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Emphysema is a chronic obstructive pulmonary disease (COPD), formerly termed a chronic obstructive lung disease (COLD). It is often caused by exposure to toxic chemicals or long-term exposure to tobacco smoke. Emphysema is caused by loss of elasticity (increased compliance) of the lung tissue, from destruction of structures supporting the alveoli, and destruction of capillaries feeding the alveoli, due to the action of alpha 1 antitrypsin deficiency. Thus the small airways collapse during exhalation, as alveolar collapsibility has increased. This impedes airflow and traps air in the lungs, as with other obstructive lung diseases. Symptoms include shortness of breath on exertion and later at rest, hyperventilation, and an expanded chest. Mild emphysema sufferers often maintain perfect blood oxygen levels by hyperventilating, and so are sometimes called "pink puffers". By contrast, sufferers of chronic bronchitis (another COPD disorder) are called "blue bloaters" because they have cyanosis (inadequate oxygen) due to an almost normal ventilatory drive caused by decreased sensitivity to carbon dioxide secondary to chronic hypercapnia. But any COPD disease results in hypoxaemia (decreased blood partial pressure of oxygen) and hypercapnia (increased blood partial pressure of carbon dioxide). Signs of emphysema include pursed-lipped breathing, central cyanosis and finger clubbing. The chest has increased percussion notes, particularly just above the liver, and a difficult to palpate apex beat, both due to hyperinflation. There may be decreased breath sounds and audible expiratory wheeze. In advanced disease, there are signs of fluid overload such as pitting peripheral edema. The face has a ruddy complexion if there is a secondary polycythemia. Sufferers who retain carbon dioxide have asterixis (metabolic flap) at the wrist. Many sufferers whose emphysema was caused by cigarette smoke have cigarette stains on the fingers.
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