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The pathophysiology of emphysema is best explained on the basis of decreased pulmonary elastic recoil. At any pleural pressure, the lung volume is higher than normal. Additionally, the altered relation between pleural and alveolar pressure facilitates expiratory dynamic compression of airways. Such compression limits airflow during forced expiration and, in severe instances, during tidal expiration. Another factor contributing to airflow limitation is disease of the airways, both large and small. In general, patients with relatively pure emphysema maintain blood gases in or near the normal range until very late in their course. PaO2 is maintained because of the preserved matching of ventilation and perfusion as alveolar walls are destroyed. PaCO2 is maintained because the ventilatory response to CO2 is not usually impaired. It is not clear why patients who are categorized clinically as "chronic bronchitics" are more likely to respond to an increased flow-resistive work of breathing by hypoventilating. Physical findings in emphysema are not specific. Radiologic changes are insensitive and are of less value than physiologic measurements
Salla disease, which is an autosomal recessive storage disorder causes precocious emphysema due to impaired activity of serum trypsin enzyme. Lung damage can occur with age and symptoms are seen after 50 years of age. Exposure to second hand smoke. Exposure to chemical fumes, dust from grains, cotton or wood. Exposure to pollutants like car exhaust, fumes from heating fuel. Heredity.
Diagnosis of Emphysema
Diagnosis of emphysema is based on the symptoms. A thorough physical examination is conducted to know whether all parts of the body are receiving oxygen. A medical history and family history of the person is known whether the person has smoking habits or has a family history of respiratory diseases. A stethoscope helps in knowing the rupture of the alveoli in the lungs by hearing the hollow sound. A spirometer helps in measuring the amount of air inhaled and exhaled. An arterial blood gas test is done to measure the amount of oxygen and carbon dioxide levels in the blood. Blood tests are done to assess the amount of red blood cells. An electrocardiogram can be done to detect whether the lung disease has caused any problems to the heart. A chest X-ray may be suggested to confirm the diagnosis.1
Corticosteroids inhaled as aerosol sprays can reduce the symptoms of emphysema. Drugs like bronchodialators help to lessen cough, shortness of breadth and troubled breathing due to constricted airways. Providing oxygen supplements can treat severe emphysema with low blood oxygen. Broad-spectrum antibiotics may help in relieving the symptoms of emphysema caused due to acute bronchitis, pneumonia and influenza. Flu shots annually and pneumonia shots every 5 7 years is recommended if a person is at high-risk to emphysema and other respiratory diseases. Surgery is done to remove small wedges of the damaged lung tissue by a procedure called lung volume reduction surgery. This surgery improves the functioning of the lungs with severe emphysema. Lung transplantation may be required only when all other treatments have failed to treat emphysema. Protein therapy may be suggested to persons who have inherited protein defiency.