What Is Panlobular Emphysema?

Panlobular (or panacinar) emphysema is a type of emphysema that affects a specific part of the lungs. Emphysema is a disease of the lungs in which the air sacs in the lungs (alveoli) are permanently damaged. There are three emphysema types—centriacinar, panlobular, and paraseptal—that affect different parts of the lung structure.

You may have heard the term emphysema in relation to chronic obstructive pulmonary disease (COPD). COPD is an umbrella term that includes emphysema and chronic bronchitis. Statistics show that 16.4 million adults in the United States have a diagnosis of any type of COPD, chronic bronchitis, or emphysema.

Panlobular emphysema affects the whole acinus—which is the end portion of the respiratory bronchioles, including the alveolar ducts, alveolar sacs, and alveoli. It is an evenly distributed disease in which the tissue damage is uniform throughout the acinus and secondary pulmonary lobule.

Panlobular Emphysema Symptoms

Panlobular emphysema causes chronic damage to the airways in the lungs. This damage can cause obstruction, making it difficult to breathe. 

Symptoms will vary depending on the person, history, and stage of the disease. However, common symptoms include:

• Shortness of breath
• A persistent cough
• Difficulty performing activities of daily living (like washing, dressing, walking up/down stairs)
• Weight loss
• Fatigue
• Loss of appetite
• The production of excess sputum (phlegm/mucus)
• Wheezing
• Chest tightness
• A blue tinge around the lips or in the fingernails/toenails 
• Depression or anxiety
• Frequent respiratory infections

Panlobular emphysema is a chronic disease and is irreversible. This means that symptoms worsen as the condition progresses.

Causes

Several conditions might be the root cause of panlobular emphysema, including:

• COPD (predominantly found in severe COPD): COPD is caused by smoking or inhaling other irritants or air pollutants (in the workplace, for example). The irritant causes the inner walls of the air sacs to weaken, and the lining of the alveoli becomes damaged. The damage is irreversible and causes breathing problems. 
• Alpha-1 antitrypsin deficiency (AATD):  AATD is a genetic condition in which you do not have enough of a protein/enzyme called alpha-1 antitrypsin (AAT). When AAT levels are low, your lung tissues are not well protected and are much more easily damaged by smoke or a lung infection. Damage to the alveoli can lead to emphysema.
• Ritalin lung: Ritalin (methylphenidate) abusers can develop panlobular emphysema through injecting Ritalin intravenously. This is also sometimes known as excipient lung disease.
• Swyer-James syndrome: Swyer-James syndrome is a very rare condition. It can affect either the whole lung or a portion of the lung. With this condition, the lung does not grow properly and is smaller than the opposite lung. It can follow having severe bronchiolitis or pneumonitis as a child, but how it is caused is not fully understood.
• Obliterative bronchiolitis (also known as popcorn lung): Obliterative bronchiolitis is a rare disease caused by the inhalation of chemicals, exposure to a respiratory virus, or an autoimmune disease. It can also be associated with graft-versus-host disease following a lung or bone marrow transplant.

Diagnosis

Diagnosis begins with your primary care health professional, who will take a complete medical history. Your medical history will include things like:

• Smoking history
• Family history
• Exposure to secondhand smoke
• Exposure to chemicals, fumes, dust, or other irritants in the workplace
• Allergy history
• Previous lung diseases/childhood respiratory problems

If a type of emphysema is suspected, several other tests are carried out to confirm a diagnosis. These may include:

• Imaging like an X-ray or computed tomography (CT) scan to look at your lungs in more detail
• Pulse oximetry to measure the level of oxygen in your blood
• Arterial blood gas to measure the amount of oxygen and carbon dioxide in your blood
• Blood tests to assess how well your lungs are transferring oxygen
• Lung function tests (pulmonary function tests) such as spirometry to check how well the lungs work
• Electrocardiogram (ECG) to check your heart function

Mild or moderate disease can be challenging to detect, even with CT imaging. When panlobular emphysema is severe, the most common characteristics seen on a CT scan are:

• Decreased lung attenuation
• Few visible pulmonary vessels in the abnormal regions
• Bullae or cysts are usually absent 

An experienced respiratory specialist will identify these characteristics after carefully reviewing the CT scans.

Treatment

Treatment of panlobular emphysema can vary slightly depending on the root cause; however, many treatments remain the same regardless. 

Treatment can include:

• Inhaled medications: Such as bronchodilators or steroids
• Oral medicines: Such as antibiotics and steroids
• Home oxygen therapy: Might be prescribed if oxygen levels in the blood are deficient
• Pulmonary rehabilitation: An exercise and education program for people with lung disease to help you achieve more exercise with less shortness of breath
• Nutritional advice: For some people, emphysema can cause weight loss. Therefore, a dietitian can provide advice on the best foods to help you maintain a healthy weight.
• Vaccinations: Ensuring vaccinations are up to date to help prevent lung conditions such as pneumonia, flu, or COVID-19
• Surgery: Lung reduction surgery, or a lung transplant, may be recommended in severe circumstances.

Treatment of panlobular emphysema aims to manage the symptoms and slow disease progression. 

Prognosis 

Panlobular emphysema, just like other types of emphysema, is irreversible. There is no cure.

Although it is a chronic condition, you can manage it through an individualized treatment plan that includes medication, exercise, dietary advice, and refraining from smoking/exposure to air pollutants.  

When diagnosed early, a treatment plan can help slow the disease progression. If smoking is the cause, then quitting is vital to slowing down the disease's progression. However, over time symptoms will worsen as the disease progresses.

Prognosis varies significantly from person to person depending on the severity of the emphysema, root cause, medical history, lifestyle, family history, overall health, and medication adherence. 

Coping 

Coping with panlobular emphysema and breathlessness can be challenging. It can lead to symptoms of depression or anxiety, especially if breathlessness is affecting everyday life. 

If you are experiencing feelings of depression or anxiety, your primary care health professional or respiratory medical team can help. Therapy, such as cognitive-behavioral therapy, can help with depression, anxiety, and managing symptoms of breathlessness.

Learning relaxation techniques such as breathing exercises, visualization, and meditation can also help with breathlessness and anxiety symptoms. 

There are support groups available for people with various types of lung conditions. Being around other people with a similar lung disease can show you that you are not alone, provide peers to talk to, and signpost you to relevant support. 

It is important to remember that you are not alone, and that there is a lot of support and advice available. 

A Word From Verywell 

Like any type of emphysema, panlobular emphysema can be difficult to live with. At times, breathlessness can be pretty daunting. However, there are many treatments and techniques available to help slow the progression of the disease and help with symptom management.

Be sure to seek medical advice if you are worried that you have problems with your breathing. The sooner emphysema is identified, the sooner you can start a treatment plan and appropriate medications. Doing your best to quit smoking, avoid infections, eat a varied diet, and exercise are some of the best ways to stay as healthy as you can. 

Talk to your healthcare professional or respiratory team if you are struggling to cope with panlobular emphysema. There are many ways they can offer support to make living with the condition more manageable.