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Is Emphysema The Same Thing As Interstitial Lung Disease?

Emphysema consists of an abnormal and permanent dilation of the air spaces resulting from the destruction of the alveolar tissue, while interstitial lung diseases result in an alteration of alveolointerstitial structures, that means that they affect the epithelium, the alveolar walls, the capillary endothelium and the connective tissue (perilymphatic and perivascular) comprised between the septa and located in the peribronchiolar tissue.

Interstitial lung disease (ILD) is a complex group of pulmonary disorders, primarily of the pulmonary interstitium, and includes idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, sarcoidosis, and connective tissue disease associated with interstitial lung disease.

Interstitial lung disease is a heterogeneous group of conditions with different prognoses and clinical presentations. Many are associated with increased morbidity and mortality-eg, the survival of patients with idiopathic pulmonary fibrosis (IPF) is <3 years whereas acute interstitial pneumonia can be rapidly fatal. Other diseases, such as sarcoidosis, can return without treatment.

It is important that primary care doctors refer to the specialist as soon as possible, to confirm the diagnosis and prognosis and choose the most appropriate management strategy. However, a cohort study of patients with IPF identified a mean lapse from the onset of dyspnea to the referral to the specialist of 2.2 years. This delay was associated with a higher risk of death, regardless of the severity of the disease. Diagnosis and classification also affect the possibility of entering into many pharmacological trials that are currently underway.

The classification of ILDs is complex, reflecting the diversity of the underlying causal factors and the different histopathological findings. Although most disorders are characterized by varying degrees of inflammation or fibrosis of the pulmonary interstitium (the connective tissue structure of the entire lung), some such as desquamative interstitial pneumonitis and alveolar proteinosis is characterized by airspace occupation. Some may be primarily inflammatory, such as sarcoidosis, while others, such as IPF, are primarily fibrotic and may be associated with extensive distortion of the pulmonary architecture and loss of volume.

The range of causal factors attributed to ILD includes connective tissue diseases and occupational environmental exposure such as asbestos workers, toxic drugs and radiation. IPF is the most common of the group of idiopathic interstitial pneumonia, which are PID of unknown etiology and are classified mainly according to histological findings.

On the other hand, pulmonary emphysema is defined as the abnormal and permanent dilation of the air spaces resulting from the destruction of the alveolar tissue, identified by dyspnea at rest or with mild efforts that denotes the level of affection.

From an anatomopathological point of view, emphysema is the abnormal enlargement of the air spaces distal to the terminal bronchioles with the destruction of the wall of the alveolus, which leads to a decrease in respiratory function, being emphysema a more serious complication.

Causes of Emphysema

Emphysema may be due to two causes that are mentioned:

Hereditary Emphysema: Caused by the deficiency of the anti-protease alpha-1, this fails to protect the connective tissue of the lung from all alterations that produce proteases.
Acquired Emphysema: Like obstructive or bronchogenic emphysema, this is presented by the progressive alveolar alteration with rupture of its wall that hinders the exit of inspired air. In this group are:

–Toxogenic Emphysema: Which is produced by structural alterations of the thoracic cage typical of old age, producing the degeneration of the intervertebral cartilaginous discs and the flattening of the anterior part of the vertebral bodies, the anteroposterior diameter of the thorax is enlarged and the lung tends to extend in this direction.

–Primitive Emphysema: Whose cause is unknown and does not obey the existence of valvular mechanisms, the collagen, and elastin of the lung tissue disappears little by little and in the radiograph, it is not possible to perceive pulmonary structure (evanescent lung).

–Chronic Obstructive Pulmonary Disease (COPD): It occurs when the production of anti-trypsin alfa-1 is normal, but due to the excessive accumulation of proteases, due to the smoke produced by the tobacco, macrophages release free radicals that inactivate to the anti-trypsin alfa-1 and the anti-protease concentration ends, causing a variation in the balance of the alveolus, showing a distended alveolus with impaired functionality.

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Is Emphysema The Same Thing As Interstitial Lung Disease?