Centrilobular Emphysema: What Is It?

Emphysema is one of two different progressive lung diseases that classify as a chronic obstructive pulmonary disease (COPD) diagnosis. Chronic bronchitis is the other disease that comprises the COPD group of pulmonary conditions, and usually, a COPD diagnosis means that a patient has a combination of both emphysema and chronic bronchitis. 

However, a patient can still have COPD that only involves emphysema, which means that the patient’s alveoli (air sacs) in their lungs have permanent damage. 

Centrilobular emphysema refers to a specific type of emphysema that differs from other types due to the specific area of the alveoli that is damaged. Centrilobular emphysema can greatly impact your patient’s quality of life, including their ability to perform basic day-to-day tasks. 

Today, Carda is here to talk about centrilobular emphysema, including common causes, symptoms, and treatment options. Read on to learn more about supporting pulmonary recovery and wellness with Carda. 

What Is Centrilobular Emphysema?

Centrilobular emphysema is a chronic obstructive lung disease that occurs when there is damage to the center of the lungs. The term centrilobular refers to the secondary pulmonary lobules at the center of the lungs. 

Centrilobular emphysema contrasts with another type of emphysema called panlobular emphysema, in which the lung tissue incurs areas of damage simultaneously, and throughout the lungs as opposed to a localized affected area. 

With centrilobular emphysema, the damage begins localized, in the center areas of a patient’s lungs. However, as the disease progresses, the damage spreads to the respiratory passageways that carry air to and from the mouth and nose into the lungs (called the bronchioles). 

As the damage progresses from the alveoli to the bronchioles, your entire respiratory tract can incur damage, causing symptoms like shortness of breath, wheezing, and persistent coughing.

What Causes Centrilobular Emphysema?

The alveoli are where oxygen and carbon dioxide exchange occurs to sustain healthy, consistent breathing patterns. When the alveoli receive oxygen that you inhale, these tiny pulmonary air sacs stretch and expand to promote oxygen and carbon dioxide exchange. 

However, when the alveoli incur damage, they can lose their shape and “sag.” Often, external risk factors — such as sustained long-term exposure to irritants — can lead to alveoli damage. 

Long-term exposure to cigarette smoke is the most common external risk factor that causes centrilobular emphysema. The toxic chemicals that cigarettes contain not only cause damage to the air sacs, but can also cause overall lung irritation and inflammation, which weakens the lungs. 

Additionally, cigarette smoke can greatly narrow the bronchioles and can not just damage the air sacs, but can permanently destroy them.

In addition to cigarette smoke, long-term exposure to other toxic fumes, such as secondhand smoke, pollution, or charcoal dust, are other risk factors for centrilobular emphysema. 

What Are the Symptoms of Centrilobular Emphysema?

Damage to the alveoli can cause symptoms such as coughing, wheezing, and shortness of breath. These symptoms often lead to other symptoms, including chest tightness, excess mucus while coughing, and difficulty performing daily tasks. 

Let’s take a look at each of these symptoms more in-depth below. 

Chest Tightness

If a patient reports that they struggle to breathe, especially to take deeper breaths, then they are likely experiencing chest tightness. Chest tightness can also feel like heavy pressure, a squeezing sensation, or a pressing and constricting feeling in the chest. 

Inadequate oxygen exchange within a patient’s lungs can lead to shortness of breath, which can, in turn, lead to chest tightness. Wheezing can also often present hand-in-hand with chest tightness for patients with centrilobular emphysema.

Because centrilobular emphysema involves damage to the lung tissue, this chronic condition permanently changes the structure of the lungs, often narrowing or reducing the size of pulmonary tissue. The decreased size and altered structure can cause a patient to experience episodes where they feel like their chest constricts. 

Chest tightness may first present only after physical exertion, but as the condition worsens, it can also start to present when a patient is at rest. 

Excess Mucus While Coughing

Excess mucus while coughing is a common symptom of centrilobular emphysema. The damage to the air sacs prevents the healthy exchange of oxygen and carbon dioxide in and out of the lungs. 

The pulmonary tissue damage also prevents the lungs from properly filtering the particles out of the air that you inhale. As such, mucus builds up in the bronchioles and air sacs, further obstructing airflow to make breathing more difficult. 

The excess phlegm that builds up in the patient's air sacs and respiratory tract is often expelled while coughing and can worsen if the patient develops an infection. 

Difficulty Performing Daily Tasks

The airflow obstruction caused by centrilobular emphysema can make it difficult to breathe and perform daily tasks. Generally, as this disease is progressive, patients will start out struggling to perform tasks that involve more physical exertion, such as walking quickly or exercising. 

As the disease progresses, the patient experiences more and more difficulty with less physically demanding tasks and may eventually struggle with even simple tasks that require no mobility. Patients might experience difficulty breathing at rest while in a chair and might have a hard time walking to the bathroom or bedroom. 

What Are the Risk Factors for Centrilobular Emphysema?

Smoking, exposure to fumes, and lung damage are the primary risk factors for centrilobular emphysema. Let’s explore each of these risk factors below. 


Smoking is the primary risk factor for centrilobular emphysema. Smoking pipes or cigars can also be a risk factor, but neither poses as high a risk as cigarette smoking. 

The longer a patient smokes cigarettes, the higher their risk of developing this type of emphysema. 

Exposure to Fumes 

Exposure to strong fumes, such as secondhand smoke, air pollutants, or dust, is another risk factor for centrilobular emphysema. Long-term exposure to air pollutant fumes that result from burning fuel, as well as to car exhaust, charcoal dust, or fumes from crops such as grain or cotton, can additionally cause someone to develop this chronic lung disease. 

Lung Damage

Lung damage, including a collapsed lung or hole in the lung, is another less common risk factor for centrilobular emphysema. If there is a hole in the lung, the lung has less volume to expand with air, which can lead to shortness of breath and other complications. 

Additionally, lung bullae can also cause air to leak out of the lung and into the pleural space in the chest cavity, where the air then presses inward on the lung. This can cause a lung collapse, or pneumothorax, which can be life-threatening without immediate medical attention. 

How Can Centrilobular Emphysema Be Treated?

Unfortunately, there is no way to treat the disease because centrilobular emphysema is a chronic condition. However, it is possible to slow its progression in patients. 

The best treatment option for this pulmonary condition is to manage the symptoms effectively such that the disease progression timeline slows. 

Inhaled medicines are a common intervention to help manage symptoms because they can help a patient breathe better and experience less chest tightness. Albuterol inhalers can work well for short-term relief, whereas Salmeterol or Foradil may work better for longer-term relief. 

In addition to inhaled medications, other ways to manage the symptoms of centrilobular emphysema include: 

  • Oxygen support to help with difficulty breathing
  • Antibiotics in case of respiratory infection
  • A computed tomography (Ct) scan or an X-ray to track the damage

Cardiac Rehab for Treatment

A pulmonary and cardiac rehabilitation program is another treatment option to help relieve symptoms of centrilobular emphysema. Cardiac rehab can also help cultivate awareness and management practices in each patient to help them track their condition's progression. 

Rehabilitation works to improve a patient’s cardiovascular and pulmonary health through interventions like monitored exercise, dietary guidance, and education. The interventions help promote heart and lung health and even help boost overall wellness. 

If you are looking to refer your patients to life-saving outpatient care and rehab that can help relieve the symptoms of their subcutaneous emphysema, Carda is here to help. 

The Bottom Line

Centrilobular emphysema is a form of emphysema that involves damage to air sacs in the center area of the lungs. Damage can progress outwards to affect the bronchioles as well, and the disease can worsen over time. 

Cigarette smoking is the primary cause of centrilobular emphysema, but excess exposure to other toxic fumes, such as secondhand smoke, coal dust, or car fumes, can also cause this chronic lung condition. Additionally, a hole in the lungs is another risk factor for centrilobular emphysema. 

While there is no cure for this chronic lung condition, there are ways to manage symptoms and slow disease progression. Carda’s expert physiologists can help guide you in supporting your patient’s heart and pulmonary health. 


The Definition of Emphysema | Report of a National Heart, Lung, and Blood Institute, Division of Lung Diseases Workshop1 | American Review of Respiratory Disease 

Centrilobularzemphysema and panlobular emphysema: two different diseases | Thorax 

Centrilobular emphysema: CT-pathologic correlation. | Radiology 

Get Back On Your Feet With Carda Health

Refer a Patient

Help your patients — refer today.
Carda can help your patients recover from cardiopulmonary events, gain independence, and improve overall fitness. Our program is loved by thousands of patients and trusted by dozens of providers and health plans.
Refer a Patient

More Blog Posts

View All Posts