Emphysema
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It is a destructive process in the gas-exchanging air spaces of the lung 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
- Sputum culture and Microbial sensitivity
- Coarse early inspiratory crackles
- Pursed-lip breathing
- Signs of cor pulmonale (raised JVP, peripheral oedema, hepatomegaly etc)
- Cyanosis
- Asterixis
Investigations
- Haematocrit (men>52% and >47men) Or FBP (look at haematocrit)
- ABG (look for bicarbonate-metabolic alkalosis)
- CXR
- Sputum culture and microbial sensitivity
- Pulmonary function tests
- Six minutes' 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 (albuterol, ipratropium) or long-acting (salmeterol, tiotropium). These medicines may be available as inhalers ("puffers") or as a solution. A nebulizer machine aerosolizes the bronchodilator solution, which is then breathed through a tube. For more detail refer to Treatment in Asthma.
Table 9.10: COPD Staging and recommended Therapies
| GOLD FEV1 Stage | Exacerbation Per Year | Mild Symptoms | Mod/Severe Symptoms |
| I: ≥80% | ≤2 | Group A Bronchodilator (SABA-PRN) | Group B LAMA or LABA |
| II: 50-79% | |||
| III: 30-49% | ≥2 | Group C LAMA + LABA |
Group D LAMA or LAMA + LAMA or ICS + LABA |
| IV: 30% |