EMPHYSEMA

DEFINITION:
 Emphysema, or pulmonary emphysema, is a lower respiratory tract
disease,characterised by air-filled spaces (pneumatoses) in the lungs, that
can vary in size and may be very large. The spaces are caused by the
breakdown of the walls of the alveoli .
 This reduces the total alveolar surface available for gas exchange leading to
a reduction in oxygen supply for the blood.

TYPES
 Centrilobular
 Centrilobular emphysema, also called centriacinar emphysema, affects the
centre of a pulmonary lobule (centrilobular) in the lung.
 Centrilobular emphysema is the most common type usually associated with
smoking, and with chronic bronchitis.
 Usually the upper lobes of the lungs are affected.

 Panlobular:
 Panlobular emphysema, also called panacinar emphysema affects all of the
alveoli in a lobule and can involve the whole lung or mainly the lower lobes.
 This type of emphysema is associated with alpha-1 antitrypsin
deficiency (A1AD or AATD),
 And is not related to smoking

Paraseptal
 Paraseptal emphysema, also called distal acinar emphysema relates to
emphysematous change next to a pleural surface.
 This type of emphysema is not associated with airflow obstruction.

ETIOLOGY
 Smoking (the main cause)
 Exposure to air pollution, such as chemical fumes, dust, and other
substances.
 Irritating fumes and dusts at work.
 A rare, inherited form of the disease called alpha 1-antitrypsin (AAT)
deficiency-related pulmonary emphysema or early onset pulmonary
emphysema.

PATHOPHYSIOLOGY
Proteases play an important role in health
and disease of the lung. In the normal
lungs, proteases maintain their homeostatic
functions that regulate processes like its
regeneration and repair.

CLINICAL MANIFESTATIONS

DIAGNOSTIC EVALUATION
 Imaging tests
 A chest X-ray can help support a diagnosis of advanced emphysema and rule
out other causes of shortness of breath. But the chest X-ray can also show
normal findings if you have emphysema.
 Lab tests-ABG
 Blood taken from an artery in your wrist can be tested to determine how well
your lungs transfer oxygen into, and remove carbon dioxide from, your
bloodstream.
 Lung function tests
 These noninvasive tests measure how much air your lungs can hold and how
well the air flows in and out of your lungs. They can also measure how well
your lungs deliver oxygen to your bloodstream. One of the most common tests
uses a simple instrument called a spirometer, which you blow into.

MANAGEMENT
 Medications
 Depending upon the severity of your symptoms:
 Bronchodilators. These drugs can help relieve coughing, shortness of breath
and breathing problems by relaxing constricted airways.
 Inhaled steroids. Corticosteroid drugs inhaled as aerosol sprays reduce
inflammation and may help relieve shortness of breath.EG.PREDNISOLONE
 Antibiotics. If you have a bacterial infection, like acute bronchitis or
pneumonia, antibiotics are appropriate.
EG. ceftriaxone.
levofloxacin.
cefepime.
piperacillin-tazobactam.
aztreonam.

 Combination Inhaled Medicines
 Albuterol and ipratropium (Combivent Respimat; Duoneb)
 Budesonide and formoterol (Symbicort)
 Fluticasone and salmeterol (Advair)
 Fluticasone and vilanterol (Breo Ellipta)
 Formoterol and mometasone (Dulera)
 Tiotropium and olodaterol (Stiolto Respimat)
 Azithromycin and roflumilast are available to reduce exacerbating
symptoms

SURGICAL MANAGEMENT
 Lung volume reduction surgery (LVRS) is a surgical option to treat
emphysema, and is only performed when the use of all medical treatments
(medications, pulmonary rehabilitation) have been tried and symptoms still
persist. During the surgery, 20% to 30% of the most diseased portions of the
lung are removed.

SURGICAL COMPLICATION
 Lung infections such as pneumonia.
 Sepsis (a serious whole-body infection)
 Pneumothorax (collapsed lung)
 Respiratory failure.
 Slow or impaired wound healing

NURSING MANAGEMENT