Geelyn Marie A.

Luzon
BSPT III-I
 Definition
Emphysema is defined anatomically as
abnormal, permanent enlargement
of alveoli and alveolar ducts, with
destruction of alveolar walls and
breakdown of connective tissue
support of lower airways.
 Etiology
*Downward progression of
inflammatory damage with repeated
episodes of chronic bronchitis.
*Cigarette smoking
*AAT (α-antitrypsin) deficiency
 Epidemiology
*Up to 2.5 million Americans suffer from
emphysema.
*Cigarette smoking and air pollution are
major risk factors for emphysema.
*Aging
*An estimated 2% of cases of emphysema
are caused by (α-antitrypsin) AAT
deficiency
Pathophysiology
of
Emphysema
By: Alyssa Paula L. Tomas
BSPT III-I
Normal Emphysemic lung
 Smoking

Particle deposition in
airways

Low level inflammatory

response
Decreased alpha1 –
antitrypsin production
Phagocytosis by
neutrophils

Release of elastase

Elastase degrades
elastic tissue in septa
 Classification of Emphysema

• Centriacinar or Centrilobular

- is due to destruction of terminal bronchioli

muchosis, due to chronic bronchitis. This is
found mostly in elderly people with a long
history of smoking or extreme cases of
passive smoking.
Centriacinar or Centrilobular
 Classification of Emphysema

• Panacinar Emphysema
• is related to the destruction of alveoli,
because of an inflammation or
deficiency of alpha 1-antitrypsin. It is
found more in young adults who do not
have chronic bronchitis.
Panacinar Emphysema
Leo Marlon M. Gamundoy Jr. M.D.
 Symptoms

Shortness of breath (dyspnea)


Cough


DOE


Exacerbation

Cyanosis


Edema


Fatigue


Headaches


Weight loss
 Signs

Barrel chest

Crackles and wheezes

Vibration of the chest (Fremitus)


Pursed Lip Breathing


Patients also may have a tendency to
lean forward

Anxiety


depression


sleep disturbances
 Complications

Cor pulmonale

Heart failure

Pneumonia and other lung infections

Pneumothorax

Polycythemia

Respiratory failure
.....gO Lucille!!!!!!!......Pengeng
LaNgis!!!!!
DIFFERENTIAL DIAGNOSIS
Disease Cause Manifestation
Bronchioles Chronic cough.
- abnormal permanent collapse, and air
enlargement of air
becomes trapped
Loss of appetite
spaces distal to the
terminal bronchioles, in the air sacs, and weight loss.
accompanied by the
destruction of the walls
which Fatigue.
and without obvious overstretches
fibrosis. them and
interferes with
your ability to
exhale
(hyperinflation).
Disease Cause Manifestation
- uncommon disease Abnormal dilation of •Dyspnea
that results in the the proximal and •Pleuritic chest pain
abnormal and medium-sized bronchi •Wheezing
permanent distortion (>2 mm in diameter)
•Fever
of one or more of the caused by weakening
or destruction of the •Weakness
conducting bronchi or
airways, most oft en muscular and elastic •Weight loss
secondary to an components of the
infectious process. bronchial walls.
Disease Cause Manifestation
Caused most often by
Bronchitis is the
exposure to airborne
Persistent
inflammation of the pollutants such as cough
lining of the bronchial
cigarette smoke,
tubes. When the excessive dust in the air, Productive
bronchi are inflamed or chemicals. The
and/or infected, less bronchial lining becomes
cough
air is able to flow toinflamed and the Sputum cough
and from the lungs constant exposure to
such pollutants begins to
and a heavy mucus or
cause damage in the
phlegm is coughed up. bronchioles (the smaller
airways in the lungs).
Disease Cause Manifestation

- occurs when the

airways in your lungs Exposure to various Shortness of breath
(bronchial tubes) allergens and irritants Chest tightness or pain
become inflamed and Trouble sleeping
constricted. The An audible whistling or
muscles of the wheezing sound when
bronchial walls exhaling
tighten, and your Bouts of coughing or
airways produce extra wheezing
mucus that blocks
your airways.
Disease Cause Manifestation
Disease of uncontrolled Cigarette smoking is the Cough that doesn't go away
cell growth in tissues of leading cause of lung Coughing up blood
the lung. This growth cancer. Shortness of breath
Secondhand smoke Wheezing
may lead to metastasis,
(breathing the smoke of Chest pain
which is invasion of
others) increases your risk Loss of appetite
adjacent tissue and
Losing weight without trying
infiltration beyond the of lung cancer. Fatigue
lungs. Weakness
Swallowing difficulty
Nail problems
Joint pain
Hoarseness or changing voice
Swelling of the face
Facial paralysis
Eyelid drooping
Bone pain or tenderness
PT Management
Patient education includes:
proper breathing techniques,
clearance of secretions,
understanding their medications and devices,
the ability to travel,
efficient body mechanics, and
networking with other lung patients
• This is the most important measure you can
take for your overall health and the only one
that can halt the progression of emphysema.
Join a smoking cessation program if you need
help giving up smoking. As much as possible,
avoid secondhand smoke. Sit in nonsmoking
areas when you're out, and ask family and
friends not to smoke in your home.
Bronchodilators
Bronchodilators are used to relax the smooth
muscles that surround the bronchioles and
allow the breathing tubes to dilate and allow
more air flow.
Oxygen
As the disease progresses, patients may require
supplemental oxygen to be able to function.
Often it begins with nighttime use, then with
exercise, and as the disease worsens, the need
to use oxygen during the day for routine
activities increases.
(+) hypoxia
 Long term oxygen therapy will improve survival
and quality of life.
Pursed-lip breathing
Try the diaphragmatic breathing exercises with
your lips pursed as you exhale, that is, with
your lips puckered — the flow of air should
make a soft "sssss" sound. Inhale deeply
through your nose or your mouth, whichever is
more comfortable for you, and then exhale.
Repeat 10 times at each session. Breathing out
against pursed lips increases the air pressure
inside the airways, including your very small
airways, which minimizes how much they
collapse.
Deep-breathing exercise
While sitting or standing, pull your elbows
firmly backward as you inhale deeply. Hold
the breath in, with your chest arched, for a
count to five, and then force the air out by
contracting your abdominal muscles and
letting your elbows to return to their starting
position. Repeat the exercise 10 times.
• Stop smoking. This is the most important
measure you can take for your overall health
and the only one that can halt the progression
of emphysema. Join a smoking cessation
program if you need help giving up smoking.
As much as possible, avoid secondhand smoke.
Sit in nonsmoking areas when you're out, and
ask family and friends not to smoke in your
home.
• Avoid other respiratory irritants. These
include fumes from paint and automobile
exhaust, some cooking odors, certain perfumes,
even burning candles and incense. Change
furnace and air conditioner filters regularly to
limit pollutants.
• Exercise regularly. Try not to let your
breathing problems keep you from getting
regular exercise, which can significantly
increase your capacity for physical activity.
• Clear your airways. With emphysema, mucus
tends to collect in your air passages and can be
difficult to clear. To keep secretions thin and
easy to bring up, drink plenty of nonalcoholic
fluids every day.
Maintain good nutrition. A balanced diet
gives your body the nutrients it needs for
energy, for building and maintaining cells, and
for regulating body processes. Work toward
and maintain a desirable body weight. Being
overweight requires more oxygen and can
interfere with breathing. If you're underweight,
achieving a healthy weight may increase your
strength.
Assess baseline endurance, using 12-minute
walk.
Begin incremental exercise program to improve
through ambulation and stair climbing. Begin
with 5-minute sessions, followed by rest
periods between sessions. When the patient
tolerates 20 minutes of total exercise per day,
begin consolidating the sessions. Initial
treatments on daily basis during weeks 1 and 2,
taper to 3x per week over weeks 3 and 4 and
then taper to home program with self-
monitoring in weeks 5 and 6.
Review proper body mechanics and coordinate
with breathing patterns, using diaphragmatic
and pursed-lip breathing when appropriate.
 Prepared by:
ESTRADA, Ernest Michael
History of smoking
Occupational exposure
Hypertrophy of the mm of the neck
Pursed-lip breathing
These are very helpful diagnostic tools because they
are noninvasive and can detect emphysema before a
person has any symptoms. These tests measure how
much air lungs can hold and the flow of air in and out
of lungs. They can also measure the amount of gases
exchanged across the membrane between your
alveolar wall and capillary membrane.
Done to:

 Diagnose certain types of lung disease (especially

asthma, bronchitis, and emphysema)

 Find the cause of SOB

 Measure whether exposure to contaminants at work

affects lung function
1. SPIROMETRY - a spirometer is a device used by your
physician that assesses lung function.May be necessary
for any/all of the following reasons:
 to determine how well the lungs receive, hold, and
utilize air
 to monitor a lung disease
 to determine the severity of a lung disease
 to determine whether the lung disease is restrictive
(decreased airflow) or obstructive (disruption of
airflow)
2. Peak flow monitoring (PFM) - a device used to measure
the fastest speed in which a person can blow air out of
the lungs. This measurement is very important in
evaluating how well or how poorly the disease is being
controlled.
Chest X-ray
A chest X-ray is usually used to help rule out other
lung problems rather than to diagnose emphysema.
Arterial blood gases analysis
These blood tests measure how well lungs transfer
oxygen to your bloodstream and how effectively they
remove carbon dioxide from the blood.
 Pulse oximetry test
This test involves use of a small device that is being attached
to your fingertip. The device is called oximeter. It measures
the amount of oxygen in blood.
* Lung volume tests also may be performed to measure lung
capacity and function. In these tests, the patient inhales and
exhales into a machine that measures the total lung capacity
(TLC) and residual volume following exhalation. Rates that
are higher than normal can indicate emphysema.
Computerized tomography scan
A CT scan allows a doctor to see organs in two-dimensional
images, done by a computer. Split-second computer
processing creates images as a series of very thin X-ray
beams are passed through your body. A CT scan can detect
emphysema sooner than an X-ray can.
Sputum examination
Analysis of cells in sputum can help determine the
cause of some lung problems. The common bacteria are
well-known, and today physicians properly prescribe
antibiotics based on their knowledge of the most
common organisms and will do so if sputum increases
in volume and becomes colored. Yellow or greenish
sputum is almost always infected and requires antibiotics.
Electrocardiogram (ECG or EKG) - a test that records
the electrical activity of the heart, shows abnormal
rhythms and detects heart muscle damage.

Radiology - Normal in early disease; localized

radiolucency with decreased vascular markings