A destructive lung disease that is characterized by deterioration of the alveoli that helps in promoting exchange of oxygen between the air and the bloodstream is called emphysema.
Emphysema is a progressive disease of the lung. It is a long standing disease which results when the alveolar walls are destroyed with the capillary blood vessels within them. This decreases the total area in the lung limiting the potential for oxygen and carbon dioxide transfer.[/expand]Classification of Emphysema
• Panacinar: Lower half of the lung is affected. The damage occurs throughout the acinus.
Classification of emphysema depends upon the area of lung destruction involved:
• Centrilobular emphysema-This type of emphysema most predominantly affects the bronchioles of the respiratory system especially in the central portion of acini and hence involves the middle portion of the secondary lobules.
• Panlobular emphysema-This type of emphysema involves all the parts or components of the acinus but not in uniform style and hence it involves entire secondary lobules. This type is usually associated with deficiency of a very important enzyme protein called as alpha-1-protease inhibitor.
• Paraseptal emphysema-This type of emphysema involves the ducts of alveoli and sacs in the lungs periphery, and with the parts of destruction often posses a margin of interlobular septa.
• Occupational exposure to fumes or dust.
• Intravenous drug abuse
• Exposure to indoor and outdoor pollution.
• Infections like Pneumocystis carinii can cause inflammatory changes in the lung
• Rarely, emphysema is caused by an inherited deficiency of a protein, called Alpha-1 antitrypsin that protects the elastic structures in the lungs.
• Shortness of breath.
• Initially the shortness of breath occurs with activity but with time shortness of breath occurs even while at rest.
• Chronic Bronchitis
• Chest X-ray
• Computerized tomography (CT scan)
• Complete blood count
• Pulmonary function tests
• Oximetry test is done to measure the percentage of red blood cells that have oxygen.
• Drugs for smoking cessation.
• Corticosteroid drugs inhaled as aerosol sprays
Depending on the severity of emphysema, one of the following surgical procedures may be adopted, including:
• Lung volume reduction.
• Lung transplantation.
Patient is educated about:
• Proper breathing techniques
• Clearance of secretions
• Understanding medicines and devices
• Antioxidants are beneficial for lungs e.g. fresh fruits and vegetables.
• Avoid caffeine containing beverages.
• Avoid alcohol.
• Drink adequate water to maintain moisture in air passage.
• Apple is very beneficial in restoring lung function.
Emphysema affects quality of life. Aim of treatment is to prevent further damage to lung and to maximize function of healthy lung tissue.
It is a long term illness. Medicines improve the quality of life. But the condition gets worse if the patient doesn’t stop smoking.
• Need for breathing machine and oxygen therapy
• Irregular heartbeat
• Thinning of the bones (osteoporosis)
• Right-sided heart failure or cor pulmonale
• Severe weight loss and malnutrition
• Excessive dyspnoea must be supported in a sitting posture in bed.
• Great difficulty in expiration.
• Breathing rapid, short, heavy and anxious.
• Great rattling of mucus in bronchial tubes, particularly just below the larynx.
• Gasping for breath at the beginning of every coughing spell.
• Violent pains from chest to shoulder.
• Dyspnoea leads to suffocation, with great anxiety and restlessness.
• Tightness of chest as if bound by a hoop.
• Burning in chest.
• Face cyanotic and covered with cold perspiration.
• Bronchorrhoea with albuminoid expectoration.
• Short, hurried, anxious breathing, heavy and stertorous.
• Disturbed circulation.
• Dizziness, headache, palpitation of heart and fullness of abdomen.
• Aggravation from slightest exposure, cough from midnight till morning.
• Sleeps with head thrown back.
• Dry spasmodic cough of old people.
• Collection of mucus difficult to expectorate and giving only temporary relief.
• Nausea, dyspnoea with difficult expiration.
• Contraction of chest, with deep inhalations.
• Short inhalation and long, deep exhalation.
• Inclination to sigh or to get a very deep breath.
• Burning feeling in the chest, passing upward; dry tracheal and bronchial catarrh.
• Thorax fixed in inspiration, which lasts much longer than expiration.
• Respirations ten or twelve per minute.
• Attacks of dyspnoea with great oppression of chest, somewhat relieved by violent movements of the arms and upper body.
• Attacks of suffocation.
• Breathing anxious, oppressed.
• Short on walking fast.
• Better in open air.
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