Pathophysiology of emphysema

The pathophysiology of emphysema is best explained on the basis of decreased pulmonary elastic recoil. At any pleural pressure, the lung volume is higher than normal. Additionally, the altered relation between pleural and alveolar pressure facilitates expiratory dynamic compression of airways. Such compression limits airflow during forced expiration and, in severe instances, during tidal expiration. Another factor contributing to airflow limitation is disease of the airways, both large and small. In general, patients with relatively pure emphysema maintain blood gases in or near the normal range until very late in their course. PaO2 is maintained because of the preserved matching of ventilation and perfusion as alveolar walls are destroyed. PaCO2 is maintained because the ventilatory response to CO2 is not usually impaired. It is not clear why patients who are categorized clinically as "chronic bronchitics" are more likely to respond to an increased flow-resistive work of breathing by hypoventilating. Physical findings in emphysema are not specific. Radiologic changes are insensitive and are of less value than physiologic measurements

Signs and Symptoms of Emphysema

The signs and symptoms of emphysema involve the following. Trouble in breathing while lying down, during and after respiratory infections like colds and flu. Shortness of breadth and reduced physical activity, which becomes worse with progress of the disease. Chronic or mild cough with the production of sputum. Loss of appetite and weight loss is seen, as persons with this condition find difficulty in eating. Fatigue due to difficulty in breathing and less oxygen supply to the body.

Causes and Risk Factors of Emphysema

Smoking is the major cause and environmental risk factor for emphysema. The other causes and risk factors of emphysema are as follows. If people use intravenous drugs, then there is pulmonary vascular damage. Immune deficiency syndrome and Pneumocystis carinii infection damages the apical and cortical bullous lungs. Vasculitis syndrome, which is associated with obstructive lung disease. Connective tissue disorders, which is a congenital condition and affects the synthesis of elastin and tropoelastin.

Salla disease, which is an autosomal recessive storage disorder causes precocious emphysema due to impaired activity of serum trypsin enzyme. Lung damage can occur with age and symptoms are seen after 50 years of age. Exposure to second hand smoke. Exposure to chemical fumes, dust from grains, cotton or wood. Exposure to pollutants like car exhaust, fumes from heating fuel. Heredity.

Diagnosis of Emphysema
Diagnosis of emphysema is based on the symptoms. A thorough physical examination is conducted to know whether all parts of the body are receiving oxygen. A medical history and family history of the person is known whether the person has smoking habits or has a family history of respiratory diseases. A stethoscope helps in knowing the rupture of the alveoli in the lungs by hearing the hollow sound. A spirometer helps in measuring the amount of air inhaled and exhaled. An arterial blood gas test is done to measure the amount of oxygen and carbon dioxide levels in the blood. Blood tests are done to assess the amount of red blood cells. An electrocardiogram can be done to detect whether the lung disease has caused any problems to the heart. A chest X-ray may be suggested to confirm the diagnosis.1

Treatment for Emphysema

Quitting smoking is a quintessential component of management of emphysema. A few available treatment modalities help in alleviating the symptoms and avoiding complications. They include the following:1

Corticosteroids inhaled as aerosol sprays can reduce the symptoms of emphysema. Drugs like bronchodialators help to lessen cough, shortness of breadth and troubled breathing due to constricted airways. Providing oxygen supplements can treat severe emphysema with low blood oxygen. Broad-spectrum antibiotics may help in relieving the symptoms of emphysema caused due to acute bronchitis, pneumonia and influenza. Flu shots annually and pneumonia shots every 5 7 years is recommended if a person is at high-risk to emphysema and other respiratory diseases. Surgery is done to remove small wedges of the damaged lung tissue by a procedure called lung volume reduction surgery. This surgery improves the functioning of the lungs with severe emphysema. Lung transplantation may be required only when all other treatments have failed to treat emphysema. Protein therapy may be suggested to persons who have inherited protein defiency.

Prevention for Emphysema

The following steps might help in preventing emphysema.4 Quitting smoking. Limiting the exposure to second hand smoke. Wearing a dust mask to avoid exposure to chemical fumes, dust etc. Avoiding respiratory irritants like automobile exhaust, fumes from paint, certain perfumes etc. Exercising regularly and following simple breathing techniques. Air passages should be kept clear without mucus and hence one should drink plenty of nonalcoholic fluids. Protecting from cold air by covering the mouth and nose with a mask as cold air can cause spasm of the bronchial passages. Being vaccinated for flu and pneumonia to avoid respiratory infections. Consuming a balanced diet with all necessary nutrients