emphysema

2. DEFINITION
Emphysema ( From greek word for
‘inhalation’)is a lung disease that involves
damage to the air sacs (alveoli)in the lungs.
Emphysema is a long- term ,progressive
disease if the lungs causes shortness of
breath due to over-inflation of the alveoli
(air sacs in the lungs).

5. Causes & risk factors
Emphysema develops due to:
 Smoking cigarettes
 Inhaling toxins or other irritants
 Alpha1-antitrypsin deficiency
(A1AD)—a genetic defect which can
cause emphysema t an early stage in
non smokers.

6. These factors increase the chance of developing
emphysema:
 Smoking cigarettes & long term second hand
or passive smoke exposure.
 Family members with emphysema
 Exposure to pollutants at work
(chemicals,fumes or dust)
 Exposure to indoor and outdoor pollution
 Frequent lower respiratory tract infections

7. History of frequent childhood
lung infections
Connective tissue
disorders(ehlers-danlos
syndrome,marfan syndrome)
HIV infection

15. Types of emphysema
The 4 described morphological
types of emphysema are :
1. Centri acinar emphysema
2. Panacinar emphysema
3. Paraseptal emphysema
4. Irregular emphysema

16. 1. Centriacinar
 Centri acinar emphysema begins in the
respiratory bronchiole and spreads to
peripherally.
 Also termed centrilobular emphysema, this
form is associated with long standing
cigarette smoking predominantly involves
destruction of bronchioles in the upper lobe
of lungs but the alveolar sac remain in
contact.

17. Centri acinar

18. 2. panacinar
 In panacinar or panlobular emphysem there is a
destruction of the respiratory bronchioles,
alveolar duct & alveoli in the lower half of the
lungs.
 Panacinar emphysema is generally is observed in
patients with homozygous alpha1-
antitrypsin(AAT) deficiency.
 In people who spoke , focal panacinar
emphysemaat the lung bases may accompany
centriacinar emphysema.

19. panacinar

20. 3. Paraseptal emphysema
 Paraseptal emphysema,also known as distal
acinar emphysema, preferentially involves
the distal airways structures ,alveolar
ducts,and alveolar sacs .
 The process is localized around the septea
of the lungs or pleura.
 Although the airflow frequently is preserved
,the apical bullae may lead to spontaneous
pneumothorax.
 Giant bullae occassionally cause severe
compression of adjacent lung tissue.

21. Distal acinar emphysema

22. 4. Irregular emphysema
Irregular emphysema refers to
the any part of the bronchiole
or alveoli or ducts of alveoli .

23. Irregular emphysema

25. pathophysiology
Due to etiological factors
Inherited α-1 anti-trypsin
deficiency
Inflammation of airway
epithelium
Neutrophils&macrophages
release elastage
Infiltration of inflammatory cells
& release of cytokines
Α-1 anti-trypsin deficiency
leads to failure of elastage
inactivation
Increased protease activity with breakdown of elastin in
connective tissue of lungs

26. Loss of elastic recoil of bronchial wall from breakdown of elastin
by the elastage
lungs become damaged because of reaction of irritants entering
airways & alveoli
Irreversible enlargement of the air spaces distal to the terminal
bronchioles
Collapse of terminal bronchioles causing airway obstruction

27. Desctruction of alveolar walls,reduces lung surface available for
gas exchange
Loss of fibrous &muscle tone
breakdown of alveolar
elasticity
Inability of the lungs to supply
sufficient air supply to body
Impaired oxygen diffusion
causes hypoxemia.
inability of alveoli recoil
normally after expanding
Bronchial collapse. amount of
air that can be expired is
diminished
Air trapped in lung causes
over distention of lungs

28. Cinical manifestations
Emphysema usually slowly. Emphysema symptoms
are mild to begin with but steadily get worse
as the disease progresses.
Early symptoms include:
 Coughing in the morning
 Coughing up clear sputum (mucus from deep in
the lungs)
 Wheezing
 Shortness of breath during activity
 Decreased excercise tolerance

29. As the disease progresses ,patient may experience:
 Increased shortness of breath
 Rapid breathing
 Choking sensation when lying flat
 Bluish lip and complexion(cyanosis) due to lack of
oxygen in the blood
 Fatigue
 Increase in chest size(barrel chest)
 Coughing up thick & bloody mucus
 Swelling in the ankles &legs
 Loss of appetite & reduced weight
 Desired to lean forward to improve breathing
 Heart failure

30. Diagnostic evaluations
 Health history & physical examination
 Spirometry & other pulmonary function tests
 Chest x-ray &/ or CT of the chest
 ABG analysis
 CBC
 Pulse oximetry
 Sputum examination
 Pulmonary ventilation/perfusion scans
 Testing for alpha-1 antitrypsin deficiency(AAT
deficiency)

31. management
1.Medical management
2.Surgical management
3.Nursing management

32. Medical management
Treatment for emphysema can take many forms.
Different approaches to treatment are
available.
 Smoking cessation is the most important &
effective treatment.
 Only quitting smoking can stop the progession
of lung damage once it has started .

33. Medications used to improve brathing include:
 Bronchodilators: salmetrol, powder inhaler
devices, nebulizer, ipratropium bromide,
albuterol, theophylline, formetrol
 Diuretics
 Corticosteroids
 Antiboitics
 Steroids: corticosteriods, aerosal sprays
vaccines against flu & pneumonia are
recommended for people with emphysema.

34.  Deep breathing & coughing excercises
 Chest percussion
 Postural drainage
 Breathing techniques

35. Surgical management
LUNG REDUCTION SURGERY:
In an experimental procedure called (LVRS),
surgeon remove small wedges of damaged lung
tissue . Removing the diseased tissue helps
the lungs work more efficiently & helps improve
breathing . Lung reduction may eliminate the
need for supplemental oxygen & makes it much
easier for the person to breath.

36. In an another surgery ,called
bullectomy, doctors remove one or
more of the large air spaces called
bullae that form when the small air
sacs are destroyed . This is procedure
can improve breathing.
BULLECTOMY

37. Lung transplantation
Lung transplant surgery is another treatment
that may small number of emphysema suffers.
A lung transpkant is a complex procedure that
carries substantial risk of complications. This
type of surgery is performed only at major
hospitals & medical centers.

38. Pulmonary rehabilitation
pulmonary rehabilitation is probably the most
effective therapy for COPD patients with
emphysema . It improves quality of life and
decreases hospitalization .
Pulmonary rehabilitation includes education ,
nutrition, counselling, learning special breathing
techniques, help with quitting smoking and starting
an exercise regimen. Because people with
emphysema are often physically limited , they may
avoid any kind of physical activity .

39. Nursing management
 Assess for signs & symptoms of hypoxia and
hypercapnia.
 Auscultation chest to listen to breath sounds
every hour .
 Increase or decrease in PaO2 PaCO2.
 Encourage the patient to stop smoking and
avoid air pollution including second hand
cigarette smoke.
 Drink plenty of water
 Adequate nutritional intake