emphysema by Raafat Al-Awadhi for nursing.pptx

Nursing College

1. EMPHYSEMA By: Dr.Raafat AL-Awadhi

2. DEFINITION: Emphysema , or  pulmonary emphysema , is a  lower respiratory tract disease ,characterised by air-filled spaces ( pneumatoses ) in the  lungs , that can vary in size and may be very large. The spaces are caused by the breakdown of the  walls  of the  alveoli  . This reduces the total alveolar surface available for  gas exchange  leading to a reduction in oxygen supply for the blood.

3. TYPES Centrilobular Centrilobular emphysema, also called  centriacinar emphysema , affects the centre of a  pulmonary lobule  ( centrilobular ) in the lung. Centrilobular emphysema is the most common type usually associated with smoking, and with  chronic bronchitis . Usually the upper lobes of the lungs are affected .

4. Panlobular : Panlobular emphysema, also called  panacinar emphysema  affects all of the alveoli in a lobule and can involve the whole lung or mainly the lower lobes .  This type of emphysema is associated with  alpha-1 antitrypsin deficiency  (A1AD or AATD),  And is not related to smoking

5. Paraseptal Paraseptal emphysema, also called  distal acinar emphysema  relates to emphysematous change next to a  pleural   surface. This type of emphysema is not associated with airflow obstruction.

6. ETIOLOGY Smoking (the main cause)  Exposure to air pollution, such as chemical fumes, dust, and other substances. Irritating fumes and dusts at work. A rare, inherited form of the disease called alpha 1-antitrypsin (AAT) deficiency-related pulmonary emphysema or early onset pulmonary emphysema.

7. PATHOPHYSIOLOGY Proteases play an important role in health and disease of the lung. In the normal lungs, proteases maintain their homeostatic functions that regulate processes like its regeneration and repair.

8. CLINICAL MANIFESTATIONS

9. DIAGNOSTIC EVALUATION Imaging tests A chest X-ray can help support a diagnosis of advanced emphysema and rule out other causes of shortness of breath. But the chest X-ray can also show normal findings if you have emphysema. Lab tests-ABG Blood taken from an artery in your wrist can be tested to determine how well your lungs transfer oxygen into, and remove carbon dioxide from, your bloodstream. Lung function tests These noninvasive tests measure how much air your lungs can hold and how well the air flows in and out of your lungs. They can also measure how well your lungs deliver oxygen to your bloodstream. One of the most common tests uses a simple instrument called a spirometer, which you blow into.

10. MANAGEMENT Medications Depending upon the severity of your symptoms: Bronchodilators.  These drugs can help relieve coughing, shortness of breath and breathing problems by relaxing constricted airways e.g Salbutamol . Inhaled steroids.  Corticosteroid drugs inhaled as aerosol sprays reduce inflammation and may help relieve shortness of breath.EG. PREDNISOLONE Antibiotics.  If you have a bacterial infection, like acute bronchitis or pneumonia, antibiotics are appropriate. EG. ceftriaxone. levofloxacin ، cefepime . , piperacillin-tazobactam aztreonam (used to treat certain infections that are caused by bacteria

11. Combination Inhaled Medicines Albuterol and ipratropium ( Combivent Respimat ; Duoneb ) Budesonide and formoterol ( Symbicort ) Fluticasone and salmeterol ( Advair ) Fluticasone and vilanterol ( Breo Ellipta ) Formoterol and mometasone ( Dulera ) Tiotropium and olodaterol ( Stiolto Respimat ) Azithromycin and roflumilast   (is a selective phosphodiesterase-4 inhibitor indicated to decrease the risk of exacerbations in patients with severe chronic obstructive pulmonary disease (COPD)) are available to reduce exacerbating symptoms

12. SURGICAL MANAGEMENT Lung volume reduction surgery (LVRS) is a surgical option to treat emphysema , and is only performed when the use of all medical treatments (medications, pulmonary rehabilitation) have been tried and symptoms still persist. During the surgery, 20% to 30% of the most diseased portions of the lung are removed.

13. SURGICAL COMPLICATION Lung infections such as pneumonia. Sepsis (a serious whole-body infection) Pneumothorax (collapsed lung) Respiratory failure. Slow or impaired wound healing

14. NURSING MANAGEMENT