Emphysema

Emphysema

• In emphysema, impaired oxygen and carbon dioxide exchange results from destruction of the walls of overdistended alveoli.

• Pathologic term that describes an abnormal distention of airspaces beyond the terminal bronchioles and destruction of the walls of the alveoli. 

• This is the end stage of a process that progresses slowly for many years. 

• As the walls of alveoli are destroyed (a process accelerated by recurrent infections), the alveolar surface area in direct contact with the pulmonary capillaries continually decreases. 

• This causes an increase dead space (lung area where no gas exchange can occur). And impaired oxygen diffusion, which leads to hypoxemia. 

• In the later stages of disease, carbon dioxide elimination is impaired, resulting in increased carbon dioxide tension in arterial blood (hypercapnia) leading to respiratory acidosis

• As the alveolar walls continue to break down, the pulmonary capillary bed is reduced in size. 

• Consequently, resistance to pulmonary blood flow is increased, forcing the right ventricle to maintain a higher blood pressure in pulmonary artery. 

• For this reason, right sided heart failure, (Cor Pulmonale) is one of the complications of emphysema.

• Congestion, dependent edema, distended neck veins, or pain in the region of the liver suggest the development of cardiac failure. 

• Type 1 Pneumocytes

Pink Puffer

Emphysema

- Skin turns to pink because of hyperventilation

Predisposing Factor

Smoking

Lung Parenchyma

Oxygenation Process

Physiologic Dead Space

Normal part of lung that doesn’t participate in oxygenation

Tidal Volume (500 ml

15% = 350 ml

Arterial Blood Gas (ABG)

Respiratory Alkalosis

Panlobular Emphysema (Panacinar)  

• Affects upper lung

• There is destruction of the respiratory bronchiole, alveolar duct and alveolus. 

• All air spaces within the lobules are essentially enlarged, but there is little inflammatory disease.

•  A hyperinflated (hyperexpanded) chest, marked dyspnea on exertion, and weight loss typically occur. 

• To move air into and out of the lungs, negative pressure is required during inspiration. 

• And adequate level of positive pressure must be attained and maintained during expiration.

• Instead of being an involuntary passive act, expiration becomes active and requires muscular effort. 

Centrilobular Emphysema (Centroacinar)

• Affects lower lung

• Pathologic changes take place mainly in the center of the secondary lobule, preserving the peripheral portions of the acinus. 

• Frequently, there is derangement of ventilation perfusion ratios, producing chronic hypoxemia, hypercapnia, polycythemia and episodes of right sided heart failure. 

• This leads to central cyanosis and respiratory failure. 

• The patient also develops peripheral edema, which is treated with diuretic therapy.

COPD/CAL (Chronic Obstructive Pulmonary Disease/Chronic Airflow Limitation)

• Chronic Bronchitis - A productive cough that lasts 3 months in each or 2 consecutive years, in a patient whom other causes of cough are excluded. 

• Emphysema - Presence of overdistended, non- functional alveoli, which may rupture, resulting to loss of aerating surface 

• Progressive airflow limitation occurs, associated with an abnormal inflammatory response of the lungs that is not completely reversible 

• Chronic Obstructive Pulmonary disease leads to pulmonary insufficiency, pulmonary hypertension and cor pulmonale 

Assessment of COPD/CAL

1. Cough 

2. Dyspnea 

3. Chest pain 

4. Sputum production 

5. Adventitious breath sounds 

6. Pursed-lip breathing 

7. Tends to assume upright, leaning forward position 

8. Alteration in LOC (Level of Consciousness) 

9. Alteration in skin color (Pallor to cyanosis)

10. Alteration in skin temperature (cold to touch) 

11. Voice changes 

12. Deceased metabolism: weakness, fatigue, anorexia, weight loss 

13. Alteration in thoracic anatomy (barrel chest) 

14. Polycythemia 

Management of COPD/CAL

1. Rest

2. Increase fluid intake 

3. Good oral care 

4. Diet: high calorie, high protein, low carbohydrates 

5. Oxygen therapy: 1 to 3 L/m 

   • Do not give high concentration of oxygen to clients with COPD.

   • In COPD, the carbon dioxide level in the blood is consistently high. 

6. Avoid cigarette smoking, alcohol, environmental pollutants 

7. CPT (Chest Physical Therapy

8. Bronchial hygiene measures 

   • Steam inhalation 

   • Aerosol inhalation 

   • Medimist inhalation

Pharmacotherapy

• Expectorants

• Antitussives - observe for drowsiness 

• Bronchodilators - observe for tachycardia and palpitations 

• Administer bronchodilator inhalation before steroid inhalation. To open airways and ensure adequate absorption of drugs 

• Antihistamine 

• Steroids 

• Antimicrobials as ordered, if infection is present 

• Leukotriene antagonists - prevent bronchoconstriction, decrease mucosal edema and mucus production