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What causes centrilobular and pan lobular emphysema?

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Posted on Sat, 19 Jul 2014
Question: I am 57, female. was diagnosed with mild COPD in April. Since then, I had a month long bout of bronchitis (with little coughing), which has left scarring. I feel OK most of the time, some sob but not frequent or bad. I was a smoker who quit many times, finally 3 yrs ago, but was always afraid of this since my mother has it. My question mostly relates to how this was discovered and subsequent tests, etc.

I had expressed concern to my former primary back home (I moved out of state and got my medical records in March). He knew I was always worried about it and had a CT and CXR 2.5 yrs ago. He never gave me results, said all was fine. The report clearly states that I have mild centrilobular changes consistent with sm airways disease, mild bronchitis, mild bronchiecstasis and mild panlobular changes. I was shocked , felt betrayed and very upset. I still am. I called and he did not call back. I have been thinking of a letter.

I just went through a bad divorce, and smoked for 6 months again up until February. The pulmonologist here gave me spirometry and it was 93. She had never seen that with my type of CT report. I imagine it has gone down since bronchitis but am on Advair. Anyway, she said she hopes i am not on oxygen in 5 yrs. Why? So far I am doing pretty well. Is it because of the panlobular? I am really scared about having that also. Isn't that unusual to have both? Thank you.
doctor
Answered by Dr. Shashi Dangwal (7 hours later)
Brief Answer:
A person can have both types.

Detailed Answer:

Hello XXXX

Your CT findings as mentioned by you do suggest that you have centrilobular and pan lobular emphysema but the good news is that it is of mild degree.

In smokers, centrilobular is common where as panlobular is seen more in people with certain enzymatic deficiency called alpha 1 antitrypsin. but generally there is some element of overlap and a person can have both.

Since you say that your mother also had it, may be that`s the reason you have as it may run in the family.

Though in panlobular, symptoms may be more marked but in your case your spirometry results are very good and you say that you feel very good. There may be discrepancy in clinical symptoms and what is seen in the test results but we have to go by and treat the symptoms.

So, my advice to you is, first and foremast stop worrying and quit smoking completely. Once smoking is stopped, further deterioration in the lung condition also stops. You should also avoid dust and even secondary smoke ie passive smoking which means you should not be in close proximity of people who smoke.

Continue your advair, adopt a healthy lifestyle and do some physical exercise to improve your lung capacity.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Shashi Dangwal (13 hours later)
Thank you for such a thoughtful answer. I am going to try and stop worrying and take your advice. However, I still think it is unusual to have both when my symptoms are mild, and fearful of what the doctor said about oxygen so soon. My mother had it, but did not become severe until about age 75, oxygen at 80. I wonder if it is hereditary. My younger brother is afraid he has it - he quit 10 years ago.

I am not smoking and not around smokers. Perhaps the symptoms differ from the scan - the scan was over two years ago. So it must be very slow? Should I repeat the scan? Thanks!!

Thank you.
doctor
Answered by Dr. Shashi Dangwal (8 hours later)
Brief Answer:
A person can have both.You may repeat the scan.

Detailed Answer:


My answer to your queries is still the same.

A person can have both.Overlap is known.

Emphysema, esp panlobular type may be hereditary if it is due to alpha 1 antitrypsin deficiency.


There may be a mismatch between CT findings and clinical symptoms.

Very difficult to predict the rate of deterioration. However on quitting smoking the rate of deterioration of lung function stops or at least slows down.

You may repeat the scan to see the latest state of lungs.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shashi Dangwal (28 hours later)
CXR

This 2view cxr demonstrates increasing social markings in left lower lobe consistent with patchy scarring. This is not significantly changed compared to prior cxr s obtained last month although it appears slightly more prominent than on x-Ray on 3/16.

Impression:

Left basilar scarring which has been unchanged over the past month but is somewhat increased compared with 3/15. Recommend pulmonary consult or CT.

I have called my pulmonologist and cannot get an appt until 7/15. Waiting to hear back from my primary doctor.

What are your thoughts on the results? Thank you.
doctor
Answered by Dr. Shashi Dangwal (2 hours later)
Brief Answer:
There does not appear to be much change.

Detailed Answer:
Radiologist has to report what he sees. It`s clinical correlation that`s important.

From your description, there does`nt seem to be much change for worse, neither have your symptoms progressed(deteriorated).

Just relax and consult your pulmonologist.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Shashi Dangwal

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Practicing since :1979

Answered : 1156 Questions

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What causes centrilobular and pan lobular emphysema?

Brief Answer: A person can have both types. Detailed Answer: Hello XXXX Your CT findings as mentioned by you do suggest that you have centrilobular and pan lobular emphysema but the good news is that it is of mild degree. In smokers, centrilobular is common where as panlobular is seen more in people with certain enzymatic deficiency called alpha 1 antitrypsin. but generally there is some element of overlap and a person can have both. Since you say that your mother also had it, may be that`s the reason you have as it may run in the family. Though in panlobular, symptoms may be more marked but in your case your spirometry results are very good and you say that you feel very good. There may be discrepancy in clinical symptoms and what is seen in the test results but we have to go by and treat the symptoms. So, my advice to you is, first and foremast stop worrying and quit smoking completely. Once smoking is stopped, further deterioration in the lung condition also stops. You should also avoid dust and even secondary smoke ie passive smoking which means you should not be in close proximity of people who smoke. Continue your advair, adopt a healthy lifestyle and do some physical exercise to improve your lung capacity.