Emphysema Essay Sample
Emphysema occupies one of the leading places among the most common respiratory diseases with severe symptoms. The sickness rate of emphysema is constantly increasing, especially in elderly people. Autopsies reveal it in more than 60% of patients who died after 60 years, while clinicians diagnose it in less than 20%. A significant prevalence of this disease, its progressive course, temporary disability, and early disability of patients due to the development of respiratory failure and the pulmonary heart pose great threat to people. The aim of the term paper is to analyze causes, signs and symptoms, treatment, and prognosis of the disease.
Definition of the Disease
Emphysema is an anatomical alteration of lungs characterized by an abnormal expansion of the airspace located distal to the terminal bronchioles and accompanied by destructive changes of the alveolar walls. In the book Color Atlas of Pathophysiology, the authors give the following definition, “Emphysema is characterized by an increase in the volume of the airways distal to the bronchioles” (Silbernagl & Lang, 2011, p. 82). In accordance with this definition, an inherent feature of emphysema is considered to be not only expansion but also destruction of the respiratory portions of the lungs. Moreover, the term destruction should be understood not only as a failure but as a violation of the normal structure. Emphysema, along with chronic obstructive bronchitis and asthma, refers to a group of chronic obstructive pulmonary disease (COPD). Such diseases are accompanied by the bronchial obstruction (Silbernagl & Lang, 2011). In such a way, there is the similarity in the clinical picture of these diseases. However, each of the forms of COPD has its specific characteristics, and correct diagnosis of these diseases allows conducting the purposeful prevention and rational therapy.
History of the Disease
Despite numerous studies on the problem of emphysema, many aspects that reflect the essence of this pathological phenomenon, its causes, patterns of the development, possibility of timely diagnosis, as well as prevention and treatment, remain insufficiently studied. In the book Thurlbeck’s Pathology of the Lung, it is stated that “inflation of the lung was first introduced by Laennec in the early XIX century, enabling him to make the first adequate description of emphysema” (Churg, Myers, & Tazelaar, 2011, p. 109). A complete description of the clinical picture of emphysema belongs to Sergey Botkin (Churg, Myers, & Tazelaar, 2011). In 1887, he was the first to identify acute reversible pulmonary hypertension as a special form of emphysema (Churg, Myers, & Tazelaar, 2011).
Pathogenesis of the Disease
According to pathogenesis, emphysema can be primary and secondary. Primary emphysema develops without preceding respiratory pathology. It is an independent nosological form. Previously, primary emphysema has been known as idiopathic and self-existing as its causes are still insufficiently clear. However, in recent years, many researchers affirm that genetic factors, in particular a shortage of Alpha-1 antitrypsin, can be the reason of its development. Secondary emphysema appears on the background of other respiratory diseases, especially chronic obstructive bronchitis. According to the prevalence of lesions, there are diffuse and localized forms of emphysema. Primary and secondary emphysema developed on the background of chronic obstructive bronchitis refers to the diffuse form of the disease (Silbernagl & Lang, 2011).
Exogenous factors that cause the development of emphysema include smoking, air pollution, and lung infections. Tom Smith states that “far and away, the most important cause of COPD is tobacco smoking” (Smith, 2012, p. 57). Cadmium, oxides of nitrogen, and sulfur are among the most likely components of tobacco smoke causing the disease (Smith, 2012). Among the factors causing the development of emphysema, pollutants and occupational hazards are of great importance. They have a damaging effect on the lung tissue and lead to the formation of chronic processes in the respiratory tract. Pulmonary infection is one of the causes of emphysema. Infectious inflammation stimulates the proteolytic activity of macrophages and neutrophils. Bacteria can also act as an additional source of proteolytic agents (Smith, 2012).
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Pathological Anatomy of Emphysema
Changes in the histological pattern of emphysema relate to the bronchi and bronchioles, connective and elastic tissue of the lungs, alveolar epithelium, and pulmonary vessels. The main morphological criteria of diffuse emphysema are the destruction of the respiratory department of lungs (Churg, Myers, & Tazelaar, 2011). Recent studies have shown that the size of the entrance of the alveoli in a healthy person is no more than 10 microns. However, during emphysema, alveolar pores exceed 20 microns (Churg, Myers, & Tazelaar, 2011). The walls of the alveoli are presented by vascular smooth muscle. Due to disease, the capillaries become thinner and elastic fibers are in the process of degeneration. All these factors lead to a reduction of the surface in actively operating alveoli. Changed alveoli cause impaction of unchanged (Churg, Myers, & Tazelaar, 2011). This fact is also essential in violation of the lung ventilation function.
Functional changes in emphysema are caused by several interrelated mechanisms: violation of the elastic frame of the lungs leading to a change in the structure of lung volumes and mechanical properties of the lung; bronchial obstruction; as well as destruction of interalveolar walls with progressive decrease in total operating surface of the lungs and decrease in diffusion capacity. One of the important factors is the pathogenetic mechanism of the expiratory closure of small airways (Kandel & Adamec, 2003). Currently, in pathogenesis of emphysema, much attention is also paid to exhaustion of the respiratory muscles. In addition, respiratory failure is aggravated by compression of the giant bullae in the functional relation of the normal lung tissue.
Shortness of breath is the first and main complaint of patients with emphysema (Kandel & Adamec, 2003). At the beginning of the disease, it appears only during the significant physical activity. Initially, patients often do not notice it. Shortness of breath in patients with emphysema is extremely dangerous. It becomes a life-threatening condition of gradually progressing for many years. Shortness of breath usually has the expiratory character. Patients have a short and acute breath and an extended exhale. Coughing is not a specific complaint of patients with emphysema. It is mostly associated with the presence of chronic bronchitis. Typically, a cough is dry with a small amount of sputum of the mucous character. Body weight in emphysema is usually decreased. It is associated with the hard work of respiratory muscles aimed at overcoming the high resistance of the terminal part of the respiratory tract (Kandel & Adamec, 2003).
The color of skin of the patients with emphysema is more pink than cyanotic. Noticeable cyanosis is caused by prolonged retention of blood gas composition. However, cyanosis occurs only in the severe cases of the disease, which is associated with the development of hypercapnia. Patients may have a blue tint of the tongue which is a clinical indicator of hypercapnia. There is swelling of jugular’s vein during expiration due to an increase of intrathoracic pressure. In addition, barrel chest is observed during the examination of the chest. Sometimes, people with emphysema may have kyphosis. Side respiratory sounds are not typical for such patients. However, during the forced expiration, meager dry whistling rhonchus may appear (Kandel & Adamec, 2003).
The most common method of emphysema diagnosis is X-ray examination (Kandel & Adamec, 2003). The main radiological signs are the increase in transparency of the lung fields and their total area, weakening of the vascular lung pattern, low position and flattening of the diaphragm, and restriction of its mobility. Usually, the size of heart is not increased. Due to the low position of the diaphragm, it is tear-shaped. Currently, there are new methods of emphysema diagnosis (Kandel & Adamec, 2003). Computer tomography reveals changes in the lung tissue which cannot be diagnosed in other ways. It provides an opportunity to identify the smallest elements of emphysema. Along with other diagnostic methods, nuclear magnetic resonance is important in the selection of candidates for conducting the operation to reduce lung volume in patients with the severe form of the disease (Kandel & Adamec, 2003). The method allows determining the location and severity of emphysema. Moreover, perfusion scintigraphy is also an efficient method of diagnosing vascular changes in lungs which can be detected in the early stages when there are no clinical and radiographic signs of the disease (Kandel & Adamec, 2003).
Treatment of patients with emphysema is a complex task. Joseph Kandel and Christine Adamec claim that “emphysema is an incurable disease” (Kandel & Adamec, 2003, p. 102). Therapy should be directed to the proper treatment of emphysema and such complications associated with the disease as respiratory and heart failure in the case of accession of pulmonary heart. Treatment should also include activities aimed at improving the quality of patients’ life and slowing down the progression of the disease. In addition, smoking cessation is of primary importance during emphysema treatment. Considering medication, doctors may prescribe antibacterial drugs, anticholinergics (flomax, atrovent), sympathomimetic drugs (salbutamol), and theophylline (aminophylline) (Green, 2007). The choice of drug therapy and its intensity depends on the severity of the symptoms.
The absence of adequate treatment of emphysema makes the prognosis unfavorable. The progression of the disease leads to early disability. It should be emphasized that the prognosis of emphysema is individual. In most cases, much depends on the patients and their attitude to treatment.
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Emphysema is a pathological condition of the lung tissue, which is characterized by its increased lightness due to the expansion of the alveoli, as well as the destruction of the alveolar walls. The risk of emphysema in individuals with chronic obstructive ailments of lungs is extremely high. The other factors causing development of the disease include smoking, air pollution, and genetic factors. One of the main symptoms of emphysema is shortness of breath. Timely detection and proper treatment of the disease can prevent early disability of the patient.