Panlobular Emphysema: Causes, Symptoms, and More

Panlobular emphysema (PLE), or “panacinar emphysema,” is a type of emphysema that affects the entire acinus in the lung. The acinus are the parts of the lungs that are involved in air exchange.

This article gives an overview of emphysema and panlobular emphysema (PLE), including its causes, symptoms, and treatments. We also discuss how PLE may affect life expectancy.

Types of emphysema

The lungs contain tiny air sacs called “alveoli,” which allow the lungs and blood to exchange oxygen and carbon dioxide during breathing. Emphysema is a chronic disease that damages the alveoli, causing their walls to break apart.

Over time, this destruction creates large pockets of trapped, stale air inside the lungs. These air pockets make it difficult for oxygen to move in and out of the bloodstream, causing breathing difficulties and low blood oxygen levels.

As a 2023 review explains, emphysema can affect different parts or “lobes” of the lung, resulting in three subtypes:

• Centrilobular emphysema (CLE): CLE affects the central lobes of the lung.
• Paraseptal emphysema (PSE): PSE affects the outer lobes of the lungs.
• Panlobular emphysema (PLE): PLE affects all lobes of the lung.

Chronic obstructive pulmonary disease (COPD) is the collective term for a group of lung diseases that includes emphysema and chronic bronchitis. According to a 2022 review, PLE may represent a more severe form of COPD.

Causes of panlobular emphysema

According to a 2023 review, cigarette smoking is the most common cause of all types of emphysema and COPD. Among people with COPD, between 80% and 90% identify as cigarette smokers.

If you smoke cigarettes, certain factors can influence your risk of developing COPD. These include:

• how frequently you smoke
• the number of years you have smoked
• your lung function before smoking

Some additional risk factors for emphysema include:

• second hand or “passive” smoking
• exposure to environmental pollutants, like biomass fuels and particulate matter
• lung infections
• allergies
• low birth weight

According to the 2023 review, PLE in particular can occur due to a deficiency in the protein alpha one antitrypsin (AAT). This is a protein that the liver produces to help protect the lungs. If your liver doesn’t produce enough AAT, your lungs are more susceptible to damage from smoking and pollution.

AAT deficiency is an inherited disease, meaning it runs in families. The following diagnostic tests can help to check for the condition:

• a blood test to check AAT levels in the blood
• a genetic test to check for the gene mutation that causes AAT deficiency
• a pulmonary function test to check lung function

Symptoms of panlobular emphysema

As a 2023 review explains, emphysema typically causes symptoms such as a chronic, productive cough, and shortness of breath. As the disease progresses, these symptoms may worsen to the point where they interfere with daily living.

If you have advanced emphysema or COPD, you may experience more severe symptoms, such as:

• a severe cough that produces a lot of phlegm
• severe or persistent wheezing
• unintentional weight loss
• fatigue
• blue coloration of the skin and nail beds due to low blood oxygen levels

Because PLE involves more severe or widespread airway destruction, it may also cause more severe symptoms.

Treatment options for panlobular emphysema

Although there’s no cure for emphysema, treatments can help to alleviate the symptoms and improve quality of life.

According to the American Lung Association, medications for emphysema and COPD can help to ease breathing and lower symptoms by:

• relaxing and widening the airways
• reducing airway inflammation
• reducing mucus production
• treating a bacterial infection, if present

Examples of such medications include:

• bronchodilators
• oral or inhaled corticosteroids
• combination medications for inhalation or nebulization
• antibiotics

Supportive therapies that help to improve symptoms and lower the risk of emphysema and COPD complications include:

• Oxygen therapy, which involves breathing in oxygen through a nasal tube or mask to help increase blood oxygen levels
• pulmonary rehabilitation, which combines:
  • exercise training
  • education on nutrition and disease management
  • therapy
  • social support
• complementary therapies,such as:
  • massage
  • acupuncture
  • yoga

If you have AAT deficiency-induced PLE, a doctor may also prescribe specific medications to help raise AAT protein levels and slow down the lung damage.

Are panlobular emphysema treatments covered by insurance or Medicare?

Emphysema treatments that are deemed “medically necessary” by a professional are typically covered under most insurance and Medicare plans. Contact your healthcare team for the specifics of your coverage, as there may be restrictions on doctors, prerequisites, or additional copays to be aware of.

You can use the ICD-10 code J431 to look up coverage related to panlobular emphysema. These codes are used by insurance companies to identify individual conditions and treatments.

How does panlobular emphysema affect life expectancy

A 2022 study compared COPD disease severity among people with different types of emphysema. Compared with CLE and PSE, PLE was associated with the following:

• increased respiratory symptoms
• increased airflow obstruction
• higher levels of systemic inflammation
• lower body mass index (BMI)
• lower quality of life

The study refers to earlier research in which PLE was associated with a more advanced GOLD stage. “GOLD” stands for Global Initiative on Obstructive Lung Disease. It’s a system that uses lung function and other prognostic factors to help predict life expectancy in individuals with COPD.

The GOLD system assigns a grade based on the severity of obstruction (1 to 4), and for each grade, assigns a class (A, B, or E) based on the frequency of exacerbations. Generally, the higher a person’s GOLD score, the lower their estimated life expectancy.

On average, life expectancy drops by around 6 to 9 years for people with GOLD stage 3 or 4 COPD.

Takeaway

Emphysema is a chronic lung disease that damages the lungs’ tiny air sacs or alveoli. PLE is a rare type of emphysema that affects the alveoli in all lobes of the lungs. For this reason, PLE appears to cause more severe respiratory symptoms, including a severe, productive cough, persistent wheezing, and fatigue.

Although there’s no cure for PLE or other types of emphysema, medications can help ease breathing and improve the symptoms. Supportive therapies can also help to improve symptoms and quality of life. Examples include oxygen therapy, pulmonary rehabilitation, and other complementary therapies.

People with PLE tend to have more severe respiratory symptoms, higher levels of systemic inflammation, and a lower estimated life expectancy than other forms of emphysema. But if you have PLE, your doctor will work closely with you to ensure you’re receiving the most appropriate treatments for the best possible outcome.