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Expert Review of Respiratory Medicine Apr 2019Distinct pathologies can cause chronic obstructive pulmonary disease (COPD). Emphysema is a COPD-phenotype characterized by destruction of lung parenchyma. Alpha-1... (Review)
Review
Distinct pathologies can cause chronic obstructive pulmonary disease (COPD). Emphysema is a COPD-phenotype characterized by destruction of lung parenchyma. Alpha-1 antitrypsin deficiency (AATD) is a genetic cause of emphysema, whereas smoking is the most important risk factor of non-AATD emphysema. A general underappreciation of non-AATD emphysema has hampered progress in the field, and clinical guidelines have prohibited the use of emphysema as a diagnosis. Non-AATD emphysema, however, is far from irrelevant as it associates with dyspnea, reduced exercise capacity and relevant outcome measures. Areas covered: Mechanisms underlying enhanced tissue loss in emphysema are protease/antiprotease imbalance, increased oxidative stress, several fundamental cell biological processes such as programmed cell death and autophagy, and impaired repair mechanisms. Therapeutic options for emphysema vary from smoking cessation to lung volume reduction. Current pharmacological treatments have less favorable effects in emphysematous than in non-emphysematous COPD patients. Expert opinion: We advocate the acknowledgment of non-AATD emphysema as a clinical diagnosis and propose to end the era of bringing all pathologies that may lead to chronic airflow limitation together under the umbrella-term of COPD. Decelerating proteolysis and restoring damage should be main targets in emphysema. Vitamin A/K, hyaluronan, copper and roflumilast are promising candidates.
Topics: Animals; Female; Humans; Male; Pneumonectomy; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Smoking; Smoking Cessation; alpha 1-Antitrypsin Deficiency
PubMed: 30761929
DOI: 10.1080/17476348.2019.1580575 -
BMJ (Clinical Research Ed.) Nov 1994
Topics: Humans; Lung; Pulmonary Emphysema; Smoking
PubMed: 7888832
DOI: 10.1136/bmj.309.6964.1244 -
Terapevticheskii Arkhiv 1991
Review
Topics: Combined Modality Therapy; Diagnosis, Differential; Humans; Lung; Pulmonary Emphysema; alpha 1-Antitrypsin Deficiency
PubMed: 1788796
DOI: No ID Found -
Current Opinion in Pulmonary Medicine Mar 2016Several lung volume reduction (LVR) techniques have been increasingly evaluated in patients with advanced pulmonary emphysema, especially in the last decade. Radiologist... (Review)
Review
PURPOSE OF REVIEW
Several lung volume reduction (LVR) techniques have been increasingly evaluated in patients with advanced pulmonary emphysema, especially in the last decade. Radiologist plays a pivotal role in the characterization of parenchymal damage and, thus, assessment of eligibility criteria. This review aims to discuss the most common LVR techniques, namely LVR surgery, endobronchial valves, and coils LVR, with emphasis on the role of computed tomography (CT).
RECENT FINDINGS
Several trials have recently highlighted the importance of regional quantification of emphysema by computerized CT-based segmentation of hyperlucent parenchyma, which is strongly recommended for candidates to any LVR treatment. In particular, emphysema distribution pattern and fissures integrity are evaluated to tailor the choice of the most appropriate LVR technique. Furthermore, a number of CT measures have been tested for the personalization of treatment, according to imaging detected heterogeneity of parenchymal disease.
SUMMARY
CT characterization of heterogeneous parenchymal abnormalities provides criteria for selection of the preferable treatment in each patient and improves outcome of LVR as reflected by better quality of life, higher exercise tolerance, and lower mortality.
Topics: Humans; Pneumonectomy; Pulmonary Emphysema; Quality of Life; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 26807689
DOI: 10.1097/MCP.0000000000000252 -
Archivio Monaldi Per La Tisiologia E Le... 1984
Topics: Humans; Pancreatic Elastase; Pulmonary Emphysema; Respiration; Smoking; alpha 1-Antitrypsin Deficiency
PubMed: 6336054
DOI: No ID Found -
Expert Opinion on Therapeutic Targets Mar 2010Oxidative stress has been implicated in the pathogenesis of pulmonary emphysema. Nuclear factor erythroid-2-related factor 2 (Nrf2) a major antioxidant transcription... (Review)
Review
IMPORTANCE OF THE FIELD
Oxidative stress has been implicated in the pathogenesis of pulmonary emphysema. Nuclear factor erythroid-2-related factor 2 (Nrf2) a major antioxidant transcription factor could play a protective role in pulmonary emphysema.
AREAS COVERED IN THIS REVIEW
Nrf2 is ubiquitously expressed throughout the lung, but is predominantly found in epithelium and alveolar macrophages. Evidence suggests that Nrf2 and several Nrf2 downstream genes have an essential protective role in the lung against oxidative stress from environmental pollutants and toxicants such as cigarette smoke, a major causative factor for the development and progression of pulmonary emphysema. Application of Nrf2-deficient mice identified an extensive range of protective roles for Nrf2 against the pathogenesis of pulmonary emphysema. Therefore, Nrf2 promises to be an attractive therapeutic target for intervention and prevention strategies.
WHAT THE READER WILL GAIN
In this review, we discuss recent findings on the association of oxidative stress with pulmonary emphysema. We also address the mechanisms of Nrf2 lung protection against oxidative stress based on emerging evidence from experimental oxidative disease models and human studie.
TAKE HOME MESSAGE
The current literature suggests that among oxidative stress targets, Nrf2 is a valuable therapeutic target in pulmonary emphysema.
Topics: Animals; Disease Models, Animal; Drug Delivery Systems; Humans; Mice; NF-E2-Related Factor 2; Oxidative Stress; Pulmonary Emphysema
PubMed: 20148719
DOI: 10.1517/14728221003629750 -
The Quarterly Journal of Medicine Oct 1986
Review
Topics: Lung; Macrophages; Pancreatic Elastase; Pulmonary Emphysema; Smoking
PubMed: 3306757
DOI: No ID Found -
Critical Reviews in Computed Tomography 2002Accurate diagnosis and quantification of pulmonary emphysema in vivo is important to understand the natural history of the disease, to assess the extent of the disease,... (Review)
Review
Accurate diagnosis and quantification of pulmonary emphysema in vivo is important to understand the natural history of the disease, to assess the extent of the disease, and to evaluate and follow-up therapeutic interventions. Because pulmonary emphysema is defined by pathology, new diagnostic methods for quantification should be validated by reference to pathological and histological standards. Recent studies have addressed the capability of computed tomography (CT) to accurately quantify pulmonary emphysema. These studies that have been overviewed in this article have been based on CT scans obtained after deep inspiration or expiration, on subjective visual grading, and on objective measurements of attenuation values by using dedicated software providing numerical data on two-dimensional and on three-dimensional approaches, and compared CT data with pulmonary function tests. More recently, fractal and textural analyses were applied to CT scans to assess the presence, extent, and types of emphysema. Quantitative CT has already been used in patient selection for surgical treatment of pulmonary emphysema and in pharmacotherapeutical trials. However, despite numerous and extensive studies already available, this technique has not yet been standardized, and important questions about how to best use CT for the quantification of pulmonary emphysema remain to be addressed.
Topics: Age Factors; Disease Progression; Humans; Lung; Pulmonary Emphysema; Respiratory Function Tests; Tomography, X-Ray Computed
PubMed: 12521149
DOI: No ID Found -
Archives of Pathology Mar 1968
Review
Topics: Bronchi; Chronic Disease; Humans; Pulmonary Alveoli; Pulmonary Emphysema
PubMed: 4867711
DOI: No ID Found -
Clinics in Laboratory Medicine Sep 1984While the anatomic definition of emphysema has been adopted for more than 20 years, the precise application of the definition to the lung is not established. This... (Review)
Review
While the anatomic definition of emphysema has been adopted for more than 20 years, the precise application of the definition to the lung is not established. This article examines the application of the definition, pointing out that emphysema may differ from normal in a quantitative rather than a qualitative way. Then the author reviews the functional abnormalities that are associated with emphysema and speculates why airflow obstruction and abnormal gas exchange are associated with it.
Topics: Animals; Humans; Lung; Lung Compliance; Microscopy, Electron, Scanning; Pulmonary Alveoli; Pulmonary Emphysema; Pulmonary Gas Exchange; Pulmonary Ventilation; Respiratory Function Tests
PubMed: 6383697
DOI: No ID Found