While lecturing on COPD, the instructor mentions emphysema. The instructor asks the students, “If the client is a smoker, explain the physiology behind cellular changes occurring in the lung which allow destruction of the alveoli.” Which students have an accurate response? Select all that apply.

A) "Antiprotease production and release is not adequate to neutralize the excess protease production."
B) "The capillary beds can no longer bring the cells to the lung to fight off the infection since they are blocked by fatty plaque."
C) "There is ?1-antitrypsin deficiency, so this enzyme can't protect the lung from damage."
D) "The alveolar tissue is being digested by enzymes; therefore, they can't grow back to restore normal ventilation."

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Answer: A, C

A) "Antiprotease production and release is not adequate to neutralize the excess protease production."

C) "There is ?1-antitrypsin deficiency, so this enzyme can't protect the lung from damage."

Feedback: Emphysema is characterized by a loss of lung elasticity and abnormal enlargement of the air spaces distal to the terminal bronchioles, with destruction of the alveolar walls. One of the recognized causes of emphysema is an inherited deficiency of ?1-antitrypsin, an antiprotease enzyme that protects the lung from injury. Cigarette smoke stimulates the movement of inflammatory cells into the lungs, resulting in increased release of elastase and other proteases. In smokers in whom COPD develops, antiprotease production and release may be inadequate to neutralize the excess protease production such that the process of elastic tissue destruction goes unchecked.