Emphysema
Emphysema
• Emphysema is a chronic obstructive
pulmonary disease. It is defined as the
abnormal distension of air spaces beyond the
terminal bronchioles with destruction of the
walls of alveoli. In this there is loss of
elasticity of the lung tissues which result in air
trapping
Air in the alveoli
• The air sacs in the lungs become damaged and
stretched. This results in a chronic cough and
difficulty breathing.
• A condition in our body in which the air sacs
of the lungs, called alveolus are damaged and
enlarge, causing breathlessness.
• Emphysema occurs when there is damage to
the alveoli (air sacs in the lungs).
• Children can develop emphysema due to an
abnormality that is present when they are born.
Causes
• Child living in smokeful environment.
• Family predisposition with plasma protein
abnormalities.
• Environmental factors-air polution,infectious
agents,pollutants.
• Deficiency of Alpha -1 antitrypsine enzyme.
Pathophysiology
• Etiological factors.
• Airway obstruction due to inflammation and
loss of elastic recoils of lungs.
• The wall of alveoli are destroyed.
• Alveolar surface area decreases
• Increase in dead space.
• Impaired oxygen diffusion
• Hypoxemia
• Elimination of CO2 impaired
• Hypercapnia
Pathophysiology
• As the alveolar wall continues to break down,
• The pulmonary capillary bed is reduced.
• Pulmonary blood flow is increased
• Right ventricular hypertrophy
• Corpulmonale-right side heart failure.
Types of emphysema in children include:
• Alpha-1 antitrypsin deficiency
• Alpha-1 antitrypsin deficiency – this protein
protects the alveoli (air sacs in the lungs) from
damage due to a certain enzyme in the body.
This damage to the air sacs of the lungs can
lead to emphysema.
• Lobar emphysema
• Lobar emphysema – a rare respiratory condition
in which air enters the lungs but cannot escape,
leading to over-inflation of the lungs
Clinical manifestations
• Dyspnea .
• Cough.
• Wheezing.
• Tachypnea.
• Chest retraction
• On inspection-barrel chest appearance.
• On palpation-increase vibration or thrill felt.
• On auscultation-diminished breath
sounds,rhonchus,prolonged
expiration,anorexia,weight loss,cyanosis
DIAGNOSIS
• Chest x-ray
• CT scan
• Physical exam , wt, wheezing
• T he oxygen levels in blood are low (hypoxemia).
• The carbon dioxide levels in your blood are high
(hypercabnia),
because emphysema makes it hard to exhale properly.
• Cyanosis.
• Pulmonary function tests (PFTs)
• Blood Tests
A complete blood cell count (CBC)
Management
• Aerosol and inhalation powder are
indicated for children 4 years and older,
solution for inhalation for children 2 years
and older.
• Nebulization ( facemask or mouth piece ).
Use compressed air or oxygen with gas flow
of 6-10 L/min , single treatment last for 5 to 15
minutes.
• Bronchodilators. These drugs can help relieve
coughing, shortness of breath and breathing
problems by relaxing constricted airways.
• Inhaled steroids. Corticosteroid drugs inhaled
as aerosol sprays reduce inflammation and
may help relieve shortness of breath.
• Antibiotics. If you have a bacterial infection,
like acute bronchitis or pneumonia, antibiotics
are appropriate.
• Pulmonary rehabilitation. A pulmonary
rehabilitation program can teach about
breathing exercises and techniques that may
help reduce breathlessness and improve
ability to exercise.
• Nutrition therapy. Adequate diet and fluid.
• Supplemental oxygen.
• Treat infections with antibiotics
• Surgical management-lobectomy
Nursing management
• Adequate diet and fluid.
• Provide well ventilated environment.
• Maintain personal hygiene of the child.
• Give prop up position.
• Chest physiotherapy, coughing breathing
exercises,
• Pre and postop care if lobectomy.
• Health education to parents
Complications
• Respiratory infections.
• Corpulmonale
• Heart failure
• Pnuemothorax.
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