Emphysema

Geelyn Marie A. Luzon BSPT III-I

Definition Emphysema is defined anatomically as abnormal, permanent enlargement of alveoli and alveolar ducts, with destruction of alveolar walls and breakdown of connective tissue support of lower airways.

Etiology *Downward progression of inflammatory damage with repeated episodes of chronic bronchitis. *Cigarette smoking *AAT (α-antitrypsin) deficiency

Epidemiology *Up to 2.5 million Americans suffer from emphysema. *Cigarette smoking and air pollution are major risk factors for emphysema. *Aging *An estimated 2% of cases of emphysema are caused by (α-antitrypsin) AAT deficiency

Pathophysiology of Emphysema By: Alyssa Paula L. Tomas BSPT III-I

Normal

Emphysemic lung

Smoking Particle deposition in airways

Decreased alpha1 – antitrypsin production

Low level inflammatory response Phagocytosis by neutrophils Release of elastase Elastase degrades elastic tissue in septa

Classification of Emphysema • Centriacinar or Centrilobular - is due to destruction of terminal bronchioli muchosis, due to chronic bronchitis. This is found mostly in elderly people with a long history of smoking or extreme cases of passive smoking.

Centriacinar or Centrilobular

Classification of Emphysema • Panacinar Emphysema • is related to the destruction of alveoli, because of an inflammation or deficiency of alpha 1-antitrypsin. It is found more in young adults who do not have chronic bronchitis.

Panacinar Emphysema

Leo Marlon M. Gamundoy Jr. M.D.

Symptoms Shortness of breath (dyspnea)

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Cough

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DOE

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Exacerbation

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Cyanosis

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Edema

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Fatigue

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Headaches

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Weight loss

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Signs Barrel chest

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Crackles and wheezes

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Vibration of the chest (Fremitus)

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Pursed Lip Breathing

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Patients also may have a tendency to

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lean forward

Anxiety

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depression

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sleep disturbances

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Complications Cor pulmonale

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Heart failure

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Pneumonia and other lung infections

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Pneumothorax

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Polycythemia

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Respiratory failure

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DIFFERENTIAL DIAGNOSIS

Disease - abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of the walls and without obvious fibrosis.

Cause Bronchioles collapse, and air becomes trapped in the air sacs, which overstretches them and interferes with your ability to exhale (hyperinflation).

Manifestation Chronic cough. Loss of appetite and weight loss. Fatigue.

Disease Cause - uncommon disease Abnormal dilation of that results in the abnormal and permanent distortion of one or more of the conducting bronchi or airways, most oft en secondary to an infectious process.

Manifestation

•Dyspnea the proximal and •Pleuritic chest pain medium-sized bronchi •Wheezing (>2 mm in diameter) •Fever caused by weakening •Weakness or destruction of the •Weight loss muscular and elastic components of the bronchial walls.

Disease

Cause

Caused most often by exposure to airborne pollutants such as cigarette smoke, excessive dust in the air, or chemicals. The bronchial lining becomes inflamed and the constant exposure to such pollutants begins to cause damage in the phlegm is coughed up. bronchioles (the smaller

Bronchitis is the inflammation of the lining of the bronchial tubes. When the bronchi are inflamed and/or infected, less air is able to flow to and from the lungs and a heavy mucus or

airways in the lungs).

Manifestation Persistent cough Productive cough Sputum cough

Disease - occurs when the airways in your lungs (bronchial tubes) become inflamed and constricted. The muscles of the bronchial walls tighten, and your airways produce extra mucus that blocks your airways.

Cause

Manifestation

Exposure to various allergens and irritants

Shortness of breath Chest tightness or pain Trouble sleeping An audible whistling or wheezing sound when exhaling Bouts of coughing or wheezing

Disease

Cause

Manifestation

Disease of uncontrolled cell growth in tissues of the lung. This growth may lead to metastasis, which is invasion of adjacent tissue and infiltration beyond the lungs.

Cigarette smoking is the leading cause of lung cancer.

Cough that doesn't go away Coughing up blood Shortness of breath Wheezing Chest pain Loss of appetite Losing weight without trying Fatigue Weakness Swallowing difficulty Nail problems Joint pain Hoarseness or changing voice Swelling of the face Facial paralysis Eyelid drooping Bone pain or tenderness

Secondhand smoke (breathing the smoke of others) increases your risk

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of lung cancer

PT Management

Patient education includes: proper breathing techniques, clearance of secretions, understanding their medications and devices, the ability to travel, efficient body mechanics, and networking with other lung patients

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This is the most important measure you can take for your overall health and the only one that can halt the progression of emphysema. Join a smoking cessation program if you need help giving up smoking. As much as possible, avoid secondhand smoke. Sit in nonsmoking areas when you're out, and ask family and friends not to smoke in your home.

Bronchodilators Bronchodilators are used to relax the smooth muscles that surround the bronchioles and allow the breathing tubes to dilate and allow more air flow.

Oxygen As the disease progresses, patients may require supplemental oxygen to be able to function. Often it begins with nighttime use, then with exercise, and as the disease worsens, the need to use oxygen during the day for routine activities increases.

(+) hypoxia 

Long term oxygen therapy will improve survival and quality of life.

Pursed-lip breathing

Try the diaphragmatic breathing exercises with your lips pursed as you exhale, that is, with your lips puckered — the flow of air should make a soft "sssss" sound. Inhale deeply through your nose or your mouth, whichever is more comfortable for you, and then exhale. Repeat 10 times at each session. Breathing out against pursed lips increases the air pressure inside the airways, including your very small airways, which minimizes how much they collapse.

Deep-breathing exercise While sitting or standing, pull your elbows firmly backward as you inhale deeply. Hold the breath in, with your chest arched, for a count to five, and then force the air out by contracting your abdominal muscles and letting your elbows to return to their starting position. Repeat the exercise 10 times.

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Stop smoking. This is the most important measure you can take for your overall health and the only one that can halt the progression of emphysema. Join a smoking cessation program if you need help giving up smoking. As much as possible, avoid secondhand smoke. Sit in nonsmoking areas when you're out, and ask family and friends not to smoke in your home.

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Avoid other respiratory irritants. These include fumes from paint and automobile exhaust, some cooking odors, certain perfumes, even burning candles and incense. Change furnace and air conditioner filters regularly to limit pollutants.

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Exercise regularly. Try not to let your breathing problems keep you from getting regular exercise, which can significantly increase your capacity for physical activity.

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Clear your airways. With emphysema, mucus tends to collect in your air passages and can be difficult to clear. To keep secretions thin and easy to bring up, drink plenty of nonalcoholic fluids every day.

Maintain good nutrition. A balanced diet gives your body the nutrients it needs for energy, for building and maintaining cells, and for regulating body processes. Work toward and maintain a desirable body weight. Being overweight requires more oxygen and can interfere with breathing. If you're underweight, achieving a healthy weight may increase your strength.

Assess baseline endurance, using 12-minute walk.

Begin incremental exercise program to improve through ambulation and stair climbing. Begin with 5-minute sessions, followed by rest periods between sessions. When the patient tolerates 20 minutes of total exercise per day, begin consolidating the sessions. Initial treatments on daily basis during weeks 1 and 2, taper to 3x per week over weeks 3 and 4 and then taper to home program with selfmonitoring in weeks 5 and 6.

Review proper body mechanics and coordinate with breathing patterns, using diaphragmatic and pursed-lip breathing when appropriate.

Prepared by: ESTRADA, Ernest Michael

History of smoking Occupational exposure Hypertrophy of the mm of the neck Pursed-lip breathing

These are very helpful diagnostic tools because they are noninvasive and can detect emphysema before a person has any symptoms. These tests measure how much air lungs can hold and the flow of air in and out of lungs. They can also measure the amount of gases exchanged across the membrane between your alveolar wall and capillary membrane.

Done to: 

Diagnose certain types of lung disease (especially asthma, bronchitis, and emphysema)

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Find the cause of SOB

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Measure whether exposure to contaminants at work affects lung function

1. SPIROMETRY - a spirometer is a device used by your physician that assesses lung function.May be necessary for any/all of the following reasons:  to determine how well the lungs receive, hold, and

utilize air  to monitor a lung disease  to determine the severity of a lung disease  to determine whether the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow)

2. Peak flow monitoring (PFM) - a device used to measure the fastest speed in which a person can blow air out of the lungs. This measurement is very important in evaluating how well or how poorly the disease is being controlled.

Chest X-ray A chest X-ray is usually used to help rule out other lung problems rather than to diagnose emphysema. Arterial blood gases analysis These blood tests measure how well lungs transfer oxygen to your bloodstream and how effectively they remove carbon dioxide from the blood.

Pulse oximetry test This test involves use of a small device that is being attached to your fingertip. The device is called oximeter. It measures the amount of oxygen in blood. * Lung volume tests also may be performed to measure lung capacity and function. In these tests, the patient inhales and exhales into a machine that measures the total lung capacity (TLC) and residual volume following exhalation. Rates that are higher than normal can indicate emphysema.

Computerized tomography scan A CT scan allows a doctor to see organs in two-dimensional images, done by a computer. Split-second computer processing creates images as a series of very thin X-ray beams are passed through your body. A CT scan can detect emphysema sooner than an X-ray can.

Sputum examination Analysis of cells in sputum can help determine the cause of some lung problems. The common bacteria are well-known, and today physicians properly prescribe antibiotics based on their knowledge of the most common organisms and will do so if sputum increases in volume and becomes colored. Yellow or greenish sputum is almost always infected and requires antibiotics.

Electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms and detects heart muscle damage. Radiology - Normal in early disease; localized radiolucency with decreased vascular markings