OverviewWhat is emphysema?Emphysema is a disease of the lungs that usually develops after many years of smoking. Both chronic bronchitis and emphysema belong to a group of lung diseases known as chronic obstructive pulmonary disease (COPD). Once it develops, emphysema can’t be reversed. This is why not smoking or stopping smoking is very important. Show
 Emphysema is a condition that involves damage to the walls of the air sacs (alveoli) of the lung. Alveoli are small, thin-walled, very fragile air sacs located in clusters at the end of the bronchial tubes deep inside the lungs. There are about 300 million alveoli in normal lungs. As you breathe in air, the alveoli stretch, drawing oxygen in and transporting it to the blood. When you exhale, the alveoli shrink, forcing carbon dioxide out of the body. When emphysema develops, the alveoli and lung tissue are destroyed. With this damage, the alveoli cannot support the bronchial tubes. The tubes collapse and cause an “obstruction” (a blockage), which traps air inside the lungs. Too much air trapped in the lungs can give some patients a barrel-chested appearance. Also, because there are fewer alveoli, less oxygen will be able to move into the bloodstream. Who gets emphysema?Over 3 million people in the United States have been diagnosed with emphysema. Over 11 million Americans have COPD. Emphysema is most common in men between the ages of 50 and 70. Symptoms and CausesWhat causes emphysema?Smoking is the number one factor. Because of this, emphysema is one of the most preventable types of respiratory diseases. Air pollutants in the home and workplace, genetic (inherited) factors (alpha-1 antitrypsin deficiency), and respiratory infections can also play a role in causing emphysema. Cigarette smoking not only destroys lung tissue, it also irritates the airways. This causes inflammation and damage to cilia that line the bronchial tubes. This results in swollen airways, mucus production, and difficulty clearing the airways. All of these changes can lead to shortness of breath. What are symptoms of emphysema?Symptoms of emphysema may include coughing, wheezing, shortness of breath, chest tightness, and an increased production of mucus. Often times, symptoms may not be noticed until 50 percent or more of the lung tissue has been destroyed. Until then, the only symptoms may be a gradual development of shortness of breath and tiredness (fatigue), which can be mistaken for other illnesses. People who develop emphysema have an increased risk of pneumonia, bronchitis, and other lung infections. See your doctor if any of these symptoms arise:
Diagnosis and TestsHow is emphysema diagnosed?The diagnosis of emphysema cannot be made solely on symptoms. Several tests are used to make the diagnosis. One simple test is to tap on your chest and listen with a stethoscope for a hollow sound. This means that air is being trapped in your lungs. Other tests include:
You might also talk to your doctor about whether testing for alpha-1 antitrypsin deficiency is appropriate for you. Management and TreatmentHow is emphysema treated?Because emphysema can worsen over time and there is no known cure, treatment is focused on slowing the speed of decline. The type of treatment will depend on the severity of the disease. Quitting smoking: If you smoke, quit. This is the most important step you can take to protect your lungs. It is never too late to quit. Your doctor can help you find the best smoking quitting method for you. Bronchodilator medications: These medicines relax the muscles around the airways. They are often used to treat asthma. Bronchodilators, given through hand-held inhalants, produce more immediate results and have fewer side effects than oral medications. Anti-inflammatory medication: These medications reduce inflammation in the airways. However, long-term side effects of these drugs include osteoporosis, hypertension, high blood sugar, and fat redistribution. Oxygen therapy: Oxygen therapy is prescribed for patients whose lungs are not getting enough oxygen to the blood (hypoxemia). These patients can’t absorb enough oxygen from the outside air and need to get more oxygen through a machine (a nasal catheter or a facemask). Lung volume reduction surgery: Lung volume reduction surgery involves removing a portion of diseased lung tissue, then joining together the remaining tissue. Doing this may relieve pressure on the breathing muscles and help improve lung elasticity (or stretch). The results of the surgery have been very promising. Not all patients with emphysema are candidates for this surgery. What are some tips for managing emphysema?The best way to prevent or reduce further problems is to prevent respiratory infections by:
How do you assess for oxygenation?Pulse oximetry measures how much oxygen the haemoglobin in your blood is carrying. This is called the oxygen saturation and is a percentage (scored out of 100). It's a simple, painless test which uses a sensor placed on your fingertip or earlobe.
How do you assess if a patient needs oxygen?Oximetry This is the method used most often. A small, clip-on device shines a light through your finger or earlobe and measures the amount of light absorbed by the oxygen-carrying hemoglobin in the red blood cells.
Which assessment findings support the presence of hypoxia?Early signs of hypoxia are anxiety, confusion, and restlessness; if hypoxia is not corrected, hypotension will develop. As hypoxia worsens, the patient's vital signs, activity tolerance, and level of consciousness will decrease.
What areas will you inspect when assessing a patient with impaired oxygenation?1. Assess respiratory rate, depth, and effort, including the use of accessory muscles, nasal flaring, and abnormal breathing patterns. Rapid and shallow breathing patterns and hypoventilation affect gas exchange (Gosselink & Stam, 2005).
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Which diagnostic test provides instant feedback about a patients oxygenation status?
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