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Emphysema

Emphysema is one of several diseases usually labeled collectively as chronic obstructive pulmonary disease (COPD). It's the most common cause of death from respiratory disease in the United States; approximately 2 million Americans are afflicted with the disease. Emphysema appears to be more prevalent in men than in women. Postmortem findings reveal few adult lungs without some degree of emphysema.

Causes

Emphysema may be caused by a genetic deficiency of alpha1 -antitrypsin (AAT) and by cigarette smoking. Genetically, one in 3,000 newborns are found with the disease, and 1 % to 3% of all cases of emphysema are due to AAT deficiency. Cigarette smoking is thought to cause up to 20% of the cases. Other causative factors are unknown. Recurrent inflammation associated with the release of proteolytic enzymes from lung cells causes abnormal, irreversible enlargement of the air spaces distal to the terminal bronchioles. This leads to the destruction of alveolar walls, which results in a breakdown of elasticity.

Signs and Symptoms

  • Shortness of breath- feeling like you can't get your breath out
  • A barrel-shaped chest
  • Wheezing
  • Feeling tired (fatigue)
  • Losing weight without trying

People might think that feeling short of breath is a normal sign of aging- but it's not. If you have these signs and symptoms, see your doctor. Ask for spirometry, a simple test that measures how much air you move out of your lungs.

Diagnostic tests

Chest X-rays in advanced disease may show a flattened diaphragm, reduced vascular markings at the lung periphery, overaeration of the lungs, a vertical heart, enlarged anteroposterior chest diameter, and large retrosternal air space.

Pulmonary function tests typically indicate increased residual volume and total lung capacity, reduced diffusing capacity, and increased inspiratory flow.

Arterial blood gas analysis usually shows reduced partial pressure of arterial oxygen and normal partial pressure of arterial carbon dioxide until late in the disease.

Electrocardiography may reveal tall, symmetrical P waves in leads II, III, and aVF; vertical QRS axis; and signs of right ventricular hypertrophy late in the disease.

Red blood cell count usually demonstrates an increased hemoglobin level late in the disease when the patient has persistent severe hypoxia.

Treatment

Emphysema management usually includes bronchodilators such as aminophylline to promote mucociliary clearance; antibiotics to treat respiratory tract infection; and immunizations to prevent influenza and pneumococcal pneumonia.

Other treatment measures include adequate hydration and (in selected patients) chest physiotherapy to mobilize secretions.

Some patients may require oxygen therapy (at low settings) to correct hypoxia. They may also require transtracheal catheterization to receive oxygen at home. Counseling about avoiding smoking and air pollutants is necessary.

Prevention

Many risk factors for emphysema can be completely eliminated. Smoking cessation is vital for those who smoke. Sources of indoor air pollution can be identified and removed. It's important to avoid secondhand smoke. The best method to prevent emphysema is to avoid smoking. Even patients with inherited emphysema should avoid smoking, as it especially worsens the onset and severity. If patients quit smoking as soon as evidence of small airway obstruction begins, they can significantly improve their prognosis. Patients are cautioned to reduce exposure to air pollutants and to people who are ill with respiratory problems. Exposure to air pollutants should also be limited.



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