Paraseptal emphysema refers to inflammation and tissue damage to the distal airways and alveolar sacs near the outer boundaries of the lungs. While more common types of emphysema impair major airway structures and disrupt normal airflow, paraseptal emphysema is unlikely to cause noticeable breathing problems in its initial stages. Many cases remain undiagnosed and untreated for several years, and complications may never occur. It is possible, however, for this type of emphysema to cause a lung to collapse or progress to envelop larger areas of lung tissue. Treatment depends on the severity of lung damage and may involve medications, surgery, or both.
Adults between the ages of 18 and 30 are at the highest risk of developing paraseptal emphysema, though doctors are not sure why that is the case. The disease is likely related to an inherited defect or an autoimmune condition. Some cases arise later in life in combination with another type of emphysema as a complication of long-term smoking. The condition usually presents by itself in young adults, though older people often suffer from chronic bronchitis as well.
The alveolar sacs that are affected in paraseptal emphysema sit very close to the pleura, or lung lining. Sacs become inflamed and enlarged, which limits the rate and amount of air that can be passed through them. Distal airways are not as vital as larger structures in the middle of the lungs, so a person may not have significant breathing difficulties. If symptoms are present, they may mimic asthma symptoms of coughing, shortness of breath, and fatigue.
The proximity of inflamed alveoli to the pleura presents the risk of damage to the lung lining. If the pleura is compromised, air can escape into the chest cavity and result in a collapsed lung. Paraseptal emphysema frequently goes undiagnosed until it is found incidentally when a patient receives treatment for a collapsed lung. X-rays, computerized tomography scans, and lung biopsies help doctors confirm the presence of emphysema.
If paraseptal emphysema does not cause problems, it might not need to be treated at all. Patients are simply encouraged to attend regular checkups to make sure problems do not arise. Any breathing difficulties can usually be relieved with bronchodilator inhalers, which help to relax and open the airways for easier breathing. If emphysema spreads and inflames major structures, a surgeon may need to excise part or all of a lung. Physical therapy and ongoing medical care may be necessary if surgery is performed.