Panlobular Emphysema: Symptoms, Centrilobular Comparison, COPD

Panlobular Emphysema:

• What is Panlobular Emphysema?
• Symptoms
• Centrilobular Comparison
• COPD

What is Panlobular Emphysema?

Panlobular emphysema, also known as panacinar emphysema, is a form of emphysema in which the entire pulmonary acinus—from the respiratory bronchiole to the alveoli—is uniformly affected. This condition leads to widespread destruction of alveolar walls, resulting in enlarged air spaces and reduced surface area for gas exchange. Unlike other forms of emphysema that affect specific lung regions, panlobular emphysema involves a more diffuse and uniform pattern of lung damage.

This type of emphysema is classically associated with alpha-1 antitrypsin (AAT) deficiency, a genetic disorder that reduces the lung’s ability to protect itself from enzymatic damage. As a result, lung tissue becomes progressively destroyed even in non-smokers or younger individuals. Panlobular emphysema typically affects the lower lobes of the lungs more prominently and can lead to early-onset respiratory symptoms if not recognized and managed in time.

Symptoms

The symptoms of panlobular emphysema develop gradually and worsen over time as lung damage progresses. The most common symptom is progressive shortness of breath, initially noticeable during physical activity and later occurring even at rest. Patients often report fatigue, reduced exercise tolerance, and difficulty performing daily activities due to impaired oxygen exchange.

Additional symptoms may include chronic cough, wheezing, unintentional weight loss, and a barrel-shaped chest caused by lung hyperinflation. In advanced stages, patients may develop cyanosis (bluish discoloration of lips and fingers) or signs of respiratory failure. Because symptoms can resemble other forms of COPD, accurate diagnosis through imaging and clinical history is essential for proper management.

Centrilobular Comparison

When comparing panlobular emphysema with centrilobular emphysema, the key difference lies in the pattern and cause of lung damage. Panlobular emphysema affects the entire acinus uniformly and is most commonly linked to alpha-1 antitrypsin deficiency. In contrast, centrilobular emphysema primarily damages the central part of the acinus and is strongly associated with cigarette smoking.

Another important distinction is lung distribution. Panlobular emphysema tends to involve the lower lung zones, while centrilobular emphysema predominantly affects the upper lobes. Clinically, centrilobular emphysema is more common overall, but panlobular emphysema is more severe at a younger age. Understanding these differences helps clinicians identify underlying causes and tailor treatment strategies appropriately.

COPD

Panlobular emphysema is a recognized subtype of Chronic Obstructive Pulmonary Disease (COPD). COPD is a progressive lung disease characterized by airflow limitation that is not fully reversible. In panlobular emphysema, airflow obstruction results from loss of elastic recoil and collapse of small airways during exhalation.

Management of panlobular emphysema within COPD includes bronchodilators, inhaled corticosteroids (in selected patients), pulmonary rehabilitation, and supplemental oxygen when needed. For patients with alpha-1 antitrypsin deficiency, AAT augmentation therapy may slow disease progression. Early diagnosis, smoking avoidance, and long-term follow-up are critical to improving quality of life and reducing complications associated with COPD.