Obstruction of the Respiratory Orifices, Larynx, Trachea and Bronchia
Burkhard Madea in Asphyxiation, Suffocation,and Neck Pressure Deaths, 2020
A particularly significant role is played by the aspiration of chyme and blood. Only in cases where at least the small bronchi on both sides are obstructed by the aspirate up to the periphery is the evaluation of aspiration of chyme or blood as the cause of death justified. Some of these cases are accompanied by the development of areas of chyme and blood aspiration. An acute pulmonary emphysema may frequently be observed. If aspirated material is only found in the trachea and the primary bronchia, and this section of the airways is not completely obstructed, death by asphyxiation may not be assumed. These findings may be interpreted as agonal aspiration with another underlying cause of death. In rare cases, teeth are aspirated; although this may result in respiratory impairment, this generally does not cause death by asphyxiation.
Respiratory Effects
Lars Friberg, Tord Kjellström, Carl-Gustaf Elinder, Gunnar F. Nordberg in Cadmium and Health: A Toxicological and Epidemiological Appraisal, 2019
As the findings regarding chronic effects of the respiratory system may appear somewhat controversial and inconsistent, the main results from the studies will be presented in some detail in the following text. It should be emphasized that the diagnostic criteria used for detecting and diagnosing lung disease in cadmium workers have been variable and that different types of criteria were used by different investigators. Indeed, the clinical conditions which were regarded by the early investigators as emphysema would nowadays be classified as chronic nonspecific lung disease (CNSLD).106 According to an expert group meeting,106 the term chronic nonspecific lung disease can be used “to describe the group of conditions in which there is chronic sputum production and/or shortness of breath at rest and/or on exercise”. Emphysema is one pathological condition which may be seen among patients suffering from CNSLD, but not always. It is difficult to diagnose emphysema correctly and it is often necessary to perform microscopic examinations of lung tissue specimens.
The respiratory system
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella in Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Emphysema is a respiratory disease that is characterized by destruction and permanent dilation of the terminal bronchioles and alveolar air sacs (see Figure 8.13). The vast majority (>95%) of all patients with emphysema were chronic cigarette smokers. Although the exact etiology of emphysema is complex and multifactorial, it appears that chronic exposure to cigarette smoke causes chronic inflammation of the alveolar airways that results in infiltration by lymphocytes and macrophages. Excess release of inflammatory cytokines and protease enzymes (such as trypsin) from immune cells can damage and destroy the elastic proteins (i.e., elastin) that are found in walls of the alveoli. As a result, alveolar air sacs become enlarged and distended as their structure is affected and their elasticity lost. Levels of the protective anti-protease enzyme α1-antitrypsin are also decreased over time in individuals who are chronic cigarette smokers. The endogenous α1- antitrypsin enzyme inactivates destructive protease enzymes in lung tissue. A rare form of genetic emphysema occurs in individuals who are not cigarette smokers but who do have a defect in the gene that produces α1-antitrypsin.
Microwave ablation of lung malignancies with coexisting severe emphysema: a retrospective analysis of safety and efficacy in 26 patients
Published in International Journal of Hyperthermia, 2021
Jinzhao Peng, Zhixin Bie, Yuanming Li, Bin Li, Runqi Guo, Chengen Wang, Xiaoguang Li
Emphysema is not only an independent risk factor for lung cancer but also a significant predictor of death from lung cancer [19,20]. The treatment of lung malignancies with concurrent severe emphysema remains a challenge. The scope of surgery and radiotherapy is limited in cases of severe emphysema. Previous studies have shown that severe emphysema is a poor prognostic predictor of long-term survival in lung cancer patients undergoing surgery. Moreover, coexisting emphysema increases the incidence of perioperative complications requiring treatment and mortality [2,3]. A study reported a high in-hospital mortality rate of 14% following anatomical lobectomy in patients with NSCLC and severe emphysema [21]. MWA can be an alternative treatment for lung malignancies in patients who are medically inoperable due to high-risk conditions or refuse to accept surgery. For patients with high-risk conditions, such as patients with a single lung after prior pneumonectomy, thermal ablation appeared to be a safe and effective option as demonstrated in several studies [10–12]. However, the safety and efficacy of MWA for primary lung cancer or metastases with coexisting severe emphysema have not been fully determined.
Differential lung inflammation and injury with tobacco smoke exposure in Wistar Kyoto and spontaneously hypertensive rats
Published in Inhalation Toxicology, 2020
Alexa K. Pham, Ching-Wen Wu, Xing Qiu, Jingyi Xu, Suzette Smiley-Jewell, Dale Uyeminami, Priya Upadhyay, Dewei Zhao, Kent E. Pinkerton
The classic hallmark of emphysema is the destruction of alveolar tissues leading to airspace enlargement. Loss of alveolar tissue including the capillary structure results in decreased gas exchange, difficulty in breathing and compromised lung function (Suki et al. 2013). The pathogenesis of emphysema can be attributed to airway inflammation that recruits inflammatory cells following tobacco smoke exposure, leading to induced matrix metalloproteinase expression that can degrade alveolar tissues (Churg et al. 2002; Churg et al. 2012). The second classic hallmark of COPD is chronic bronchitis which includes goblet cell metaplasia, mucus hypersecretion, and inflammation of the lining of the bronchus leading to narrowing and restriction of the airways resulting in severe lung dysfunction (Hoang et al. 2016).
Pharmacogenomics of chronic obstructive pulmonary disease
Published in Expert Review of Respiratory Medicine, 2019
After COPD diagnosis and lung function, emphysema has been the most widely studied phenotype in COPD genetics studies. Emphysema can be assessed based on quantitative analysis of chest CT scans [67]. GWAS have identified genome-wide significant associations with quantitative measures of emphysema [68,69], emphysema patterns [70], and emphysema distribution [57,58]. Some of the emphysema associations overlap with COPD GWAS findings, including genes such as HHIP and FAM13A, which have been demonstrated to influence emphysema in mouse smoking models [71,72]. However, some of the emphysema associations have not been found in previous COPD GWAS, demonstrating the complementary information which can be obtained from analysis of COPD-related phenotypes. Additional genes for quantitative emphysema have been identified by gene expression profiling in lung tissue samples [73–75].
Related Knowledge Centers
- Alveolus
- Gas Exchange
- Respiratory Tract
- Lung
- Chronic Obstructive Pulmonary Disease
- Pulmonary Alveolus
- Middle Age
- Old Age
- Tobacco Smoking
- Alpha-1 Antitrypsin Deficiency