What is Emphysema

   Respiratory system

The Respiratory system is the network of organs and tissues that help you breathe. It includes airways, lungs, and blood vessels. The muscles that power your lungs are also part of the Respiratory system. These parts work together to move oxygen throughout the body and clean out waste gases like carbon dioxide.

The respiratory system has many functions. The following are the five key functions of the respiratory system.

1. Inhalation and Exhalation are pulmonary ventilation—that’s Breathing.

2. External respiration exchanges gases between the lungs and the blood stream.

3. Internal respiration exchanges gases between the bloodstream and body tissues.

4. Air vibrating the vocal cords creates sound.

5. Olfaction, or smelling, is a chemical sensation

The respiratory system has many different part that work together to help you breathe. Airways deliver air to the lungs. The airways include

•Mouth and nose˸ Openings that pull air from outside your body into your respiratory system.

•Sinuses˸ Hollow areas between the bones in your head that help regulate the temperature and humidity of the air you inhale.

•Pharynx (throat) Tube that delivers air from your mouth and nose to the trachea.

•Epiglottis A structure that hangs at the entrance of the larynx and Prevents food from entering the larynx and the trachea while swallowing.

Respiratory system cont ..

•Larynx (voice box) ˸ Hollow organ that connects the pharynx with the trachea, and allows you to talk and make sounds when air moves in and out.

•Trachea (windpipe) ˸ Passage connecting your throat and lungs.

•Bronchial tubes˸ Tubes at the bottom of your windpipe that connect into each lung.

•Lungs˸ Two organs that remove oxygen from the air and pass it into your blood.

From the lungs, the bloodstream delivers oxygen to all organs and other tissues. Muscles and bones help move the air you inhale into and out of your lungs. Some of the bones and muscles in the respiratory system.

•Diaphragm Muscles that helps your lungs pull in air and push it out.

•Ribs Bones that surround and protect your lungs and heart.

When you breathe out, your blood carries CO2 and other waste out of the body. Other components that work with the lungs and blood vessels include

•Alveoli˸ Are an important part of the respiratory system, located at the very end of the respiratory system. Alveoli are tiny balloon shaped structures and a network of capillaries surround each alveolus. It is the smallest passageway of the respiratory system. Whose function it is to exchange oxygen and carbon dioxide molecules to and from the blood stream.

•Bronchioles˸ Small branches of the bronchial tubes that lead to alveoli.

•Capillaries˸ Blood vessels in the alveoli walls that move O2 and CO2.

•Pleura Membranes that cover the lungs, which secrete slippery fluid that decreases friction from the movement of the lungs during breathing.

•Cilia˸ Tiny hairs that move in a wave like motion to filter dust and other irritants out of the airways.

Emphysema

Emphysema is a respiratory disease, and it is a type of COPD (Chronic obstructive pulmonary disease). COPD is a group of lung diseases that make it hard to breathe and get worse over time.

In emphysema, the lung’s air sacs, called alveoli, become damaged. The walls of air sacs grow weak and lose their elastic qualities. These natural elastic fibers help you to breathe out after you take a breathe in. 

Eventually these alveoli can rupture, forming empty spaces called bullae. Small airways also become narrow, reducing the flow of air. The combination of damaged alveoli and narrowed airways cause problems with breathing out. The number of individuals with emphysema in the united states is estimated to be 2 million. 

Smoking is number one factor. Because of this, emphysema is one of the most preventable types of respiratory diseases. Air pollutants in the home and workplace, genetic (inherited) factors (alpha-1 antitrypsin deficiency), and respiratory infections can also play a role in causing emphysema.

Emphysema symptoms

Early Symptoms of Emphysema

You can have emphysema for years and not know it. But there is one major symptom and it usually starts slowly: shortness of breath.

Symptoms of Moderate Emphysema

In addition to shortness of breath, you may also have:       

•Wheezing

•A cough that won’t go away​

•Chest tightness or pain​

•Reduced Exercise Tolerance

Severe Symptoms and Complications of Emphysema

As your emphysema gets worse, you may notice:

•Loss of appetite

•Depression

•Sleep problems

•Blue lips 

•Fatigue

•Frequent lung infections

•Morning headaches

•Weight loss

•Heart Disease

•Pulmonary Hypertension

•Respiratory Failure

Living with Emphysema

After a diagnosis of emphysema, you are likely to feel a lot of different emotions such as shock, worry, fear, anxiety… this is normal. It may take some time to come to terms with this and to find out more information about your available emphysema treatment options. You may need to make some changes to your life, for example, stopping smoking or starting an exercise regime. 

There is no way to say how emphysema will affect a person’s life, because each person is an individual and will experience their symptoms differently. The condition progresses differently for everybody. However, below we explore different aspects of life with emphysema.

Impact on daily living

People with emphysema are still able to find a good quality of life. Many still work, socialise, travel and so on. Depending on how severe your condition is, you may find some aspects of daily life challenging due to being breathless or fatigued. This is more likely for anyone living with advanced emphysema.

• Getting around – mobility can sometimes be an issue for people with severe emphysema and you may require some mobility equipment. (Mobility aids: Transit wheelchair)

• Sleeping and relaxing – feeling out of breath can be discomforting and stressful, with some people finding breathlessness symptoms worse at night, resulting in poor quality sleep. (Bed and chair aids: Electrically operated bed)

• housework – again, fatigue and breathlessness can mean that doing chores  becomes difficult. (Aids for household chores:

Household trolley)

• Mental health – it can be difficult to live with a health condition, and some people find they have low mood, anxiety, anger, stress or depression as a result. for advice consider counselling to discuss your problems . 

Managing the Disease

Ideally, you should lead a healthy life style that includes not smoking, eating healthy foods, having normal body weight, exercising regularly, getting 7 – 8 hours of sleep each night, and avoiding too much stress. A yearly flu shot is recommended to reduce the chances of getting the flu. There are two different pneumonia shots which are recommended to prevent to the most common bacterial cause of pneumonia. It is important to use your inhaled medications correctly and as prescribed by your healthcare provider on a regular schedule.

Diet for emphysema

Keeping to a healthy weight and eating healthy foods is important for people with emphysema, to help ensure the lungs and heart are not put under additional stress. There is no definitive emphysema diet to follow, except for a balanced one. Drinking lots of fluid, especially water, can help to reduce excess mucus and flush toxins through the body 

Exercise for emphysema

You will be advised to get regular, aerobic exercise that gets your heart beating faster. You may be advised to go on a pulmonary rehabilitation course.

Emphysema and employment

People with emphysema may be able to continue to work. Some may need to change jobs or reduce their hours. Everyone is different. If you decide to continue to work, you may benefit from telling your employer about your condition.

The diagnosis of Emphysema

The diagnosis of emphysema cannot be made solely on symptoms. Several tests are used to make the diagnosis. The doctor will review your medical history, asking in particular if you are a smoker or if you are always around hazardous fumes or pollutants at work or at home.

The following tests may then be conducted to make a definite diagnosis: 

Chest Radiography

X-rays are generally not useful for detecting early stages of emphysema. However,

X-rays can help diagnose moderate or severe cases. Once the test is completed, the readings are compared to X-rays of healthy or normal lungs.

High Resolution Computed Tomography (HRCT)

(HRCT) scanning is more sensitive than standard chest radiography. HRCT scanning is highly specific for diagnosing emphysema and outlines bullae that are not always observed on radiographs. A CT scan is indicated when the patient is being considered for a surgical

intervention such as bullectomy or lung-volume reduction surgery. A CT scan is not indicated in the routine care of patients with COPD.

Pulmonary Function Tests (PFT)

These measurements are necessary for the diagnosis of obstructive airway disease and for assessments of its severity. In addition, spirometry is helpful for assessing responses to treatment and disease progression. A (PFT) tests the lung’s volume by measuring airflow while the patient inhales and exhales. This test is done by taking a deep breath and then blowing into a tube that is hooked up to a specialized machine. These tests are compared to normal results from people of similar gender, age, height, weight and ethnic background

Arterial blood gas analysis

Patients with mild chronic obstructive pulmonary disease (COPD) have mild-to-moderate hypoxemia without hypercapnia. As the disease progresses, hypoxemia worsens and hypercapnia develops. This test measures the amount of oxygen and carbon dioxide in blood from and artery. It’s a test often used as emphysema worsens. It’s especially helpful in determining if a patient needs extra oxygen.

Sputum evaluation

In patients with stable chronic bronchitis and in emphysema, the sputum is mucoid and the predominant cells are macrophages. Analysis of cells in the sputum can help determine the cause of some lung problems.

Pulse oximetry

This test is also known as an oxygen saturation test. Pulse oximetry is used to measure the oxygen content of the blood. This is done by attaching the monitor to a person’s finger, forehead, or earlobe.

Electrocardiogram (ECG)

ECGs check heart function and are used to rule out heart disease as a cause of shortness of breath.

Emphysema Treatment & Management

The goal of therapy is to relieve symptoms, prevent disease progression, improve exercise tolerance and health status, prevent and treat complications and exacerbations, and reduce mortality.

This article deals with some of the most common treatments, they include:

(Medications)

Bronchodilators

Bronchodilators are the backbone of any COPD treatment regimen. They work by dilating airways and thereby decreasing airflow resistance. This increases airflow and decreases dynamic hyperinflation. Bronchodilators often use an inhaler (” puffer”) they also come in pill or liquid form, but these don’t work as well as an inhaler, and they can have more side effects.

There are short-acting and long-acting bronchodilators.

Bronchodilators come in two forms:

Anticholinergics stop the muscles around your airways from tightening. They also make it easier to clear mucus from the lungs. 

Beta-agonists relax muscles around the airways.

Inhaled Corticosteroid Medications

Inflammation plays a significant role in the pathogenesis of COPD. Oral and inhaled corticosteroids (ICS) attempt to temper this inflammation and positively alter the course of disease and may help relieve shortness of breath. Over time, long-term side effects of these drugs include weight gain, osteoporosis, hypertension, high blood suger and cataracts.

Antibiotics

Respiratory infections such as acute bronchitis, pneumonia, and influenza can aggravate emphysema symptoms. Antibiotics treat these infections.

Vaccination

Infections can lead to COPD exacerbations. Vaccinations are a safe and effective modality to reduce infections in susceptible COPD patients.

(Therapy)

Oxygen therapy

Oxygen therapy is prescribed for patients whose lungs are not getting enough oxygen to the blood and may require supplemental oxygen. Oxygen comes in various forms and may be delivered with different devices.

Protein Therapy

Some people have an inherited form of emphysema that’s caused by a lack of the protein alpha-1 antitrypsin (AAT) Getting infusions of AAT can help slow down lung damage.

Pulmonary Rehabilitation

Pulmonary rehabilitation (PR) is beneficial for symptomatic medically stable patients with COPD and supervised, center-based PR is also effective during or soon after acute exacerbations. Which including nutrition, counseling, learning special breathing techniques, help with quitting smoking and starting as an exercise regimen.

(Surgery)

There are a number of different types of operations for more serious cases of emphysema. They include:

Lung volume reduction surgery

Lung volume reduction surgery (LVRS) attempts to decrease hyperinflation by surgically resecting the most diseased parts of the

lung. This improves airflow by increasing the elastic recoil of the remaining lung.

Lung transplantation

Reserved for treating patients with very severe emphysema who do not have other treatment options. A lung transplant involves removing a damaged lung and replacing it with a healthy lung from a deceased donor. Lung transplants can significantly improve lung function and quality of life, but involves many risks, including the risk of infection, and even death if the body rejects the transplanted lung. 

Bullectomy 

In rare cases, air sacs in the lungs caused by emphysema grow larger and can press against healthy parts of the lung. These oversized sacs are called bullae. Giant bullae may compress adjacent lung tissue, reducing the blood flow and ventilation to the relatively healthy lung. Bullectomy is surgery to remove them. Removal of these bullae may result in expansion of compressed lungs and improvement of lung function.

Mucolytics

Mucolytic agents reduce sputum viscosity and improve secretion clearance. Although mucolytic agents have been shown to decrease cough and chest discomfort, they have not been shown to improve dyspnea or lung function