WELCOME

TO

MY

PRESENTATION

EMPHYSEMA

Content:

What is emphysema

Lung anatomy and physiology

Lung comparism

Incidence and prevalence

Type

Cause

Pathology

Risk factor

Symptom

Diagnosis

Breath sound

Treatment

Prevention

conclusion

Introduction: Affects 2 out of 1,000 people

1.8 million Americans in the United States

have emphysema.

Emphysema is ranked 15th among chronic

conditions or diseases which limit people’s

daily activity

More common in men vs. women

Studies show that the amount of women

with the disease is gradually increasing

What is EmphysemaA condition in our body in which the

air sacs of the lungs, called alveolus

are damaged and enlarge, causing

breathlessness.

LUNG ANATOMY & PHYSIOLOGYThe function of the lungs is to Oxygenate our blood by

removing Carbon Dioxide and replacing it with Oxygen.

LUNG COMPARISONS

SIDE-BY-SIDE COMPARISON

Type of emphysema

There are four type:

1. Centriacinar

2. Panacinar

3. Paraseptal [Distal acinar]

4. Mixed and unclassified

[Irregular]

Centriacinar :

[ centrilobular, Proximal acinar ]

• Dilatation of Respiratory Bronchiole

• Upper lobes - severely involved

• Can coexist with chronic bronchitis

• Invariably occurs in smokers

• Coal mine workers [carbon, dust]

Panacinar Emphysema:

• Whole of Acinus uniformly affected

• Lower lobes severely involved

• Association:

… A1AT deficiency

… Cigarette smokers

Paraseptal (Distal Acinar)

• Localized along pleura - peripheral part

of the acinus

• Predisposes to spontaneous peumothorax

• Adjacent to foci of fibrosis

• Least common

Mixed – IRREGULAR EMPHYSEMA:

• MOST COMMON

• LEAST SIGNIFICANT

• COMMON AROUND SCAR TISSUE

• COMBINATION OF TYPES

What Are The Causes

MOST COMMON

Smoking

SMOKING FACTS ON EMPHYSEM

80 percent of emphysema causes result from

the long term effects of smoking cigarettes

About 90 percent of emphysema causes are

heavy smokers

Cont…

Prolonged exposure to second

hand smoke

Chemical fumes

Dust

Air pollution

IN RARE CASES

Deficiency of the Alpha-1 Antitrypsin

A protein made by the liver that protects the lungs.

That is inherited

MM: normal level

MS: 80% of normal

MZ: 60% of normal

SZ: 40% of normal

ZZ: 10% of normal level

Is It Transmitted??

Pathophysiology

What are the Effects to Our

Body?

People with emphysema will not oxygenated their blood well.

They can’t remove carbon dioxide from their blood and lungs.

They have a rapid breathing rate.

WHO IS AT RISK

Emphysema effects both men and women.

Usually does not appear until the sixties.

But the disease can appear as early as forty depending

on certain factors.

Any ethnic group can develop emphysema.

One exception is the inherited form that mainly

effects European.

Occurrence among Male and

Female

Occur more in male than

females due to percentage of

male smokers.

As the number of female

smokers increase, emphysema

also develops in them rapidly.

Death rate increase rapidly.

THE PERCENTAGE OF EMPHYSEMA

DEATHS IN MEN AND WOMEN

0%10%20%30%40%50%60%70%80%90%

100%

non smoker

smoker

SYMPTOMS OF EMPHYSEMA

Coughing with or without phlegm

(sometimes referred to as “smokers cough”)

Dyspnoea (shortness of breath)

Trouble catching one’s breath

Fatigue

Wheezing

Barrel- like distended chest

Lethargy or difficulty concentrating

Difficulty sleeping

DIAGNOSIS

History

Physical examination

• The most common physical change may be in the chest, which takes on a barrel-like appearance

• physical examination may show "pursed-lip" breathing

• the breath sounds become quite diminished

• if any wheezing, and exhalation becomes prolonged (exhalation takes more than twice as long as inhalation)

• Bluish discoloration of the lips and nail beds

Investigation• Chest x-ray

A plain chest x-ray may show lungs that have become too inflated and too lucent, signs that lung tissue destruction has occurred.

Radiologic Findings

Chest radiograph

Translucent (dark) lung fields

Depressed or flattened diaphragms

Long and narrow heart

Enlarged heart

Increased retrosternal air space (lateral radiograph)

• Blood test

Arterial Blood Gas (ABG)

• Lung Function Test also called Pulmonary

Function Test or PFT (most common)

cont…

A variety of lung functions can be

measured and may include how much

air the lungs can hold and empty with

each breath, the degree of airflow

obstruction, the available surface for

exchange of carbon dioxide and oxygen,

the amount of trapped gases, and how

elastic the lungs are with inspiration

and expiration.

Oximetry

Oxygenated blood is a brighter red and becomes purple in color

when oxygen is removed. The dosimeter is a device usually placed

on a finger and detects the pulse of blood. A light is transmitted

through the tissue, and the amount of the brighter red color is

determined, enabling a measure of oxygen saturation, a measure

of hemoglobin oxygen content. This value is usually greater than

90%.

Breath sound in emphysema

Diminished breath sound

with prolong expiration.

Wheeze (in severe cases).

Treatment

STOP smoking (if you smoke)

Bronchodilators (inhalers)

Ex. Atrovent, Spiriva, Serevent,

Foradil, and Albuterol

Anti-inflammatory medication

Ex. Singulair and Roflimulast

Antibiotics

Oxygen therapy

Cont….

Pulmonary rehabilitation

Conserve energy, improve stamina, and reduce breathlessness

Surgery

physiotherapy

Other things include

Avoid being around smoke and other irritants

Avoiding the cold

Physiotherapy management

To minimize dyspnoea

positioning-supported sitting or huffing

Diaphragmatic breathing

To establish a coordinated pattern of breathing

Shorten expiratory phase and being inspiration before the airways have a chance to close down

To assist in the removal of secretions

Manual chest therapy-shaking, vibration

or clapping

Postural drainage

To increase the range of movement of the

joints of the thoracic cage

Free active exercise of the whole spine

Shoulder girdle retraction and lateral

rotation of arms followed by breathing

control exercise

To increase exercise tolerance

Breathing control exercise in relation to

activities of daily livings, eg.walking and

stair climbing

prognosis

Mild emphysema- 80% of patients are

alive after 4 years

Moderate emphysema- 60-70% are alive

after 4 years

Severe emphysema- 50% are alive after

4 years

Very severe emphysema- short life

expectancy

Rehabilitation

Pulmonary rehabilitation combines exercise training and

behavioral and educational programs designed to help

individuals with emphysema control symptoms and improve day-

to-day activities. It is a team approach. Individuals work closely

with their doctors, nurses, respiratory, physical,

and occupational therapists, psychologists and exercise

specialists. The main goals of pulmonary rehabilitation are to

help individuals improve their day-to-day lives and to restore

their ability to function independently. Pulmonary rehabilitation

can help reduce the number and length of hospital stays and

increase the chances of living longer.

Pulmonary rehabilitation involves exercise training and

ventilator muscle training. It also includes psychosocial support

and educational programs.

Since smoking is well known to be the primary risk factor for the

onset and progression of emphysema, many pulmonary

rehabilitation programs provide educational sessions and

counseling to help individuals stop smoking.

complication

Enlargement and strain on the right

side of the heart (cur pulmonale)

may occur, resulting in swelling of

the feet and legs.

Respiratory infections are frequent

may often result in hospitalization

Other possible complications

collapsed lung (are pneumothorax)

and giant bulla.

Ability to Work (Return to Work

Considerations)

Individuals need to stay away from inhaled irritants

and extremes of air temperatures in the work

environment. The amount of physical work they can

do depends on their lung function. Individuals wearing

continuous oxygen must work in areas where there is

no danger of explosion from the gas or open flames or

sparks. Individuals must not work in areas that require

respirator use.

The ideal work environment for individuals with

emphysema is a dry atmosphere, free of pollution.

Maximum Medical

Improvement

60 days.

Failure to Recover

If an individual fails to recover within

the expected maximum duration

period, the reader may wish to

consider the following questions to

better understand the specifics of an

individual's medical case.

Prevention

Live away from

polluted urban

areas

1 prevention is to

STOP SMOKING

Incidence and Prevalence

In 2011, 4.7 million Americans

reported ever being diagnosed

with emphysema, a lifetime

prevalence rate of 20.2 per

1,000 persons. Over 90% of the

cases were among people over

45 years old (NCHS).

Worldwide Mortality Rate

36.60%

16.40%

10.40%

5.80%

4.80%

2.90%

2.90%

2%

1.90%

1.80%1.50%

1.50% 1.40%

1.40%

0.80%

0.70%

0.70% 0.70%

0.60% 0.60%

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