| Emphysema |
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| CATEGORIES ABOUT EMPHYSEMA | |
| pulmonology | |
Emphysema is a type of Chronic Obstructive Lung Disease . It is often caused by exposure to Toxic Chemical s or long-term exposure to Tobacco Smoke . SIGNS AND SYMPTOMS Emphysema is caused by loss of elasticity (increased compliance) of the lung tissue, from destruction of structures supporting the Alveoli , and destruction of capillaries feeding the alveoli. The result is that the ''small airways'' collapse during exhalation (although ''alveolar'' collapsability has increased), leading to an obstructive form of lung disease (airflow is impeded and air is generally "trapped" in the lungs in Obstructive Lung Diseases ). Symptoms include Shortness Of Breath on exertion (typically when climbing stairs or inclines, and later at rest), Hypoventilation , and an expanded chest. Emphysema patients are sometimes referred to as "pink puffers". This is because emphysema sufferers may Hyperventilate to maintain adequate blood oxygen levels. Hyperventilation explains why mild emphysema patients do not appear Cyanotic as chronic Bronchitis (another COPD disorder) sufferers often do; hence they are "pink puffers" (able to maintain almost normal blood gases through hyperventilation) and not "blue bloaters" ( Cyanosis ; inadequate oxygen in the blood). However, any severely chronically obstructed (COPD) respiratory disease will result in hypoxia (decreased blood partial pressure of oxygen) and hypercapnia (increased blood partial pressure of Carbon Dioxide); so called Blue Bloaters. Blue Bloaters are so named as they have almost normal ventilatory drive (due to decreased sensitivity to carbon dioxide secondary to chronic hypercapnia), are plethoric (red face/cheeks due to a polycythemia secondary to chronic hypoxia) and cyanotic (due to decreased hemoglobin saturation). CLINICAL SIGNS Clinical signs at the fingers include cigarette stains (although actually tar) and is NOT a general feature of emphysema). Examination of the face reveals a plethoric complexion (if there is a secondary Polycythemia ), pursed-lipped breathing, and central Cyanosis . Examination of the chest reveals increased percussion notes (particularly over the liver) and a difficult to palpate Apex Beat (all due to hyperinflation), decreased breath sounds, audible expiratory wheeze, as well as signs of fluid overload (seen in advanced disease) such as pitting Peripheral Edema . Classically, clinical examination of an emphysematic patient reveals no overt crackles, however, in some patients the fine opening of airway 'popping' (dissimilar to the fine crackles of Pulmonary Fibrosis or coarse crackles of Mucinous or Oedematous Fluid ) can be Auscultated . This is known as "Barclay's sign". DIAGNOSIS Diagnosis is by Spirometry (lung function testing), including diffusion testing. Findings will often demonstrate a decrease in FEV1 but an increase in Total Lung Capacity (TLC). Diffusion tests such as DLCO will show a decreased diffusion capacity. Other investigations might include X-rays, high resolution spiral chest CT-scan, bronchoscopy (when other lung disease is suspected, including malignancy), blood tests, pulse. It might also be under the category of Alpha-1 Antitrypsin Deficiency, AAT. A way to help AAT is to put more into the blood flow and eat more protein. PATHOPHYSIOLOGY |
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