Emphysema is a chronic lung disease involving damage to tiny air sacs within the lungs called alveoli. Paraseptal emphysema (PSE) is a type of emphysema that affects the outer regions of the lung.
PSE may occur alongside other types of emphysema, causing symptoms such as tightness in the chest, shortness of breath, and wheezing. If PSE occurs on its own, you may not experience any symptoms until other complications develop.
Chronic obstructive pulmonary disease (COPD) is an umbrella term for a group of lung diseases that includes emphysema and chronic bronchitis .
This article provides an overview of emphysema and its different types, considers the causes and symptoms of PSE, outlines the treatment options for PSE, and considers the outlook of people living with emphysema.
Causes of paraseptal emphysema
The lungs contain air passages called bronchioles, which attach to tiny air sacs called alveoli. The alveoli allow the lungs and blood to exchange oxygen and carbon dioxide during breathing.
Emphysema damages the alveoli in the lungs, causing them to break apart. Over time, this process creates one or more large air pockets instead of multiple small ones.
The big air pockets trap stale air, making it difficult for oxygen to move in and out of the bloodstream. This causes breathing difficulties and symptoms associated with low blood oxygen .
Cigarette smoking is the most common cause of emphysema and COPD in general. Around 80% to 90% of people with a COPD diagnosis identify as cigarette smokers, and around 10% to 15% of people who smoke cigarettes will develop COPD.
If you smoke cigarettes, factors that can influence your risk of developing emphysema or COPD include:
- how much you smoke
- the number of years you smoke
- your baseline lung function
A 2023 case study notes that PSE is more common among people who smoke cannabis compared with those who smoke only tobacco .
The authors suggest this could be due to the Valsalva maneuver or similar maneuvers people use when inhaling cannabis. These maneuvers may be more likely to damage the lungs and lead to large air pockets called apical bullae .
In people who smoke cannabis, PSE may represent an earlier stage of this disease process.
Other factors that may cause or contribute to emphysema include :
Symptoms of paraseptal emphysema
PSE can occur on its own or in addition to centrilobular emphysema or panlobular emphysema.
According to a 2023 case study , PSE that occurs on its own or is the predominant type typically does not cause any symptoms. The first sign is often a collapsed lung , which is a medical emergency.
Symptoms of a collapsed lung typically come on suddenly and may include :
In people with more than one type of emphysema, the signs and symptoms may take years to develop. The most common early signs are:
Treatment options for paraseptal emphysema
Although there is no cure for emphysema, treatments are available to help alleviate symptoms. Treatment usually involves a combination of medications and supportive therapies.
Medications
Doctors may prescribe one or more of the following medications to help treat emphysema or COPD:
- Bronchodilators: There are two main types of bronchodilators. One type relaxes muscles around the airways, while the other prevents the muscles from tightening. Both types help the airways open, which helps you breathe.
- Corticosteroids: These drugs decrease inflammation, swelling, and mucus production in the airways. Doctors typically only prescribe corticosteroids for short-term use due to their risk of severe side effects.
- Combination medications: These combine two or more medications in a single inhaler or nebulizer. This approach can simplify emphysema treatment and improve its overall effectiveness.
- Antibiotics: Doctors may prescribe antibiotics to help treat a COPD flare that’s the result of a bacterial infection.
Supportive therapies
Doctors may recommend supportive therapies for severe cases of emphysema or COPD. Examples include :
- Oxygen therapy: This therapy involves breathing in oxygen through a nasal tube or mask to help increase the amount of oxygen entering the lungs. Oxygen therapy can boost blood oxygen levels, and this can alleviate shortness of breath and fatigue.
- Pulmonary rehabilitation: This program aims to improve lung function, reduce COPD symptoms, and improve quality of life. Pulmonary rehabilitation typically involves a combination of:
- exercise training
- nutrition education
- disease management education
- social support
- Complementary therapies: These are non-standard medical therapies that may help alleviate symptoms and improve quality of life. Examples of complementary therapies for COPD include :
Are treatments for paraseptal emphysema covered by insurance?
Treatments that are deemed “medically necessary” for emphysema and its different subtypes are typically covered by medical insurance and Medicare.
The ICD-10 code for “other emphysema” is J438. You can use this code to check with your insurance provider for more information.
You can check more ICD-10 codes from the Centers for Medicare & Medicaid Services here . Note you will need to download them to your device to access them.
You may have to provide documentation for insurance coverage to apply. There may also be additional copays.
Prognosis for paraseptal emphysema
Emphysema is a chronic condition that causes a gradual decline in lung function. However, the rate of this decline may differ from person to person and can depend on several factors, including:
- your individual symptoms
- your overall health
- your age
- whether you have smoked, and if so, for how long
- your GOLD and BODE ratings
GOLD and BODE ratings
Doctors use the Global Initiative on Obstructive Lung Disease (GOLD) system to assess COPD severity. The system uses a lung function test called a forced expiratory volume (FEV1) test to see how much air you can forcefully breathe out in one second.
Depending on the result of the test, a doctor will diagnose one of four COPD disease stages :
- GOLD stage 1 (mild COPD): A FEV1 greater than or equal to 80%.
- GOLD stage 2 (moderate COPD): A FEV1 between 50% and 80%.
- GOLD stage 3 (severe COPD): A FEV1 between 20% and 50%.
- GOLD stage 4 (very severe COPD): A FEV1 less than 30%.
Generally, the higher the GOLD stage, the lower life expectancy is likely to be. However, the GOLD system also considers other important factors, such as your specific breathing issues and the number of COPD flares you tend to have.
Doctors may use the GOLD system in combination with the BODE system to assess quality of life and help predict life expectancy in people with COPD.
BODE stands for:
- Body mass index (BMI): indicates the extent of COPD-induced weight loss
- Obstruction of the airways: uses the FEV1 and other lung function test results to determine the extent of airflow issues
- Dyspnea: denotes your level of breathing difficulty
- Exercise capacity: denotes the level of physical activity you can manage
BODE scores range from 0 to 10. A BODE score of 10 indicates the most severe symptoms and lowest estimated life expectancy.
However, it’s important to note that these are only estimates. Estimates around life expectancy are always extremely personal. Only your doctor can help determine your outlook. Talk with your primary healthcare professional to get the best information.
Takeaway
Emphysema is a chronic lung disease that involves damage to the alveoli within the lungs. Paraseptal emphysema (PSE) affects the alveoli in the outer regions of the lungs. It may occur on its own or in addition to other types of emphysema. Symptoms of emphysema may include tightness in the chest, shortness of breath, and wheezing.
Cigarette smoking is the most common cause of all types of emphysema. However, cannabis smoking appears to increase the risk of PSE specifically.
Other potential causes of emphysema include exposure to environmental pollutants, lung infections, and allergies. While there’s no cure for emphysema, medical treatments and supportive therapies can help alleviate your symptoms and improve your quality of life.
Emphysema is a chronic condition that causes a gradual decline in lung function. The rate of this decline depends on several factors, including your symptoms, as well as your overall health and age.
Doctors may also assess your GOLD and BOLD ratings to stage your emphysema and give you a better idea of your individual outlook.
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