Emphysema management

Emphysema

Emphysema is a destructive process involving the gas-exchanging air spaces of the lungs that results in perforations, obliteration of airspace walls, and coalescence of small distinct airspaces into much larger ones, leading to enlargement of the gas-exchanging units of the lungs.

These changes cause loss of elastic recoil of the lungs and abnormal gas exchange.

Clinical presentation

• Shortness of breath

• Cough, sometimes caused by the production of mucus

• Wheezing

• Slow and prolonged expiration

• Chest wall hyperinflation

• Limited diaphragmatic motion on auscultation

• Distant breath sounds and heart sounds

• Coarse early inspiratory crackles

• Use of accessory muscles

• Pursed-lip breathing

• Signs of cor pulmonale:

  • Raised JVP

  • Peripheral oedema

  • Hepatomegaly

  • Other features of right heart failure

• Cyanosis

• Asterixis

Investigations

• Haematocrit:

  • Men >52%

  • Women >47%

OR

• FBP (look at haematocrit)

• ABG (look for elevated bicarbonate/metabolic alkalosis)

• CXR

• Sputum culture and microbial sensitivity

• Pulmonary function tests

• Six-minute walk test

• CT scan of the chest/HRCT (for evaluation for lung volume reduction surgery)

Non-pharmacological treatment

• Stop smoking.

• Give oxygen after evaluation.

Pharmacological treatment

Inhaled bronchodilators relax and open the airways.

They may be:

Short-acting bronchodilators

• Albuterol

• Ipratropium

Long-acting bronchodilators

• Salmeterol

• Tiotropium

These medicines may be available as inhalers ("puffers") or as solutions for nebulization.

A nebulizer machine aerosolizes the bronchodilator solution, which is then breathed through a tube.

For more details, refer to treatment in Section 9.2 above.

Table: COPD staging and recommended therapies

Abbreviations

• FEV1 = Forced Expiratory Volume in 1 second

• SABA = Short-Acting Beta-Agonist

• LABA = Long-Acting Beta-Agonist

• LAMA = Long-Acting Muscarinic Antagonist

• ICS = Inhaled Corticosteroid

• HRCT = High-Resolution Computed Tomography

• ABG = Arterial Blood Gas

• CXR = Chest X-ray

• FBP = Full Blood Picture

• JVP = Jugular Venous Pressure