Smoking is primarily associated with which pattern of emphysema?

• A. Panlobar
• B. Centrilobar
• C. Paraseptal
• D. Ineffective

Answer: (B)

The association of smoking with centrilobar emphysema is well-documented and rooted in the pathophysiological changes that occur in the lungs as a response to the harmful substances found in tobacco smoke. Centrilobar emphysema, also known as centriacinar emphysema, predominantly affects the respiratory bronchioles located in the central region of the secondary pulmonary lobule.

In the context of smoking, the inhaled particles and gases lead to inflammation and damage specifically in these central airways, which results in the destruction of alveolar walls surrounding the bronchioles. This pattern is characterized by the loss of elastic recoil and airflow limitation, which are classic features of emphysema.

While other forms of emphysema do exist, such as panlobar (which may involve the entire acinus) and paraseptal (which tends to occur at the lung periphery and is less directly linked to smoking), centrilobar emphysema is particularly noted for its strong connection to heavy cigarette smoking. This makes the choice of centrilobar emphysema the most accurate representation of emphysema patterns primarily associated with smoking.