EMPHYSEMA(chronic obstructive pulmonary disease)

DEFINITION or ETIOLOGY•It is included in a group of diseases called chronic obstructive pulmonary disease or COPD (pulmonary refers to the lungs). Emphysema is called an obstructive lung disease because airflow on exhalation is slowed or stopped because over-inflated alveoli do not exchange gases when a person breaths due to little or no movement of gases out of the alveoli.•It is a long-term, progressive disease of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli (air sacs in the lung).

Emphysema classified according to site of damage

•Centri-acinar emphysema

Distension and damage of lung tissue is concentrated around the respiratory bronchioles, whilst the more distal alveolar ducts and alveoli tend to be well preserved. This form of emphysema is extremely common; when of modest extent, it is not necessarily associated with disability.

•Pan-acinar emphysema This is less common distension and destruction appear to involve the whole of the acinus and in the extreme form the lung becomes a mass of bullae. Severe airflow limitation and VA/Q mismatch occur.

•Irregular emphysema

There is scarring and damage affecting the lung parenchyma patchily without particular regard for acinar structure.

CAUSES• Cigarette smoking is by far the most dangerous behavior that

causes people to develop emphysema, and it is also the most preventable cause.

• Air pollution acts in a similar manner to cigarette smoke. The pollutants cause inflammation in the airways, leading to lung tissue destruction. 

• Close relatives of people with emphysema are more likely to develop the disease themselves.  

• Abnormal airway reactivity, such as bronchial asthma, has been shown to be a risk factor for the development of emphysema.

• Men are more likely to develop emphysema than women. The exact reason for this is unknown, but differences between male and female hormones are suspected. 

• Older age is a risk factor for emphysema. Lung function normally declines with age.

SYMPTOMS

•productive cough or acute chest illness-cough usually is worse in the morning and produces small amounts of colorless sputum

•Breathlessness

•Wheezing may occur in some patients, particularly during exertion and exacerbations

SIGNS

•Cyanosis•Wheeze•tachypnea•Hyperinflation•cricosternal distance <3cm•reduce chest expansion•resonant or hyper-resonant percussion•quite breath sounds

Medical Treatment

•Stop smoking

•Bronchodilating medications

•Steroid medications

•Antibiotics

•Oxygen

PREVENTION

For individuals that have emphysema caused by other causes such as air pollution, avoiding the pollution is the best first step toward prevention.

Flare-ups of emphysema can be reduced or prevented by taking medications as prescribed and seeking medical care for any signs or symptoms of respiratory infection or shortness of breath. Also, if you have emphysema, you should keep current on vaccines that can prevent respiratory infection. It is important to obtain the pneumococcal vaccine every 5 years and the influenza virus vaccine every year, before flu season.

SCREENING PREVENTION

•OximetryOxygenated blood is a brighter red and becomes purpler in color when oxygen is removed. The oximeter is a device usually placed on a finger and detects the pulse of blood. A light is transmitted through the tissue, and the amount of the brighter red color is determined, enabling a measure of oxygen saturation, a measure of hemoglobin oxygen content. This value is usually greater than 90%.

•Blood TestsAn arterial blood gas test will measure the amount of oxygen and carbon dioxide in the blood and combined with other measurements can help the healthcare provider decide whether the body has been able to adapt to the lower oxygen concentrations in the body. In some laboratories, the arterial blood gas result will include a carbon monoxide percentage, most often found in the body because of smoking. For each hemoglobin molecule that has carbon monoxide attached, there is one less that can carry oxygen.

•Radiology

A plain chest x-ray may show lungs that have become too inflated and too lucent, signs that lung tissue destruction has occurred.

•Pulmonary Function Tests

A variety of lung functions can be measured and may include how much air the lungs can hold and empty with each breath, the degree of airflow obstruction, the available surface for exchange of carbon dioxide and oxygen, the amount of trapped gases, and how elastic the lungs are with inspiration and expiration. By comparing results to a "normal" person of the same age, sex and size, estimations can be made as to the severity of the emphysema.

•Oximetry

•Blood Tests

•Radiology

•Pulmonary Function Tests

PROGRAM OF PREVENTION

•Oxygen Therapy Program

It has the ability to cleanse the inner lining of the lungs and restore the ability to breathe.

•Yoga-Based Program

Stretching and Breathing Suggestions for Maintenance of Lung Function

•Home Respiratory Rehabilitation Program