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  3. 3. Content:  What is emphysema  Lung anatomy and physiology  Lung comparism  Incidence and prevalence  Type  Cause  Pathology  Risk factor  Symptom  Diagnosis  Breath sound  Treatment  Prevention  conclusion
  4. 4. Introduction:  Affects 2 out of 1,000 people  1.8 million Americans in the United States have emphysema.  Emphysema is ranked 15th among chronic conditions or diseases which limit people’s daily activity  More common in men vs. women  Studies show that the amount of women with the disease is gradually increasing
  5. 5. What is Emphysema A condition in our body in which the air sacs of the lungs, called alveolus are damaged and enlarge, causing breathlessness.
  6. 6. LUNG ANATOMY & PHYSIOLOGY The function of the lungs is to Oxygenate our blood by removing Carbon Dioxide and replacing it with Oxygen.
  9. 9. Type of emphysema  There are four type: 1. Centriacinar 2. Panacinar 3. Paraseptal [Distal acinar] 4. Mixed and unclassified [Irregular]
  10. 10.  Centriacinar : [ centrilobular, Proximal acinar ] • Dilatation of Respiratory Bronchiole • Upper lobes - severely involved • Can coexist with chronic bronchitis • Invariably occurs in smokers • Coal mine workers [carbon, dust]
  11. 11.  Panacinar Emphysema: • Whole of Acinus uniformly affected • Lower lobes severely involved • Association: … A1AT deficiency … Cigarette smokers
  12. 12.  Paraseptal (Distal Acinar) • Localized along pleura - peripheral part of the acinus • Predisposes to spontaneous peumothorax • Adjacent to foci of fibrosis • Least common
  14. 14. What Are The Causes MOST COMMON  Smoking SMOKING FACTS ON EMPHYSEM 80 percent of emphysema causes result from the long term effects of smoking cigarettes About 90 percent of emphysema causes are heavy smokers
  15. 15. Cont… Prolonged exposure to second hand smoke Chemical fumes Dust Air pollution
  16. 16. IN RARE CASES  Deficiency of the Alpha-1 Antitrypsin  A protein made by the liver that protects the lungs.  That is inherited MM: normal level MS: 80% of normal MZ: 60% of normal SZ: 40% of normal ZZ: 10% of normal level
  17. 17. Is It Transmitted??
  18. 18. Pathophysiology
  19. 19. What are the Effects to Our Body?  People with emphysema will not oxygenated their blood well.  They can’t remove carbon dioxide from their blood and lungs.  They have a rapid breathing rate.
  20. 20. WHO IS AT RISK  Emphysema effects both men and women.  Usually does not appear until the sixties.  But the disease can appear as early as forty depending on certain factors.  Any ethnic group can develop emphysema.  One exception is the inherited form that mainly effects European.
  21. 21. Occurrence among Male and Female  Occur more in male than females due to percentage of male smokers.  As the number of female smokers increase, emphysema also develops in them rapidly.  Death rate increase rapidly.
  22. 22. THE PERCENTAGE OF EMPHYSEMA DEATHS IN MEN AND WOMEN 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% non smoker smoker
  23. 23. SYMPTOMS OF EMPHYSEMA  Coughing with or without phlegm (sometimes referred to as “smokers cough”)  Dyspnoea (shortness of breath)  Trouble catching one’s breath  Fatigue  Wheezing  Barrel- like distended chest  Lethargy or difficulty concentrating  Difficulty sleeping
  24. 24. DIAGNOSIS  History  Physical examination • The most common physical change may be in the chest, which takes on a barrel-like appearance • physical examination may show "pursed-lip" breathing • the breath sounds become quite diminished • if any wheezing, and exhalation becomes prolonged (exhalation takes more than twice as long as inhalation) • Bluish discoloration of the lips and nail beds
  25. 25. Investigation • Chest x-ray  A plain chest x-ray may show lungs that have become too inflated and too lucent, signs that lung tissue destruction has occurred.  Radiologic Findings Chest radiograph  Translucent (dark) lung fields  Depressed or flattened diaphragms  Long and narrow heart  Enlarged heart  Increased retrosternal air space (lateral radiograph)
  26. 26. • Blood test Arterial Blood Gas (ABG) • Lung Function Test also called Pulmonary Function Test or PFT (most common)
  27. 27. cont…  A variety of lung functions can be measured and may include how much air the lungs can hold and empty with each breath, the degree of airflow obstruction, the available surface for exchange of carbon dioxide and oxygen, the amount of trapped gases, and how elastic the lungs are with inspiration and expiration.
  28. 28.  Oximetry  Oxygenated blood is a brighter red and becomes purple in color when oxygen is removed. The dosimeter is a device usually placed on a finger and detects the pulse of blood. A light is transmitted through the tissue, and the amount of the brighter red color is determined, enabling a measure of oxygen saturation, a measure of hemoglobin oxygen content. This value is usually greater than 90%.
  29. 29. Breath sound in emphysema Diminished breath sound with prolong expiration. Wheeze (in severe cases).
  30. 30. Treatment  STOP smoking (if you smoke)  Bronchodilators (inhalers) Ex. Atrovent, Spiriva, Serevent, Foradil, and Albuterol  Anti-inflammatory medication Ex. Singulair and Roflimulast  Antibiotics  Oxygen therapy
  31. 31. Cont….  Pulmonary rehabilitation Conserve energy, improve stamina, and reduce breathlessness  Surgery  physiotherapy Other things include  Avoid being around smoke and other irritants  Avoiding the cold
  32. 32. Physiotherapy management  To minimize dyspnoea  positioning-supported sitting or huffing  Diaphragmatic breathing  To establish a coordinated pattern of breathing  Shorten expiratory phase and being inspiration before the airways have a chance to close down
  33. 33.  To assist in the removal of secretions  Manual chest therapy-shaking, vibration or clapping  Postural drainage  To increase the range of movement of the joints of the thoracic cage  Free active exercise of the whole spine  Shoulder girdle retraction and lateral rotation of arms followed by breathing control exercise  To increase exercise tolerance  Breathing control exercise in relation to activities of daily livings, eg.walking and stair climbing
  34. 34. prognosis  Mild emphysema- 80% of patients are alive after 4 years  Moderate emphysema- 60-70% are alive after 4 years  Severe emphysema- 50% are alive after 4 years  Very severe emphysema- short life expectancy
  35. 35. Rehabilitation  Pulmonary rehabilitation combines exercise training and behavioral and educational programs designed to help individuals with emphysema control symptoms and improve day- to-day activities. It is a team approach. Individuals work closely with their doctors, nurses, respiratory, physical, and occupational therapists, psychologists and exercise specialists. The main goals of pulmonary rehabilitation are to help individuals improve their day-to-day lives and to restore their ability to function independently. Pulmonary rehabilitation can help reduce the number and length of hospital stays and increase the chances of living longer. Pulmonary rehabilitation involves exercise training and ventilator muscle training. It also includes psychosocial support and educational programs. Since smoking is well known to be the primary risk factor for the onset and progression of emphysema, many pulmonary rehabilitation programs provide educational sessions and counseling to help individuals stop smoking.
  36. 36. complication  Enlargement and strain on the right side of the heart (cur pulmonale) may occur, resulting in swelling of the feet and legs.  Respiratory infections are frequent  may often result in hospitalization  Other possible complications collapsed lung (are pneumothorax) and giant bulla.
  37. 37. Ability to Work (Return to Work Considerations)  Individuals need to stay away from inhaled irritants and extremes of air temperatures in the work environment. The amount of physical work they can do depends on their lung function. Individuals wearing continuous oxygen must work in areas where there is no danger of explosion from the gas or open flames or sparks. Individuals must not work in areas that require respirator use. The ideal work environment for individuals with emphysema is a dry atmosphere, free of pollution.
  38. 38. Maximum Medical Improvement  60 days. Failure to Recover  If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.
  39. 39. Prevention  Live away from polluted urban areas  1 prevention is to STOP SMOKING
  40. 40. Incidence and Prevalence  In 2011, 4.7 million Americans reported ever being diagnosed with emphysema, a lifetime prevalence rate of 20.2 per 1,000 persons. Over 90% of the cases were among people over 45 years old (NCHS).
  41. 41. Worldwide Mortality Rate 36.60% 16.40% 10.40% 5.80% 4.80% 2.90% 2.90% 2% 1.90% 1.80% 1.50% 1.50% 1.40% 1.40% 0.80% 0.70% 0.70% 0.70% 0.60% 0.60% United States Japan Brazil Mexico Germany Netherlands South Africa Hungary Romania Canada Thailand Australia Austria Spain Kyrgyzstan Argentina Sweden Colombia Poland Venezuela