Emphysema

What is it?

• It's a disease of the alveoli
• Alveoli are the small air sacs in the lungs
• This is where carbon dioxide is exchanged for life giving oxygen
• (Lescher 147; Olde 268-269)

Signs/Symptoms

• Having a barrel chest
• The chest is enlarged so more air can get in (inspiration)
• People breath rapidly, and shallowly (tachypnea)
• (Lescher 147; Olde 268-269)

Signs/Symptoms cont'd

• People also hyperventilate:
• They breath rapidly and deeply
• This leads to an abnormal loss of carbon dioxide from the blood
• (Lescher 147; American Lung)

Signs/Symptoms cont'd

• People also hyperventilate:
• They breath rapidly and deeply
• This leads to an abnormal loss of carbon dioxide from the blood
• (Lescher 147; American Lung)

Signs/Symtoms cont'd

• Initially, people don't:
• Have a cough, or spit up mucus
• There isn't a bronchial obstruction, or inflammation (Lescher 147)
• This can change over time (American Lung)

Smoking

• The Main Cause of Emphysema
• (Lescher 147, American Lung)

Incidence

• 3.8 Billion people in the US have emphysema
• 94% are over 45
• More women than men have the disease
• 2 Billion women vs. 1.8 Billion men
• (Lescher 147)

Genetics can contribute

• You can have a congenital lung deficiency
• There is a protective lung protein that's missing
• (The protein is Alpha 1-an-trypsin [ATT])
• Problems show up after you're 32
• (Lescher 147; Alpha-1)

Is it COPD?

• YES!
• COPD is Chronic Obstructive Pulmonary Disease
• (Lescher 147; American Lung)

COPD

• 3 Progressive Lung Diseases:
• Emphysema
• Chronic Bronchitis
• Refractory (non-reversible) Asthma
• (Lescher 147; American Lung)

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• Not everyone who smokes gets Emphysema
• Smoking just makes it more likely you will get a lung disease
• People can have multiple lung ailments
• For example: People can have both Emphysema and Chronic Bronchitis
• (American Lung)

Early Stage

• People may be short of breath - but only when they're active (Lescher 147)
• Best thing: Stop smoking (American Lung; Olde 270)
• Health plans help pay for patients to stop smoking
• (smoking cessation programs)

Early Stage Treatment

• People can take medications:
• Bronchiodilators
• (these allow more air to flow into the lungs)
• Steroids - in aerosol sprays
• (these help with shortness of breath)
• (American Lung)

Later Stage

• There's no cure
• People are short of breath (dyspnea) all the time
• The walls of the alveoli have been destroyed
• Lung elasticity has been lost (American Lung; Olde 270)

Later Stage cont'd

• People have trouble breathing:
• The lungs can't expand or contract
• There's less area in the lungs for gaseous exchange
• (i.e., exchanging carbon dioxide for oxygen)
• (American Lung)

Later Stage cont'd

• Air can't be expelled from lungs (can't push air out)
• Fresh air can't get into lungs
• People have a high risk of getting infections, like:
• the flu, pneumonia, etc.
• (American Lung; Olde 269)

Advanced Emphysema

• Requires oxygen therapy
• Need to use a portable oxygen tank all the time
• May need surgery
• (American Lung)

Surgery Options

• Lung volume reduction
• (a small section of the damaged lung tissue is removed)
• Lung transplant
• (this is rare - it is performed when all else has failed)
• Challenge: Must find a matching donor to provide new lungs (American Lung; American Thoracic; Innes)

Adjunct to Surgery

• Pulmonary Rehabilitation
• It helps patients prepare for surgery
• It makes it easier for people to recover following surgery
• Goal:
• Restore patients to their highest level of independent function
• (American Lung; American Thoracic)

Pulmonary Rehab - What is it?

• It's a combination of upper and lower extremity exercises
• There's an education component
• There's also psychosocial support
• (American Lung; American Thoracic)

With Moderate Exercise:

• People have more energy
• They're able to breath easier
• People have greater cardiovascular fitness
• They tend to be less anxious, and cope with stress better
• (American Lung; American Thoracic)

Results from Rehab

• People become more physically active
• They learn more about their disease
• People learn about treatment options
• They learn how to cope with their disease
• (American Lung; American Thoracic)

A Procedure being Tested

• The Zephyr Endobronchial Valve
• A small plastic part is inserted into the lung
• This closes off areas of damaged lung
• (Webster)

Zephyr Edobronchial Valve cont'd

• Surgery takes only 30 minutes
• Patients can live without supplemental oxygen
• It's approved for use in Europe
• Trials are taking place in the U.S. (Webster)

Bibliography

• Alpha-1 Foundation. n.d. Web. 26 May 2016.
• American Lung Association. n.d. Web. 26 May 2016.
• American Thoracic Society. n.d. Web. 26 May 2016.

Bibliography cont'd

• Innes Y. P. Wan, et. al. "Bronchoscopic lung volume reduction for end-stage emphysema*: report on the first 98 patients." Chest March 2006: 518+. 26 May 2016.
• Lescher, Penelope J. Pathology for the Physical Therapist Assistant. Philadelphia: F. A. Davis, 2011.

Bibliography cont'd

• Olde, Teresa G. "Emphysema." The Gale Encyclopedia of Environmental Health. Ed. Jacqueline L. Longe. Vol. 1. Detroit: Gale, 2013. 268-271. Gale Virtual Reference Library. Web. 26 May 2016.
• Webster, Richard A. "New Orleans CityBusiness." 7 February 2005. New Orleans CityBusiness. The Dolan Media Holding Company. Web. 26 May 2016.