EMPHYSEMA

Definition
- abnormal, permanent enlargement of the acini accompanied by the
destruction of alveolar walls.
- loss of elasticity
- common on cigarette smokers and A1ADS (Alpha 1 –Antitrypsin
Deficiency)

Pathophysiology

In normal breathing, air is drawn

in through the bronchial passages
and down into the increasingly
fine network of tubing in the
lungs called the alveoli, w/c are
many millions of tiny sacs
surrounded by capillaries.

These absorb the oxygen

and transfer it into the blood.

When toxins such as smoke are

breathed into the lungs, the
particles are trapped and cause a
localized inflammatory response.

Chemicals released during the

inflammatory response (e.g.
elastase) can break down the
walls of alveoli (alveolar septum)

This leads to fewer but larger

alveoli, with a decreased surface
area and a decreased ability to
absorb oxygen and exude carbon
dioxide by diffusion.
The activity of another
molecule called Alpha1–
Antitrypsin normally
neutralizes the destructive
action of one of these
damaging molecules.

After a prolonged period,

hyperventilation becomes
inadequate to maintain high
enough oxygen levels in the
blood.

The body compensates by

vasoconstriction appropriate
vessels.

This leads to pulmonary

hypertension, which places
increased strain on the right
side of the heart, the one that
pumps unoxygenated blood to
the lungs, fails.

The failure caused the heart

muscle to thicken to pump
more blood.

Eventually, as the heart

continues to fail, it becomes
larger and blood backs up in
the liver.
Signs and Symptoms

1. Tachypnea
2. Dyspnea on exertion
3. Barrel chest shape- use of accessory muscles
4. Wheezes and Crackles on inspiration – caused by bronchial collapse
5. Prolonged expiration- brought about by grunting and use of accessory
muscles
6. Decreased tactile fremitus- because of air trapping in alveoli

Complications

1. Cor Pulmonale
2. Respiratory Failure
3. Current Respiratory Tract Infection

Diagnosis

1. CXR –flat diaphragm

2. EFT- increase residual volume and total lung capacity
3. ABG – decrease PaO2, normal PaCO2
4. ECG- right ventricular hypertrophy
5. CBC- increase hemoglobin, increase hematocrit

Treatment

1. Cessation of Smoking
2. Assess changes in baseline respiratory function
3. Chest Physiotherapy if not contraindicated
4. High Protein and high Caloric diet

Prepared by:
Merie Joy Del
Rosario
Dyren Mendoza
Aldin Acenas