1. NICO ROGELIO

2.  A pathologic diagnosis defined as an abnormal, permanent enlargement of the airspaces distal to the terminal bronchiole accompanied by destruction of alveolar walls and without obvious fibrosis  Inflammation causes:  Loss of alveolar walls resulting in decreased elastic recoil  Loss of alveolar supporting structure leads to airway narrowing  Bronchitis leads to obstruction by causing narrowing of airways  All cause limitation in airflow, causing hyperinflation of the alveoli

3. 1. Centriacinar  Begins in bronchioles and spreads peripherally  Most associated with smoking  Predominantly involves upper half of lungs 2. Panacinar  Destroys uniformly  Predominant in the lower lobes  Most observed in alpha1-antitrypsin deficiency 3. Paraseptal  Preferentially involves distal airway structrues  Localized around the septae of lungs lungs or pleura  Apical bullae may lead to spontaneous pneumothorax

5. HISTORYPHYSICAL EXAM  Productive cough  Acute chest illness  Cough usually worse in the morning  Breathlessness  Wheezing  AAT-deficiency  causing loss of elasticity in lungs  Tachypnea  Use of accessory muscles  Cyanosis  Elevated JVP  Peripheral edema  Barrel chest  Wheezing  Decreased breath sounds  Hyperresonance  Prolonged expiration  Forced expiratory time > 6 s