scholar
  34. 34.
    Pratt PC, Vollmer RT. The beneficial effect of alcohol consumption on the prevalence and extent of centrilobular emphysema: a retrospective autopsy analysis. Chest 1984; 85: 372 – 377.PubMedCrossRefGoogle Scholar
  35. 35.
    Thurlbeck WM. Postmortem lung volumes. Thorax 1979; 34: 735 – 739.PubMedCrossRefGoogle Scholar
  36. 36.
    Pratt PC, Klugh GA. Chronic expiratory airflow obstruction-cause or effect of centrilobular emphysema? Dis Chest 1967; 52: 342 – 349.PubMedCrossRefGoogle Scholar
  37. 37.
    Sutinen S, Christoforidis AJ, Klugh GA, Pratt PC. Roentgenologic criteria for the recognition of nonsymptomatic pulmonary emphysema. Am Rev Respir Dis 1965; 91: 69 – 76.PubMedGoogle Scholar
  38. 38.
    Dayman H. Mechanics of air flow in health and disease. J Clin Invest 1951; 30: 1175 – 1190.PubMedCrossRefGoogle Scholar
  39. 39.
    Pratt PC. Intrapulmonary radial traction: measurement, magnitude and mechanics. US Public Health Sery Rep 1969; 1879: 159 – 182.Google Scholar
  40. 40.
    Hentel W, Longfield AH, Vincent TN, Filley GF, Mitchell RS. Fatal chronic bronchitis. Am Rev Respir Dis 1963; 87: 216 – 224.PubMedGoogle Scholar
  41. 41.
    Pratt PC, Thong-Yai K. The relative importance of bronchiolitis and extent of centrilobular emphysema in pulmonary ventilatory interference. US Public Health Sery Rep 1967; 1787: 339 – 356.Google Scholar
  42. 42.
    Forster RE. Diffusion of gases. In: Fenn WO, Balen H, eds. Handbook of physiology. Sect. 3, Respiration. Vol. 1. Washington DC: American Physiological Society, 1964: 839 – 872.Google Scholar
  43. 43.
    Thurlbeck WM. Internal Surface area and other measurements in emphysema. Thorax 1967; 22: 483 – 496.PubMedCrossRefGoogle Scholar
  44. 44.
    Jenkins DE, Greenberg SD, Boushy SF. Correlation of morphologic emphysema and pulmonary function parameters. Trans Assoc Am Physicians 1965; 78: 218 – 230.PubMedGoogle Scholar
  45. 45.
    Gelb AF, Gold WM, Wright RR, Breech HR, Nadel JA. Physiologic diagnosis of clinically unsuspected pulmonary emphysema. Am Rev Respir Dis 1973; 107: 50 – 63.PubMedGoogle Scholar
  46. 46.
    Anderson JA, Dunnill MA, Ryder RC. Dependence of the incidence of emphysema on smoking history, age and sex. Thorax 1972; 27: 547 – 551.PubMedCrossRefGoogle Scholar
  47. 47.
    Thurlbeck WM, Ryder RC, Sternby N. A comparative study of the severity of emphysema in necropsy populations in three different countries. Am Rev Respir Dis 1974; 109: 239 – 248.PubMedGoogle Scholar
  48. 48.
    Laurell CB, Eriksson S. The electrophoretic alpha 1-globulin pattern of serum in alpha 1-antitrypsin deficiency. Scand J Clin Lab Invest, 1963; 15: 132 – 140.Google Scholar
  49. 49.
    Gross P, Pfitzer EA, Toker E, Babyak MA, Kaschak M. Experimental emphysema. Its production with papain in normal and silocotic rats. Arch Environ Health 1965; 11: 50 – 58.PubMedGoogle Scholar
  50. 50.
    Snider GL. The pathogenesis of emphysema. Twenty years of progress. Am Rev Respir Dis 1981; 124: 321 – 324.PubMedGoogle Scholar
  51. 51.
    Cohen AB, ed. Proteases and antiproteases in the lung. Am Rev Respir Dis 1983;127 (Part 2):S2—S58 (Suppl).Google Scholar
  52. 52.
    janoff A. Elastases and emphysema: current assessment of the protease—antiproteast hypothesis. Am Rev Respir Dis 1985; 132: 417 – 433.PubMedGoogle Scholar
  53. 53.
    Morrow PE, Gibb FR, Giazioglu KM. A study of particulate clearance from the human lungs. Am Rev Respir Dis 1967; 96: 1209 – 1221.PubMedGoogle Scholar

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© Springer Science+Business Media New York 1988

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  • Philip C. Pratt

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