The patient has both a chronic and an acute process. Slides 3.1 and 3.2 demonstrates the gross and microscopic appearance of the chronic process. Slides 3.3 to 3.6 show gross and microscopic findings with the acute process. Describe both processes. The result is the appearance of clubbed septa.
Smokers have a greater number of neutrophils and macrophages in their alveoli.
Smoking irritates alveolar macrophages, which in turn release neutrophil chemotactic factors, such as interleukin 8, thus recruiting neutrophils. Proteases, particularly elastase, are secreted by these neutrophils and macrophages. Proteases are enzymes that are capable of digesting lung tissue and these chemicals are responsible for the damage seen in emphysema. Oxidants and free radicals in smoke also inhibit the alpha-1 antitrypsin circulating in the lung that protects alveoli from proteases. Chronic irritation by smoke also can lead to chronic bronchitis with excess production of mucus.