Emphysema
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Definition/Description[edit | edit source]
Emphysema can be defined as having a loss of lung elasticity, permanent enlargement of the air spaces distal to the terminal bronchioles, and destruction to the alveolar walls. It can be classified under the umbrella term chronic obstructive pulmonary disorder (COPD) [1] .
There are three types of emphysema; centriacinar, panacinar, paraseptal. Centriacinar emphysema affects the alveoli and airways in the central acinus, destroying the alveoli in the walls of the repiratory bronchioles and alveolar ducts Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title . Panacinar emphysema affects the whole acinus Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title . Paraseptal emphysema is believed to be the basic lesion of pulmonary bullous disease Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title .
Epidemiology[edit | edit source]
Emphysema is generally found in those less than 40 years old, and more frequently found in those of Scandinavian decent, commonly developing in the 3rd to 5th decade of a life [2]Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title . The disease tends to express no signs and symptoms until 50% of lung function is lost, as a result of the airway obstructions beginning in the smaller airways Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title . 1% of cases of emphysema are thought to be due to the deficiency of the alpha1-antitrypsin enzyme Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title .
The statistics relating to Emphysema are usually held within the wider spectrum of COPD, causing death to more than 14 million Americans, it is thought to be the fourth leading cause of deaths in America [3] . Within England and Wales, 1.5 million people are said to be affected by Emphysema being within the top 5 leading causes of death [4] .
Aetiology[edit | edit source]
<ref> tag; name cannot be a simple integer. Use a descriptive title. Another common association is the deficiency of the enzyme alpha₁-antitrypsin, which is the protein protecting the alveoli Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title . <ref> tag; name cannot be a simple integer. Use a descriptive title.Pathophysiology[edit | edit source]
The alveoli and the small distal airways are primarily affected by the disease, followed by effects in the larger airways Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title . Elastic recoil is usually responsible for splinting the bronchioles open. However, with emphysema, the bronchioles lose their stabilizing function and therefore causing a collapse in the airways resulting in gas to be trapped distally Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title .
There is an erosion in the alveolar septa causing there to be an enlargement of the available air space in the alveoli Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title . There is sometimes a formation of bullae with their thin walls of diminished lung tissue.
Smoking contributes to the development of the condition initially by activating the inflammatory process Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title . The inhaled irritants cause inflammatory cells to be released from polymorphonuclear leukocytes and alveolar macrophages to move into the lungs Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title . Inflammatory cells are known as proteolytic enzymes, which the lungs are usually protected against due to the action of antiproteases such as the alpha1-antitrypsin Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title . However, the irritants from smoking will have an effect on the alpha1-antitrypsin, reducing its activity. Therefore emphysema develops in this situation when the production and activity of antiprotease are not sufficient to counter the harmful effects of excess protease production Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title . A result of this is the destruction of the alveolar walls and the breakdown of elastic tissue and collagen Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title . The loss of alveolar tissue leads to a reduction in the surface area for gas exchange, which increases the rate of blood flow through the pulmonary capillary system Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title .
Investigations[edit | edit source]
CT scan is a common method used to diagnosis emphysema. The observations mainly seen to identify emphysema are a decrease in lung attenuation and a decrease in the number and diameter of pulmonary vessels in the affected area [5] .
Clinical Manifestations[edit | edit source]
Patients diagnosed with emphysema may complain of difficult/laboured breathing and reduced exercise capacity as their predominating symptoms Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. The loss of the elastic recoil in the lungs leads to irreversible bronchial obstruction and lung hyperinflation, which increases the volume over normal tidal breathing and functional residual capacity Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Outcome Measures[edit | edit source]
The main aims of treating patients with Emphysema are to relieve symptoms and to improve quality of life Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title [6] . To measure patients’ quality of life, the St George’s Respiratory Questionnaire (SGRQ) and the Guyatt’s Chronic Respiratory Questionnaire (CRQ) are often completed in order to measure the effectiveness of a treatment intervention Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title .
Diagnostic Procedures [edit | edit source]
<ref> tag; name cannot be a simple integer. Use a descriptive title . In order to accurately diagnose Emphysema, the history of the patient’s condition needs to be fully understood Cite error: Invalid
<ref> tag; name cannot be a simple integer. Use a descriptive title . The use of high-resolution CT scans is part of the standard procedure when trying to detect this condition as it is non-invasive and is found to be sensitive in detecting pathological changes related to Emphysema Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title . Physiotherapy and Other Management[edit | edit source]
Physiotherapy and other management. Other health professionals will be treating your patient. What is their input?
Prevention[edit | edit source]
As COPD is the umbrella term used for diseases like Emphysema, the prevention strategies are very similar. The most common suggestion for preventing emphysema, and such, is to stop smoking, and to avoid breathing in any harmful pollutants [8] .
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References[edit | edit source]
- ↑ Voelkel NF, Gomez-Arroyo J, Mizuno S. COPD/emphysema: The vascular story. Pulmonary Circulation 2011; 1(3): 320–326.
- ↑ Banasik J. Diagnosing alpha1-antitrypsin deficiency. Nurse Pract, 2001;26(1):58—67
- ↑ Mattison S, Christensen M. The pathophysiology of emphysema: Considerations for critical care nursing practice. Intensive and Critical Care Nursing 2006; 22: 329-337.
- ↑ Health and Safety Executive. Occupational Respiratory Diseases: Work-Related Chronic Obstructive Respiratory disease — Intervention and Evaluation Plans Draft Document. London: Health and Safety executive; 2005.
- ↑ Newell, J. CT of Emphysema. Radiologic Clinics of North America 2002; 40 (1): 31-42.
- ↑ Naunheim KS, Wood DE, Mohsenifar Z, Sternberg AL, Criner GJ, DeCamp MM, Deschamps CC, Martinez FJ, Sciurba FC, Tonascia J, Fishman AP. Long-term follow-up of patients receiving lung-volume-reduction surgery versus medical therapy for severe emphysema by the national emphysema treatment trial research group. The Annals of Thoracic Surgery 2006; 82 (2): 421-443.
- ↑ Klein JS, Gamsu G, Webb WR, Golden JA, Muller NL. High-resolution CT diagnosis of emphysema in symptomatic patients with normal chest radiographs and isolated low diffusing capacity. Radiology 1992; 182: 817-821.
- ↑ National Health Service. NHS Choices. http://www.nhs.uk/Conditions/Chronic-obstructive-pulmonary-disease/Pages/Introduction.aspx (accessed 02 June 2015).
