Emphysema

Emphysema is a chronic obstructive pulmonary disease. It is often caused by exposure to toxic chemicals, including long-term exposure to tobacco smoke.Emphysema is characterized by loss of elasticity (increased Pulmonary compliance) of the lung tissue, from destruction of structures supporting the alveoli, and destruction of capillaries feeding the alveoli, owing to the action of alpha 1 antitrypsin deficiency. Thus the small airways collapse during exhalation, as alveolar collapsibility has increased. This impedes airflow and traps air in the lungs, as with other obstructive lung diseases. Symptoms include shortness of breath on exertion and later at rest, hyperventilation, and an expanded chest. However, the constricted air passages are not immediately deadly, and treatment is available.Any COPD disease results in hypoxaemia and hypercapnia. However skin perfusion can play a role in the differential diagnosis:Mild emphysema sufferers often maintain adequate blood oxygen levels by hyperventilating, and so are sometimes called "pink puffers." This disease can often be caused by smoking. By contrast, sufferers of chronic bronchitis (another COPD disorder) are called "blue bloaters" because they have cyanosis (inadequate oxygen) due to an almost normal ventilatory drive caused by decreased sensitivity to carbon dioxide. Signs of emphysema include pursed-lipped breathing, central cyanosis and finger clubbing. The chest has increased percussion notes, particularly just above the liver, and a difficult to palpate apex beat, both due to hyperinflation. There may be decreased breath sounds and audible expiratory wheeze. In advanced disease, there are signs of fluid overload such as pitting peripheral edema. The face has a ruddy complexion if there is a secondary polycythemia. Sufferers who retain carbon dioxide have asterixis (metabolic flap) at the wrist. Emfyseem Lungenemphysem L’emphysème pulmonaire L'enfisema EmfysemClassically, clinical examination reveals no overt crackles, but in some patients the fine opening of airway 'popping' can be heard. It is unlike the fine crackles of pulmonary fibrosis or coarse crackles of mucus or oedematous fluid.