Pulmonary Hyperinflation (Emphysema): Causes

Pathogenesis (disease development)

Pulmonary emphysema predominantly develops as a consequence of chronic obstructive pulmonary disease (COPD). According to the protease/antiprotease concept, inflammatory changes occur, leading to protease overgrowth. These proteases cause congestion of the lungs.

Furthermore, with advancing age, there is an enlargement of the air spaces distal to the terminal bronchioles (“senile emphysema”).

Etiology (Causes)

Biographic causes

• Genetic burden from parents, grandparents, especially in alpha-1 antitrypsin deficiency.
  • Genetic diseases:
    • Alpha-1-antitrypsin deficiency (AATD; α1-antitrypsin deficiency; synonyms: Laurell-Eriksson syndrome, protease inhibitor deficiency, AAT deficiency) – relatively common genetic disorder with autosomal recessive inheritance in which too little alpha-1-antitrypsin is produced because of a polymorphism (occurrence of multiple gene variants). A deficiency of protease inhibitors is manifested by a lack of inhibition of elastase, which causes the elastin of the pulmonary alveoli to degrade. As a result, chronic obstructive bronchitis with emphysema (COPD, progressive airway obstruction that is not fully reversible) occurs. At the liver, protease inhibitor deficiency leads to chronic hepatitis (liver inflammation) with transition to cirrhosis (non-reversible damage to the liver with marked remodeling of liver tissue).The prevalence (disease frequency) of homozygous alpha-1 antitrypsin deficiency is estimated at 0.01-0.02 percent in the European population.
• Age – at an older age physiologically occurs atrophic emphysema (“senile emphysema”).
• Occupations – bes. Occupations with quartz exposure (years of inhalation of quartz-containing dusts).

Behavioral causes

• Inhaled pollutants such as nicotine – tobacco (smoking).

Disease-related causes

• Chronic bronchitis (inflammation of the larger branched airways (bronchi) with cough and sputum).
• Unspecified viral infections of the lungs

Environmental pollution – intoxications (poisonings).

• Environmental pollution due to air pollution
  • Various gases, dusts (esp. quartz)
  • Ozone and nitrogen oxides

Other causes

• After partial lung resection (“over-expansion emphysema”).