Emphysema ppt
- 2. DEFINITION Emphysema ( From greek word for ‘inhalation’)is a lung disease that involves damage to the air sacs (alveoli)in the lungs. Emphysema is a long- term ,progressive disease if the lungs causes shortness of breath due to over-inflation of the alveoli (air sacs in the lungs).
- 5. Causes & risk factors Emphysema develops due to: Smoking cigarettes Inhaling toxins or other irritants Alpha1-antitrypsin deficiency (A1AD)—a genetic defect which can cause emphysema t an early stage in non smokers.
- 6. These factors increase the chance of developing emphysema: Smoking cigarettes & long term second hand or passive smoke exposure. Family members with emphysema Exposure to pollutants at work (chemicals,fumes or dust) Exposure to indoor and outdoor pollution Frequent lower respiratory tract infections
- 7. History of frequent childhood lung infections Connective tissue disorders(ehlers-danlos syndrome,marfan syndrome) HIV infection
- 15. Types of emphysema The 4 described morphological types of emphysema are : 1. Centri acinar emphysema 2. Panacinar emphysema 3. Paraseptal emphysema 4. Irregular emphysema
- 16. 1. Centriacinar Centri acinar emphysema begins in the respiratory bronchiole and spreads to peripherally. Also termed centrilobular emphysema, this form is associated with long standing cigarette smoking predominantly involves destruction of bronchioles in the upper lobe of lungs but the alveolar sac remain in contact.
- 17. Centri acinar
- 18. 2. panacinar In panacinar or panlobular emphysem there is a destruction of the respiratory bronchioles, alveolar duct & alveoli in the lower half of the lungs. Panacinar emphysema is generally is observed in patients with homozygous alpha1- antitrypsin(AAT) deficiency. In people who spoke , focal panacinar emphysemaat the lung bases may accompany centriacinar emphysema.
- 19. panacinar
- 20. 3. Paraseptal emphysema Paraseptal emphysema,also known as distal acinar emphysema, preferentially involves the distal airways structures ,alveolar ducts,and alveolar sacs . The process is localized around the septea of the lungs or pleura. Although the airflow frequently is preserved ,the apical bullae may lead to spontaneous pneumothorax. Giant bullae occassionally cause severe compression of adjacent lung tissue.
- 22. 4. Irregular emphysema Irregular emphysema refers to the any part of the bronchiole or alveoli or ducts of alveoli .
- 25. pathophysiology Due to etiological factors Inherited α-1 anti-trypsin deficiency Inflammation of airway epithelium Neutrophils¯ophages release elastage Infiltration of inflammatory cells & release of cytokines Α-1 anti-trypsin deficiency leads to failure of elastage inactivation Increased protease activity with breakdown of elastin in connective tissue of lungs
- 26. Loss of elastic recoil of bronchial wall from breakdown of elastin by the elastage lungs become damaged because of reaction of irritants entering airways & alveoli Irreversible enlargement of the air spaces distal to the terminal bronchioles Collapse of terminal bronchioles causing airway obstruction
- 27. Desctruction of alveolar walls,reduces lung surface available for gas exchange Loss of fibrous &muscle tone breakdown of alveolar elasticity Inability of the lungs to supply sufficient air supply to body Impaired oxygen diffusion causes hypoxemia. inability of alveoli recoil normally after expanding Bronchial collapse. amount of air that can be expired is diminished Air trapped in lung causes over distention of lungs
- 28. Cinical manifestations Emphysema usually slowly. Emphysema symptoms are mild to begin with but steadily get worse as the disease progresses. Early symptoms include: Coughing in the morning Coughing up clear sputum (mucus from deep in the lungs) Wheezing Shortness of breath during activity Decreased excercise tolerance
- 29. As the disease progresses ,patient may experience: Increased shortness of breath Rapid breathing Choking sensation when lying flat Bluish lip and complexion(cyanosis) due to lack of oxygen in the blood Fatigue Increase in chest size(barrel chest) Coughing up thick & bloody mucus Swelling in the ankles &legs Loss of appetite & reduced weight Desired to lean forward to improve breathing Heart failure
- 30. Diagnostic evaluations Health history & physical examination Spirometry & other pulmonary function tests Chest x-ray &/ or CT of the chest ABG analysis CBC Pulse oximetry Sputum examination Pulmonary ventilation/perfusion scans Testing for alpha-1 antitrypsin deficiency(AAT deficiency)
- 32. Medical management Treatment for emphysema can take many forms. Different approaches to treatment are available. Smoking cessation is the most important & effective treatment. Only quitting smoking can stop the progession of lung damage once it has started .
- 33. Medications used to improve brathing include: Bronchodilators: salmetrol, powder inhaler devices, nebulizer, ipratropium bromide, albuterol, theophylline, formetrol Diuretics Corticosteroids Antiboitics Steroids: corticosteriods, aerosal sprays vaccines against flu & pneumonia are recommended for people with emphysema.
- 34. Deep breathing & coughing excercises Chest percussion Postural drainage Breathing techniques
- 35. Surgical management LUNG REDUCTION SURGERY: In an experimental procedure called (LVRS), surgeon remove small wedges of damaged lung tissue . Removing the diseased tissue helps the lungs work more efficiently & helps improve breathing . Lung reduction may eliminate the need for supplemental oxygen & makes it much easier for the person to breath.
- 36. In an another surgery ,called bullectomy, doctors remove one or more of the large air spaces called bullae that form when the small air sacs are destroyed . This is procedure can improve breathing. BULLECTOMY
- 37. Lung transplantation Lung transplant surgery is another treatment that may small number of emphysema suffers. A lung transpkant is a complex procedure that carries substantial risk of complications. This type of surgery is performed only at major hospitals & medical centers.
- 38. Pulmonary rehabilitation pulmonary rehabilitation is probably the most effective therapy for COPD patients with emphysema . It improves quality of life and decreases hospitalization . Pulmonary rehabilitation includes education , nutrition, counselling, learning special breathing techniques, help with quitting smoking and starting an exercise regimen. Because people with emphysema are often physically limited , they may avoid any kind of physical activity .
- 39. Nursing management Assess for signs & symptoms of hypoxia and hypercapnia. Auscultation chest to listen to breath sounds every hour . Increase or decrease in PaO2 PaCO2. Encourage the patient to stop smoking and avoid air pollution including second hand cigarette smoke. Drink plenty of water Adequate nutritional intake