Sunday, January 15, 2006

emphysema

Pulmonary emphysema is characterized by changes in the lung tissue with distention of the alveolar sacs (lining of lungs), rupture of the alveolar wall, and destruction of the alveolar capillary bed. This loss of elasticity results in the trapping of air that should be expired. Emphysema is found more frequently in men. In those over 60, it occurs in 60 per 1,000 persons. Mortality from emphysema increases with age from approximately 200 per 100,000 for those between 65 and 70 years of age to 450 per 100,000 for those over age 75.
One of the earliest symptoms is exertional dyspnea (labored breathing). As the disease progresses, shortness of breath may be present even when resting. A chronic cough with productive yellowish white sputum is present. Inspiration is difficult because the accessory muscles of respiration are used and expiration is prolonged and often accompanied by wheezing. The patient may appear anxious and pale. During expiration the veins in the neck are distended. In advanced pulmonary emphysema the patient may have a loss of memory, drowsiness, confusion, and loss of judgment.
These changes are due to a marked reduction in oxygen reaching the brain and an increased amount of carbon dioxide in the blood. If untreated the level may reach toxic levels resulting in lethargy, stupor, and coma. The diagnosis is made by physical examination, X-ray films and fluoroscopy (exam that shows shadows of X-ray as they pass through the body). Pulmonary functions and blood gas studies are useful. Bronchospasm (spasmodic contraction of the smooth muscle of the larger air passages of the lungs) may be reduced by epinephrine and aminophylline. In the advanced stages of the disease bronchospasms may be responsive to bronchodilator therapy.
See also ASTHMA.
Rogers, S. C., and McCue, J. D. Managing Chronic Disease. Oradell, N.J.: Medical Economics Co., 1987.
Scherer, J. C. Introductory Medical-Surgical Nursing. Philadelphia: J. B. Lippincott Co., 1982.

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