Emphysema

By:Emmanuel Ryan P. Francisco

I. Definition:

 Is a pathologic term that describes an abnormal distention of the airspaces

beyond the terminal bronchioles and destruction of the walls of alveoli

 Causes impaired oxygen and carbon dioxide exchange results from

destruction of the walls of overdistended alveoli.

 An emphysema related condition is Chronic Obstructive Pulmonary

Disease (also known as COPD),
II. Types of Emphysema

o Panlobular Emphysema

 there is destruction of the respiratory bronchiole,alveolar duct, and

alveolus.

 destroys the entire alveolus uniformly

o Centrilobular Emphysema

 pathologic changes take place mainly in the center of the secondary

lobule, preserving the peripheral portions of the acinus.

 begins in the respiratory bronchioles and spreads peripherally

III.Risk Factors

 Environmental exposures:

o Cigarette Smoking

o Smoking pipes

o Other types of tobacco

o Passive smoking

o Prolonged and intense exposure to occupational dust and chemicals

 Genetic Factor

o Deficiency in alpha-antitrypsin- an enzyme inhibitor that protects the

lung parenchyma from injury

 Age.

o Although the lung damage that occurs in emphysema

develops gradually over time, most people with tobacco-
related emphysema begin to experience symptoms of the
disease between the ages of 50 and 60.
IV. Clinical Manifestation
  Three primary symptoms:

o Chronic cough

o Sputum production

o Dypnea

 Other signs and symptoms of emphysema include:

o Mild cough or chronic cough. You may produce mucus or

phlegm when you cough hard.
o Loss of appetite and weight loss. It's a vicious cycle.
Emphysema can make eating more difficult, and the act of
eating can rob you of your breath. The result is that you
simply may not feel like eating much of the time.
o Fatigue. You're likely to feel tired both because it's more
difficult to breathe and because your body is getting less
oxygen than it needs.

V. Assessment and Diagnostic Findings

 Chest Xray. You're likely to have a chest X-ray to help rule out
other lung problems rather than to diagnose emphysema — even in
the advanced stages of emphysema disease, chest X-rays are often
normal.
 Arterial blood gases (ABG) analysis. These blood tests measure
how well your lungs transfer oxygen to your bloodstream and how
effectively they remove carbon dioxide.
 Sputum examination. Analysis of cells in sputum can help
determine the cause of some lung problems.
 Computerized tomography (CT) scan. A CT scan allows your
doctor to see your organs in 2-dimensional images or "slices."
Split-second computer processing creates these images as a series
of very thin xray beams are passed thru your body. A Cat scan can
detect emphysema sooner than an xray can, but it can't assess the
severity of emphysema as accurately as a pulmonary function test.

VI. Treatment

The most essential step in any treatment plan for smokers with emphysema is
to stop smoking immediately; it's the only way to stop the damage to your lungs
from becoming progressively worse over time. But quitting smoking is rarely
easy, and people often need the help of a comprehensive smoking cessation
plan, which may include:

• A target date to quit

• Relapse prevention
• Advice for healthy lifestyle changes
• Social support systems
 • Nicotine gum, tablets or patches and sometimes use of the antidepressant
bupropion hydrochloride (Zyban) to help curb the irritability, depression and
sleep problems that can occur in the first few weeks after quitting smoking

Pharmacologic Therapy:

 Bronchodilators. These drugs can help relieve coughing, shortness of

breath and trouble breathing by opening constricted airways, but they're not
as effective in treating emphysema as they are in treating asthma.
 Inhaled steroids. Corticosteroid drugs inhaled as aerosol sprays may
relieve symptoms of emphysema associated with asthma and bronchitis.
Although inhaled steroids have fewer side effects than oral steroids do,

Other Treatment:

 Supplemental oxygen. If you have severe emphysema with low blood

oxygen levels, using oxygen at home may provide some relief.
 Protein therapy. Infusions of AAt may help slow lung damage in people
with an inherited deficiency of the protein.
 Antibiotics. Respiratory infections such as acute bronchitis, pneumonia and
influenza are a leading complication of emphysema, increasing the amount of
sputum you produce and making breathing problems worse. Broad-spectrum
antibiotics may help relieve these symptoms, but should be used with caution
to avoid the serious and growing problem of antibiotic-resistant bacteria.
 Surgery. In a procedure called lung volume reduction surgery (LVRS),
surgeons remove small wedges of damaged lung tissue. Although it seems
counter-intuitive to treat diminished lung capacity by further reducing the
size of the lungs, the extra space that's created in the chest cavity appears
to help the remaining lung tissue and diaphragm work more efficiently

VII. Prevention

• Stop smoking
• Avoid other respiratory irritants
• Clear your airways
• Avoid respiratory infections