Archive | October 2017


“Candy corn was invented in the 1817 and designed to mimic the appearance of a kernel of corn, but was made from wax, sugar, and corn syrup. The only problem? It really does just taste like wax, sugar, and corn syrup. Candy companies now sell their extra yearly inventory to Third World Countries, who use it to pave roads.”

USA Today



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TRICK                             or                                  TREAT

halloween picture         HALLOWEEN1A

The trick to enjoying your favorite Halloween treats? Moderation, according to the results of the National Confectioners Association’s (NCA) new national survey. As the holiday approaches, nearly 80 percent of parents report that they have a plan in place to help their children make smart decisions when it comes to the enjoyment of treats. More than three-quarters of Americans will hand out candy to trick-or-treaters this year and many others will participate in community-sponsored Halloween events, display a seasonal candy bowl or attend a Halloween party. NCA projects that retail sales of Halloween candy in 2015 will be $2.6 billion, a boost to the U.S. economy that helps support 55,000 manufacturing jobs and hundreds of thousands of jobs in related industries.

“People understand that candy is a treat, and this year’s survey tells us that they are celebrating Halloween in more ways than ever and practicing moderation,” said Alison Bodor, executive vice president of the National Confectioners Association. “Parents, including me, are embracing Halloween celebrations and traditions, but we’re also using the holiday as an opportunity to teach our children how to enjoy candy as a fun part of a balanced lifestyle.”

Bodor added that the U.S. confectionery industry supports 465,000 American jobs. “From our industry’s own manufacturers to the jobs we help support on the farms where our ingredients are grown and in the stores where our products are sold, candy makers are supporting good-paying jobs in this country. Confectioners are vital to the economic success of their communities – at Halloween and year round.”

According to NCA’s seasonal survey, more than 90 percent of parents discuss or plan to discuss balance and moderation with their children relative to their candy consumption, and while most report having these conversations year-round, many use the holiday as a starting point.

Those who stay home to hand out candy also recognize the importance of balance and moderation. More than 60 percent of respondents prefer to hand candy to trick-or-treaters, rather than having the ghosts and goblins help themselves, and nearly 60 percent of those surveyed believe that up to two pieces is just the right amount per household.

Halloween Is Meant For Sharing Halloween continues to be the top candy-giving holiday with 86 percent of people gifting or sharing chocolate or other candy. Seven in 10 people believe that holidays like Halloween are meant for enjoying candy, and that it is important to do so in moderation. Parents support the notion that sharing is a critical piece of the Halloween celebration – a full 80 percent report that they enjoy some of their children’s Halloween bounty by either sneaking it when the kids aren’t looking (23 percent) or by instituting a house rule that it must be shared (57 percent).

Candy Is Always A Treat NCA’s survey revealed that 81 percent of Americans support the notion that candy is a treat and 75 percent agree that it is okay to enjoy seasonal chocolate or candy. Almost 20 percent of consumers say they are more likely to buy seasonal candy in smaller portion sizes than they were five years ago.

Everyone Has A Favorite Americans love chocolate year-round, and Halloween is no exception. A full 70 percent of people say chocolate is their favorite Halloween treat, followed by candy corn (13 percent), chewy candy (6 percent) and gummy candy (5 percent). Despite chocolate’s popularity, most Americans (63 percent) say they stock their trick-or-treat candy bowls with a mix of chocolate and non-chocolate, so that they can be sure to have something everyone will like. When it comes to selecting candies in shapes like spiders, eyeballs and brains to inspire seasonal celebrations, parents are 24 percent more likely than non-parents to pick creepy candy over other Halloween themes.

Keeping An Eye On The Candy Stash Nearly four in five parents (79 percent) encourage moderation by keeping tabs on their children’s candy consumption following Halloween, but they take different approaches. Some limit their children to a certain number of pieces per day (35 percent), a total number of pieces overall (14 percent), or a general amount of calories (9 percent) and then take the rest away. Twenty-one percent opt to take responsibility for the candy and dole it out as appropriate. NCA supported research at Pennsylvania State University to help parents learn practices that promote balance and moderation with treats in their homes. As part of that research, a scientific literature review published recently in the Journal of Pediatric Obesity concluded that simply restricting or forbidding children from having snack foods or other treats, like candy, is not an effective approach to helping them learn how to consume these foods in moderation.


Something Good to Eat

  • Let kids enjoy a little bit of trick-or-treat loot at a time — say, two snack-sized candy bars a day.
  • Don’t allow candy to substitute for healthy stuff. Plan a healthy breakfast, lunch, and dinner for Halloween day. Serving well-balanced meals should ensure that sweets do not replace essential nutrients.
  • If you’re hosting a children’s party, serve plenty of fruit and vegetables as well as a kid-friendly meal like pizza. Set up one bucket of candy and let kids take just a few pieces.

Alternative Treats

A growing number of parents are bucking the candy-giving tradition altogether. The 2000 American Express Retail Index estimated that 18% of adults distributed non-candy treats. In some of these homes, children may have special dietary needs. Other parents are alarmed by reports about the increasing rate of child obesity, and some parents just hope to lessen the day’s sugar intake.

A recent study even showed that kids welcome such alternatives. Researchers offered trick-or-treaters in five Connecticut neighborhoods two bowls to choose from: one with lollipops or fruit candy and one with inexpensive Halloween-themed trinkets. About half the kids skipped the sweet stuff and took a toy instead. So consider making the switch at your house.

From the grocery:

  • sugar-free lollipops
  • fruit
  • raisins
  • granola bars
  • popcorn
  • trail mix

From the party-supply store (purchased in bulk, these items should cost about 20 cents each):

  • plastic vampire teeth
  • glow-in-the dark stickers
  • temporary tattoos
  • spider rings

More cool options:

  • crayons and stickers: Crayola makes special crayon packs that feature three Halloween-inspired colors. The cost of twenty packs plus twenty color-in stickers is about $3.99.
  • personalized photos. Start the unique tradition of becoming the neighborhood “phantom photographer.” Dig out your child’s i-Zone camera and give everyone who comes to the door a sticker picture of himself in costume. At approximately $18 per three-pack of film, you can expect to spend about 50 cents per trick-or-treater.

Acts of Sweetness

Halloween is a great time to teach children about sharing. This is a day when kids are inspired to be like Spider-Man or other heroic do-gooders. Encourage their charitable attitude by turning trick-or-treating into a save-the-world mission. In addition to candy, have your child ask for donations for a non-profit organization or school program.


happy-halloween2 happy-halloween happyhalloween4

“By keeping Halloween a fun, safe and happy holiday for you and your kids, you’ll look forward to many happy years of Halloween fun!”

Here are a few ways you can help prevent injuries on Halloween:

Have a Healthy Halloween

Have a Healthy Halloween

halloween-safety-tips   halloween-tips

  • Monitor costume accessories. Make sure swords, knives and other accessories are short, soft and flexible.
  • Avoid trick-or-treating alone. A trusted adult should accompany smaller children, and older children should travel in groups.
  • Remain visible. Trick-or-treating is an evening activity, and it can last until after dark. Fasten reflective tape to costumes and bags to increase visibility for drivers, and use flashlights to see and be seen.
  • Be cautious with glow sticks. Glow-in-the-dark sticks and accessories should only be used under adult supervision and should never be cut or broken open.
  • Examine treats. Parents should inspect all treats for tampering and/or choking hazards before allowing children to enjoy them.
  • Limit treats. Limit the amount of candy and treats your children eat. Too much candy at one time can cause an upset stomach.
  • Test and remove makeup. If makeup is going to be used as part of a costume, always test the makeup on a small area of skin first to ensure it does not cause irritation. Remove makeup at bedtime to prevent skin or eye irritation.
  • Avoid decorative contact lenses. Decorative contact lenses can cause serious eye injuries.
  • Obey traffic rules. Look both ways before crossing the street, and use crosswalks when available. Walk on the sidewalks, when possible; if there aren’t any sidewalks, walk along the far edge of the road facing traffic.
  • Ensure costumes and accessories fit properly. Masks, costumes and shoes should fit properly to avoid blocked vision, trips and falls.
  • Eat only factory-wrapped treats. Avoid homemade treats made by strangers.
  • Carefully choose which homes you visit. Only visit well-lit houses, and enter homes only if accompanied by a trusted adult.
  • Ensure costumes are flame-resistant. As a precaution, avoid walking near lit candles or luminaries while in costume.
  • Carry a cell phone in case of emergency.Following these simple safety tips will help keep your children safe—without any unplanned scares. St. David’s Round Rock Medical Center wishes everyone a fun and safe Halloween.
  • Parents should also supervise children while carving pumpkins. Be sure children use pumpkin carving kits—or knives specifically designed for carving—to avoid injury. Younger children can even use paint, markers or other decorations that do not have sharp edges.


Here’s one tip for halloween,  some of us have dogs that go with us trick or treating but don’t forget:

1.If you dress up your pet, make sure the costume lets them breathe and move. Speaking of eating, chocolate may be a favorite in your goodie bag, but it can be deadly to dogs and cats.

The darker the chocolate, the deadlier it is to your pet, according to Dr. Ron DeHaven with the American Veterinary Association.

2.Avoid costumes with small parts they might swallow.”

8 Halloween Tips regarding your oral and overall health.

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Have a Healthy Halloween

Have a Healthy Halloween

Halloween is right around the corner, which for most children means bags of free candy and a chance to build a stockpile of sweets for the winter. No surprise, Halloween can also present parents with a variety of health and safety challenges. “It’s OK to eat that candy on Halloween but it’s important to have a eating plan of the goodies to help protect the teeth from constant exposure to sugars to the teeth and even the waist line to prevent cavities and obesity. This makes complete common sense to mom and dad with older sisters or brothers and even role models to the little peeps who may need direction by you helping them eat the goodies in a moderate way with no pigging out on the candies.

Here’s a few ideas on how you can help your family stay mouth healthy on Halloween and even through out the year for lovers of sweet goodies; especially young ones who may need direction.


So how do we go about this? Well here are some ideas that you may find useful:


1.) Know when the time is right to eat the goodies.


Eat Halloween candy (and other sugary foods) with meals or shortly after mealtime. Saliva production increases during meals. This helps cancel out acids produced by bacteria in your mouth and rinse away food particles.


2.) Choose the candy carefully you give out Halloween or have at Halloween parties for kids with the candies you allow your kids to keep throughout the year.


Avoid hard candy and other sweets that stay in your mouth for a long time. Aside from how often you snack, the length of time sugary food is in your mouth plays a role in tooth decay. Unless it is a sugar-free product, candies that stay in the mouth for a long period of time subject teeth to an increased risk for tooth decay.


3.) Avoid candies that can put your teeth in sticky situations.


Sticky candies cling to your teeth. The stickier candies, like taffy and gummy bears, take longer to get washed away by saliva, increasing the risk for tooth decay.


4.) Have a plan that you put together.


It’s tempting to keep that candy around, but your teeth will thank you if you limit your candy laying out around the house after the Halloween day or parties. So what you do is have the family pick their favorites and even consider donating the rest, like to family and friends in a moderate amount to school teachers to even your doctors at a visit for the staff to even homeless. ”   If you even can take the time look for organizations that help you donate candy to troops overseas, like Operation Gratitude to boy/girl scout organizations, etc… Do a little researching.


5.) Drink more water when eating candy.


If you choose bottled water, look for kinds that are fluoridated. Drinking fluoridated water can help prevent tooth decay. The kids won’t even know the difference.


6.) Maintain a healthy diet.


Your body is like a complex machine. Just like cars we the human body needs its fuel. For us the fuel is food. The foods you choose as fuel are so important with how often you “fill up” with them which in the end affecting your general health; this includes your teeth and gums including obesity.At these Halloween parties or on Halloween day or in even everyday life avoid excess in sodas, sport drinks and flavored waters. When teeth come in frequent contact with beverages that contain sugar, the risk of tooth decay is increased.


7.) Give out on Halloween/the Halloween parties chewing gum that are with the ADA Seal.


Chewing sugarless gum for 20 minutes after meals helps reduce tooth decay, because increased saliva flow helps wash out food and neutralize the acid produced by bacteria. You might even want to think about giving sugarless gum out as a treat instead of candy.


8.) Other general ideas with the candy suggestions is have the children do the following:

Brush your teeth twice a day for two minutes with an ADA-accepted fluoride toothpaste. Remember, replace your toothbrush every three or four months, or sooner if the bristles are frayed. A worn toothbrush won’t do a good job of cleaning your teeth.

– Cleanse between the teeth. Floss your teeth once a day. Decay-causing bacteria get between teeth where toothbrush bristles can’t reach. Flossing helps remove plaque and food particles from between the teeth and under the gum line.

-Visit an ADA Dentist

Regular visits to your ADA-member dentist can help prevent problems from occurring and catch those that do occur early, when they are easy to “treat.” This can also can help prevent them going into bigger problems and more expensive treatments to the mouth.


“Don’t fill up on junk this Halloween. Treat yourself to yummy fruits and vegetables too. They make a great healthy snack to serve for Halloween parties with some sweets. It’s Halloween and the flu season is here! Keeping hands clean by washing them with soap and water is one of the best ways to prevent the spread of germs.”

CDC Center for Disease Control and Prevention

Halloween Safety


Treats: Warn children not to eat any treats before an adult has carefully examined them for evidence of tampering.

Flame Resistant Costumes: When purchasing a costume, masks, beards, and wigs, look for the label Flame Resistant. Although this label does not mean these items won’t catch fire, it does indicate the items will resist burning and should extinguish quickly once removed from the ignition source. To minimize the risk of contact with candles or other sources of ignition, avoid costumes made with flimsy materials and outfits with big, baggy sleeves or billowing skirts.

Costume Designs: Purchase or make costumes that are light and bright enough to be clearly visible to motorists.

For greater visibility during dusk and darkness, decorate or trim costumes with reflective tape that will glow in the beam of a car’s headlights.

Bags or sacks should also be light colored or decorated with reflective tape. Reflective tape is usually available in hardware, bicycle, and sporting goods stores.

To easily see and be seen, children should also carry flashlights.

Costumes should be short enough to prevent children from tripping and falling.

Children should wear well-fitting, sturdy shoes . Mother’ s high heels are not a good idea for safe walking.

Hats and scarfs should be tied securely to prevent them from slipping over children’s eyes.

Apply a natural mask of cosmetics rather than have a child wear a loose-fitting mask that might restrict breathing or obscure vision. If a mask is used, however, make sure it fits securely and has eyeholes large enough to allow full vision. Swords, knives, and similar costume accessories should be of soft and flexible material.

Pedestrian Safety: Young children should always be accompanied by an adult or an older, responsible child. All children should WALK, not run from house to house and use the sidewalk if available, rather than walk in the street.

Children should be cautioned against running out from between parked cars, or across lawns and yards where ornaments, furniture, or clotheslines present dangers.

Choosing Safe Houses: Children should go only to homes where the residents are known and have outside lights on as a sign of welcome.

Children should not enter homes or apartments unless they are accompanied by an adult.

People expecting trick-or-treaters should remove anything that could be an obstacle from lawns, steps and porches.

Candlelit jack-o’-lanterns should be kept away from landings and doorsteps where costumes could brush against the flame. Indoor jack-o’-lanterns should be kept away from curtains, decorations, and other furnishings that could be ignited.

Even though it’s not an official holiday, Halloween is much beloved by children and adults alike. What could be more fun than trick-or-treating, apple bobbing, or costume parties?

To make sure treats are safe for children, follow these simple steps:

Snacking: Children shouldn’t snack on treats from their goody bags while they’re out trick-or-treating. Give them a light meal or snack before they head out – don’t send them out on an empty stomach. Urge them to wait until they get home and let you inspect their loot before they eat any of it.


Safe treats: Tell children not to accept – and especially not to eat – anything that isn’t commercially wrapped. Inspect commercially wrapped treats for signs of tampering, such as an unusual appearance or discoloration, tiny pinholes, or tears in wrappers. Throw away anything that looks suspicious.


Food Allergies: If your child has a food allergy, check the label to ensure the allergen isn’t present. Do not allow the child to eat any home-baked goods he or she may have received.


   Choking hazards: If you have very young children, be sure to remove any choking hazards such as gum, peanuts, hard                  candies, or small toys.


Bobbing for apples is an all-time favorite Halloween game. Here are a couple of ways to say “boo” to bacteria that can cause foodborne illness. Reduce the number of bacteria that might be present on apples and other raw fruits and vegetables by thoroughly rinsing them under cool running water. As an added precaution, use a produce brush to remove surface dirt.


Try this new spin on apple bobbing from Cut out lots of apples from red construction paper. On each apple, write activities for kids, such as “do 5 jumping jacks.” Place a paper clip on each apple and put them in a large basket. Tie a magnet to a string. Let the children take turns “bobbing” with their magnet and doing the activity written on their apple. Give children a fresh apple for participating.


If your idea of Halloween fun is a party at home, don’t forget these tips:


  • Beware of spooky cider! Unpasteurized juice or cider can contain harmful bacteria such as Salmonella. To stay safe, always serve pasteurized products at your parties.
  • No matter how tempting, don’t taste raw cookie dough or cake batter that contain uncooked eggs.
  • “Scare” bacteria away by keeping all perishable foods chilled until serving time. These include finger sandwiches, cheese platters, fruit or tossed salads, cold pasta dishes with meat, poultry, or seafood, and cream pies or cakes with whipped-cream and cream-cheese frostings.

Bacteria will creep up on you if you let foods sit out too long. Don’t leave perishable goodies out of the fridge for more than two hours (1 hour in temperatures above 90°F).

Part I What actually is Chronic Obstructive Pulmonary Disease (COPD)?

COPD2  COPD3 Usually due to smoking

This is Healthy Lung Month covering COPD.  What is Chronic Obstructive Pulmonary Disease?

Chronic obstructive pulmonary disease (COPD) is a term that applies to patients with chronic bronchitis, bronchiectasis, emphysema and, to a certain extent, asthma. A brief review of normal functional anatomy will provide a background for the discussion of pathology.

The airway down to the bronchioles normally is lined with ciliated pseudo-stratified columnar cells and goblet cells. Mucus derives from mucus glands that are freely distributed in the walls of the trachea and bronchi. The cilia sweep mucus and minor debris toward the upper airway. Low humidity, anesthesia gases, cigarette smoking and other chemical irritants paralyze the action of these cilia. The mucociliary action starts again after a matter of time. This is why people awaken to “smokers cough.”

“Chronic obstructive pulmonary disease (COPD) is a term that applies to patients with chronic bronchitis, bronchiectasis, emphysema and, to a certain extent, asthma.”

Bronchi run in septal connective tissue, but bronchioles are suspended in lung parenchyma by alveolar elastic tissue. The elastic tissue extends throughout alveolar walls, air passages, and vessels, connecting them in a delicate web. Bronchiolar epithelium is ciliated, single-layered and columnar or cuboidal. Beyond the bronchioles the epithelium is flat and lined with a film of phospholipid (surfactant), which lowers surface tension and thereby helps to keep these air spaces from collapsing. Remember that the phospholipid develops during later gestation in utero. This is the reason why premature infant’s lungs cannot stay inflated without the addition of surfactant therapy. Macrophages are found in alveolar lining. Smooth muscles surround the walls of all bronchi, bronchioles, and alveolar ducts and when stimulated they shorten and narrow the passages. Cartilage lends rigidity and lies in regular horse-shaped rings in the tracheal wall. Cartilage is absent in bronchi less than 1 mm in diameter.

The terminal bronchiole is lined with columnar epithelium and is the last purely conducting airway. An acinus includes a terminal bronchiole and its distal structures. Five to ten acini together constitute a secondary lobule, which is generally 1 to 2 cm in diameter and is partly surrounded by grossly visible fibrous septa. Passages distal to the terminal bronchiole include an average of three but as many as nine generations of respiratory bronchioles lined with both columnar and alveolar epithelium. Each of the last respiratory bronchioles gives rise to about six alveolar ducts, each of these to one or two alveolar sacs, and finally each of the sacs to perhaps seventy-five alveoli. Alveolar pores (pores of Kohn) may connect alveoli in adjacent lobules.

Two different circulations supply the lungs. The pulmonary arteries and veins are involved in gas exchange. The pulmonary arteries branch with the bronchi, dividing into capillaries at the level of the respiratory bronchiole, and supplying these as well as the alveolar ducts and alveoli. In the periphery of the lung, the pulmonary veins lie in the interlobular septa rather than accompanying the arteries and airways. The bronchial arteries are small and arise mostly from the aorta. They accompany the bronchi to supply their walls. In some cases of COPD, like bronchiectasis, extensive anastomoses develop between the pulmonary and bronchial circulations. This can allow major shunting and recirculation of blood, therefore contributing to cardiac overload and failure. Lymphatics run chiefly in bronchial walls and as a fine network in the pleural membrane. The lumina of the capillaries in the alveolar walls are separated from the alveolar lining surfaces by the alveolar-capillary membrane, consisting of thin endothelial and epithelial cells and a minute but expansile interstitial space. This interface between air and blood, only 2 microns in thickness, is the only place where gases may be exchanged effectively.

Disease Specific Review


Chronic Bronchitis

Chronic bronchitis is a clinical disorder characterized by excessive mucus secretion in the bronchi. It was traditionally defined by chronic or recurrent productive cough lasting for a minimum of three months per year and for at least two consecutive years, in which all other causes for the cough have been eliminated. Today’s definition remains more simplistic to include a productive cough progressing over a period of time and lasting longer and longer. Sometimes, chronic bronchitis is broken down into three types: simple, mucopurulent or obstructive. The pathologic changes consist of inflammation, primarily mononuclear, infiltrate in the bronchial wall, hypertrophy and hyperplasia of the mucus-secreting bronchial glands and mucosal goblet cells, metaplasia of bronchial and bronchiolar epithelium, and loss of cilia. Eventually, there may be distortion and scarring of the bronchial wall.


Asthma is a disease characterized by increased responsiveness of the trachea and bronchi to various stimuli (intrinsic or extrinsic), causing difficulty in breathing due to narrowing airways. The narrowing is dynamic and changes in degree. It occurs either spontaneously or because of therapy. The basic defect appears to be an altered state of the host, which periodically produces a hyperirritable contraction of smooth muscle and hypersecretion of bronchial mucus. This mucus is abnormally sticky and therefore obstructive. In some instances, the illness seems related to an altered immunologic state.

Histological changes of asthma include an increase in the size and number of the mucosal goblet cells and submucosal mucus glands. There is marked thickening of the bronchial basement membrane and hypertrophy of bronchial and bronchiolar smooth muscle tissue. A submucosal infiltration of mononuclear inflammatory cells, eosinophils and plugs of mucus blocks small airways. Patients who have had asthma for many years may develop cor pulmonale and emphysema.


Pulmonary emphysema is described in clinical, radiological and physiologic terms, but the condition is best defined morphologically. It is an enlargement of the air spaces distal to the terminal non-respiratory bronchiole, with destruction of alveolar walls.

Although the normal lung has about 35,000 terminal bronchioles and their total internal cross-sectional area is at least 40 times as great as that of the lobar bronchi, the bronchioles are more delicate and vulnerable. Bronchioles may be obstructed partially or completely, temporarily or permanently, by thickening of their walls, by collapse due to loss of elasticity of the surrounding parenchyma, or by influx of exudate. In advanced emphysema, the lungs are large, pale, and relatively bloodless. They do not readily collapse. They many contain many superficial blebs or bullae, which occasionally are huge. The right ventricle of the heart is often enlarged (cor pulmonale), reflecting pulmonary arterial hypertension. Right ventricular enlargement is found in about 40% of autopsies of patients with severe emphysema. The distal air spaces are distended and disrupted, thus excessively confluent and reduced in number. There may be marked decrease in the number and size of the smaller vascular channels. The decrease in alveolar-capillary membrane surface area may be critical. Death may result from infection that obliterates the small bronchi and bronchioles. There is often organized pneumonia or scarring of the lung parenchyma due to previous infections.

Classification of emphysema relies on descriptive morphology, requiring the study of inflated lungs. The two principal types are centrilobular and panlobular emphysema. The two types may coexist in the same lung or lobe.

Centrilobular emphysema (CLE) or centriacinar emphysema affects respiratory bronchioles selectively. Fenestrations develop in the walls, enlarge, become confluent, and tend to form a single space as the walls disintegrate. There is often bronchiolitis with narrowing of lumina. The more distal parenchyma (alveolar ducts and sacs and alveoli) is initially preserved, then similarly destroyed as fenestrations develop and progress.

The disease commonly affects the upper portions of the lung more severely, but it tends to be unevenly distributed. The walls of the emphysematous spaces may be deeply pigmented. This discoloration may represent failure of clearance mechanisms to remove dust particles, or perhaps the pigment plays an active role in lung destruction. CLE is much more prevalent in males than in females. It is usually associated with chronic bronchitis and is seldom found in nonsmokers.

Panlobular emphysema (PLE) or panacinar emphysema is a nearly uniform enlargement and destruction of the alveoli in the pulmonary acinus. As the disease progresses, there is gradual loss of all components of the acinus until only a few strands of tissue, which are usually blood vessels, remain. PLE is usually diffuse, but is more severe in the lower lung areas. It is often found to some degree in older people, who do not have chronic bronchitis or clinical impairment of lung function. The term senile emphysema was formerly applied to this condition. PLE occurs as commonly in women and men, but is less frequent than CLE. It is a characteristic finding in those with homozygous deficiency of serum alpha-1 antitrypsin. It has also been found that certain populations of IV Ritalin abusers show PLE.

Bullae are common in both CLE and PLE, but may exist in the absence of either. Air-filled spaces in the visceral pleura are commonly termed blebs, and those in the parenchyma greater than 1 cm in diameter are called bullae. A valve mechanism in the bronchial communication of a bulla permits air trapping and enlargement of the air space. This scenario may compress the surrounding normal lung. Blebs may rupture into the pleural cavity causing a pneumothorax, and through a valve mechanism in the bronchopleural fistula a tension pneumothorax may develop.

Paracicatricial emphysema occurring adjacent to pulmonary scars represents another type of localized emphysema. When the air spaces distal to terminal bronchioles are increased beyond the normal size but do not show destructive changes of the alveolar walls, the condition is called pulmonary overinflation. This condition may be obstructive, because of air trapping beyond an incomplete bronchial obstruction due to a foreign body or a neoplasm. Many lung lobules may be simultaneously affected as a result of many check-valve obstructions, as in bronchial asthma. Pulmonary overinflation may also be nonobstructive, less properly called “compensatory emphysema”, when associated with atelectasis or resection of other areas of the lung.


Bronchiectasis means irreversible dilation and distortion of the bronchi and bronchioles. Saccular bronchiectasis is the classic advanced form characterized by irregular dilatations and narrowing. The term cystic is used when the dilatations are especially large and numerous. Cystic bronchiectasis can be further classified as fusiform or varicose.

Tubular bronchiectasis is simply the absence of normal bronchial tapering and is usually a manifestation of severe chronic bronchitis rather than of true bronchial wall destruction.

Repeated or prolonged episodes of pneumonitis, inhaled foreign objects or neoplasms have been known to cause bronchiectasis. When the bronchiectatic process involves most or all of the bronchial tree, whether in one or both lungs, it is believed to be genetic or developmental in origin.

Mucoviscidosis, Kartagener’s syndrome (bronchiectasis with dextrocardia and paranasal sinusitis), and agammaglobulinemia are all examples of inherited or developmental diseases associated with bronchiectasis. The term pseudobronchiectasis is applied to cylindrical bronchial widening, which may complicate a pneumonitis but which disappears after a few months. Bronchiectasis is true saccular bronchiectasis but without cough or expectoration. It is located especially in the upper lobes where good dependent drainage is available. A proximal form of bronchiectasis (with normal distal airways) complicates aspergillus mucus plugging.

Advanced bronchiectasis is often accompanied by anastomoses between the bronchial and pulmonary vessels. These cause right-to-left shunts, with resulting hypoxemia, pulmonary hypertension and cor pulmonale.

Keeping a healthy lung prevents emphysema.  So for starters don’t smoke and exercise; which includes don’t be exposed to smoke frequently!