Emphysema

Emphysema Lung Is the permanent widening of the structure of pulmonary gas exchange that is distal to the terminal bronchioles, accompanied by destruction of alveolar walls.

Etiology

1. Main factors: smokers either active smoking or passive smoking depending on the length, number, how to smoke.
2. Air pollution, in the form: Particles, These chemicals, Toxic Gas
3. Infections: viral and bacterial
4. Genetics:

a. Talent arise emphysema
b. The balance of destructive enzymes (protease) & protective enzymes (alpha-1-antitrypsin).

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Pathogenesis
Inhalation of cigarette smoke or pollutants stimulate cells in the lung macrophages and neutrophils produce elastase and collagenase is an enzyme that damages the fibers of elastin and collagen, and which is the framework of the alveoli and acini in order not to collapse. Smoking also inhibit the action of alpha-1-antitrypsin, an enzyme that protects elastin fibers against proteases.
In the lung there is a balance between destroying enzyme (protease) and protective enzymes (alpha-1-antitrypsin). Due to destruction of fibers of the lung elastin & collagen loss of elastic recoil.

Complaints and Clinical Symtomps
Progressive shortness of breath, tired easily when moving.
Pure emphysema without coughing, shortness, of breath sounds, sputum.
Breathing by means of "purse lips" aims to breathe more easily because of the onset of back pressure in the bronchioles so easy expiration and prevent "water trapping".

On physical examination found:
Chest barrel shaped chest, the space between the ribs widen.
Lung hyperinflation, the percussion sounds hipersonor, reduced chest expansion, difficulties inspiration, decreased breath sounds, rhonchi could be heard when there is phlegm.

Diagnosis
Based on anamnesa, complaints and symptoms, supplemented by investigation as follows:

• PA chest X-ray photo:

Lung looks hyperaereted.
Reduced vascular picture and not look at the third peripheral lung field, it appears the bulla, where the diaphragm is low, little heart shape in the form of water droplets.

• Tests pulmonary physiology:

Showed abnormalities obstruction.
FEV1 <80% pred. and restrictive decreased FVC <70%, RV> pred. in accordance with lung hyperinflasi

• Examination of enzymatic:

Levels of alpha-1-antitrypsin is low.

• Analysis of blood gases:

There hipercapnea hypoxemia and the alveoli as a result of capillary damage and interference ratio of ventilation / perfusion.

Differential Diagnosis

• Bronchial Asthma
• Chronic Bronchitis
• Pneumothorax

Management of Emphysema

• Prevention: stop smoking, reduce exposure to air pollution.
• There is no effective treatment and satisfactory.
• Treatment with a new bronchodilator reversibility is given when there is obstruction.
• Antibiotics are given if there are signs of respiratory tract infection.
• Oxygen increases when crowded.
• Rehabilitation of relaxation with breathing exercises, postural drainage, exercise improves breathing capacity.
• Treatment of the complications.

Complications

• Pneumothorax: outbreak caused superficial bulla
• Respiratory failure: due to bad ratio of ventilation / perfusion
• Cor pulmonale: arise due to pulmonary hypertension due to hypoxemia and pulmonary vasospasm
• Weight loss until emasiasi.

Prognosis
In emphysema caused by deficiency of alpha-1-antitrypsin bad prognosis.
Prognosis is determined by:

• The rate of progression of the emphysema
• The degree of bronchial obstruction and reversibilitasnya
• The presence of complications
• The accuracy of the management of emphysema.

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