Emphysma. a condition of lower respiratory tract

dialitation of bronchi

1. EMPHYSEMA
By
MUTEGEKI ADOLF

2. Learning Objectives
By the end of this lecture, learners should be able to:
•Define Emphysma
•Describe the Pathophysiology of Emphysma
•Explain Classes of Emphysma
•Outline Causes Emphysma
•Make Diagnosis and Treat a patient presenting with Emphysma
•State Preventive measures for Emphysma

3. Definition: Emphysema is a chronic, progressive
lung condition characterized by the destruction of
the alveoli, the tiny air sacs in the lungs where gas
exchange occurs.
•This destruction leads to the formation of larger
air spaces and reduces the surface area available
for gas exchange, resulting in difficulty breathing
and reduced oxygen supply to the body

4. Incidence
•The national health interview survey reports the
prevalence of emphysemaat18 cases per 1000
persons and chronic bronchitis at 34 cases per
1000 persons.

5. Pathophysiology
•In emphysema, the walls between the alveoli are damaged, causing
them to lose their elasticity and become less efficient in expelling
air.
•This results in air becoming trapped in the lungs, leading to
hyperinflation.
•The breakdown of alveolar walls is primarily due to an imbalance
between proteases (enzymes that break down proteins) and
antiproteases(enzymes that protect tissues from damage) in the
lungs.
•This imbalance is often caused by chronic exposure to harmful
substances like cigarette smoke, which increases protease activity
and decreases antiproteaseactivity, leading to tissue destruction.

9. Signs and symptoms
•Breathlessness with exertion or even at rest
•Swelling of the legs, ankles and feet
•Bloating of abdomen due to fluid build up
•Chronic cough: Often with sputum production.
•Wheezing
•Barrel chest:Increased anterior-posterior diameter of the chest due to lung
hyperinflation.
•Weight loss
•Cyanosis

10. Classification
•Emphysema can be classified into different types based on the location and
pattern of alveolar damage:
1. Centriacinar(Centrilobular) Emphysema:
•Affects the central portions of the acini(clusters of alveoli) in the upper lobes of the
lungs.
•Most commonly associated with smoking.
2. Panacinar(Panlobular) Emphysema:
•Affects the entire acinus, typically in the lower lobes.
•Often associated with alpha-1 antitrypsin deficiency, a genetic disorder.
3. ParaseptalEmphysema:
•Affects the distal part of the acinus, usually near the pleura (outer lining of the lung).
•Can be associated with spontaneous pneumothorax.
4. Irregular Emphysema:
•Characterized by irregular involvement of the acinus, often associated with scarring.
•Not a specific pattern and often found incidentally.

11. Risk factors/ Causes
•Smoking:The leading cause of emphysema, accounting for the
majority of cases.
•Air pollution:Long-term exposure to air pollutants can contribute to
lung damage.
•Occupational exposure:Inhalation of dust, chemicals, or fumes in
certain work environments.
•Genetic factors:Alpha-1 antitrypsin deficiency is a genetic disorder
that increases the risk of developing emphysema, particularly in non-
smokers.
•Aging:Age-related changes in lung tissue may contribute to the
development of emphysema.

12. Diagnostic evaluation
1. History taking and physical examination
2. Lung function tests :Spirometry:Measures the amount of air a person can
inhale and exhale, and how quickly they can exhale. Key findings in
emphysema include:
•Reduced FEV1 (Forced Expiratory Volume in 1 second):A hallmark of obstructive
lung diseases.
•Reduced FEV1/FVC ratio (Forced Vital Capacity):Typically below 70%, indicating
airflow obstruction.
•Increased Residual Volume (RV) and Total Lung Capacity (TLC):Due to air trapping
and hyperinflation

13. •Lung volumes:Measures the volume of air in the lungs
at different phases of the breathing cycle. Emphysema
patients often have:
•Increased RV and TLC:Reflecting hyperinflation.
•Decreased Diffusing Capacity of the Lung for Carbon
Monoxide (DLCO):Indicative of impaired gas exchange due
to alveolar destruction.

14. 3. Imaging Studies
•Chest X-ray:Can show signs of hyperinflation, such as a flattened
diaphragm, increased retrosternal air space, and a long, narrow
heart shadow.
•May show reduced vascular markings in the peripheral lung fields.
•High-Resolution Computed Tomography (HRCT) of the Chest:
•More sensitive than a chest X-ray in detecting emphysema.
•Can show areas of low attenuation (dark areas) due to air trapping,
as well as bullae (large air-filled spaces) and destruction of lung
parenchyma.
•Useful for assessing the type (e.g., centrilobular, panlobular) and
extent of emphysem

15. 4. Arterial Blood Gas (ABG) Analysis:
Measures the levels of oxygen (PaO2), carbon
dioxide (PaCO2), and blood pH.
•Hypoxemia (low PaO2):Common in advanced
stages of emphysema.
•Hypercapnia(high PaCO2):May occur in
severe cases due to impaired gas exchange.
•Respiratory acidosis:A potential finding in
advanced or acute exacerbations.

16. 5. Alpha-1 Antitrypsin (AAT) Levels
•Serum alpha-1 antitrypsin levels:
•Tested in patients, especially younger ones, non-smokers, or those with a family
history of emphysema to check for AAT deficiency, a genetic condition that can cause
emphysema.
6. Oximetry: Pulse oximetry:
•A non-invasive method to measure blood oxygen saturation (SpO2). It helps in
monitoring oxygen levels in the blood, especially during exertion or sleep.
7. Six-Minute Walk Test (6MWT)
•Assesses exercise tolerance and the impact of emphysema on daily
activities.
•Measures the distance walked in six minutes and monitors oxygen levels
during the test.

17. 8. Electrocardiogram (ECG) and Echocardiography
•ECG:Used to assess the impact of emphysema on the
heart, especially to detect signs of right heart strain (cor
pulmonale) due to pulmonary hypertension.
•Echocardiography:Can assess the function and size of
the right ventricle, and check for pulmonary
hypertension.
9. Sputum Analysis: To identify bacterial infections that
might cause exacerbations of chronic obstructive
pulmonary disease (COPD), which includes emphysema.

18. Complications
•Collapsed lung (pneumothorax):
•Heart problems
•Bullae (Large holes in the lungs)
•Pulmonary Hypertension
•Respiratory Failure

19. Management
•The management of emphysema primarily focuses on relieving symptoms,
preventing complications, and slowing disease progression
1. Bronchodilators
•Short-Acting Beta-2 Agonists (SABAs)
•Example: Albuterol (Salbutamol)
•Long-Acting Beta-2 Agonists (LABAs)
•Example: Salmeterol
•Short-Acting Muscarinic Antagonists (SAMAs)
•Example: Ipratropium
•Long-Acting Muscarinic Antagonists (LAMAs)
•Example: Tiotropium

20. •Anticholinergic e.gAtropine
•Cortical steroids e.gPrednisolone
•Mast cell stabilizers e.gcromolynsodium
•Xanthine Derivatives e.gtheophylline, Aminophylline
•Oxygen therapy:For patients with severe hypoxemia
(low blood oxygen levels).
•Pulmonary rehabilitation:A program of exercise,
education, and support to help patients manage their
symptoms.

21. Surgical interventions:
•Lung volume reduction surgery (LVRS):Removal of
damaged lung tissue to improve lung function.
•Lung transplantation:For patients with end-stage
emphysema who are suitable candidates.
•Management of exacerbations:Prompt treatment
of respiratory infections and exacerbations with
antibiotics, steroids, and bronchodilators.

22. Prevention
•Avoid smoking:The most effective way to prevent emphysema is to avoid
smoking or quit if you currently smoke.
•Avoid exposure to lung irritants:Limit exposure to air pollution, chemical
fumes, and dust.
•Protective equipment:Use masks or respirators if working in environments
with lung irritants.
•Regular vaccinations:Get vaccinated against influenza and pneumococcal
pneumonia to reduce the risk of respiratory infections.
•Early detection and management:Regular check-ups, especially for those
at risk, to detect and manage the condition early.

23. •END