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Beth Baguley

on 29 November 2013

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Transcript of Emphysema

Beth, Makayla, Claire
Effects on the heart

The effect of emphysema on the heart can include increased blood pressure, heart enlargement, and heart failure.

During inhalation, air enters the lungs and passes through the bronchial tree into the alveoli, causing the alveoli to enlarge. Oxygen molecules get transferred to red blood cells, and move on to supply the rest of the body with oxygenated blood. The carbon dioxide is transferred to the alveoli so that it can be exhaled.

With emphysema, the alveoli become damaged, inflamed, and lose elasticity. This damage causes the oxygen content in blood to be reduced, and makes it more difficult to both exhale air out of the lungs and inhale new air.

- Approximately 3 million cases in the United States alone.

- 7.5 % of the worlds population suffer from COPD. Of this, 1.8 suffer from emphysema.

- Deaths reported in USA 1999 - 17,787 per year, 1,482 per month, 342 per week, 48 per day, 2 per hour

- 18% of male and 14% of female smokers are diagnosed with COPD as well as 7% male and 6% female non smokers

- Emphysema is the 4th most common cause of death in USA and is expected to become the third most common cause of death by 2020
Emphysema is a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness. The tiny sacs in the lungs, called the alveoli, become damaged and lose their elasticity. This hinders their ability to fully push the carbon dioxide and the oxygen out of the lungs. As a result, air remains in the alveoli, this is called hyperinflation, inhibiting fresh oxygen to be drawn in. This causes an increased breathing rate and the body becomes fatigued from a lack of oxygen. Due to the damage of the alveoli, emphysema is a degenerative disease meaning the damage cannot be reversed and the disease gets worse over time.

There is no cure or treatment for emphysema as it is a progressive disease that gets worse over time. There are however ways for people living with emphysema to improve their quality of life.
Two types of Emphysema

Centrilobular Emphysema - Upper lobes and the apices within the upper and lower lobes -- caused by smoking/air pollution (common)

Panlobular Emphysema – diffusion process in lobes and lungs (especially lower lobes) – Genetics/ inherited (rare) destroys all of the alveoli in lungs.

1697 – Bonet’s description of “voluminous lungs”
1769 – Morgagni’s description of 19 cases in which the lungs were “turgid”; particularly from air.
1789 – Baille created an illustration of an emphysmatic lung and described the character of the condition.
1814 – Badham used the word catarrh to describe the cough and mucus hypersecretion of chronic bronchitis.
1816 – René Laennec invented the stethoscope in France
1821 – Laennec used the word Emphysema in his book A Treatise on the Diseases of the Chest and of Mediate Auscultation to describe an autopsy he performed in which the lungs did not collapse when the chest was opened. He determined that this was because the lungs were filled with air and the air ways were filled with mucus.
1846 – John Hutchinson invented the spirometer – an instrument that measures the vital capacity of the lungs. The spirometer could only measure volume, not airflow.
1947 – Tiffeneau added to the foundational concept of the spirometer creating a way to measure airflow, which made the spirometer a helpful diagnostic instrument
1952 – J. Gough differentiated between centrilobular and panlobular emphysema.
Causes of Emphysema
Emphysema can be caused by four major factors:

1. Smoking
2. Hereditary
3. Aging
4. Pollution
The main risk factor for emphysema is smoking, it activates
inflammatory cells inside the lung. This inflammation causes
1) swelling within the bronchioles
2) activation of enzymes
called protease, these attack and destroy lung tissue. This leads
to centriacinar emphysema, which begins in the bronchioles and eventually spreads through out the whole lung. Emphysema may also be genetic, because not all smokers have emphysema.
There is also an inherited form of emphysema. This is relatively rare type of emphysema. This results in panacinar emphysema, which destroys the alveoli throughout the lung uniformly.
Emphysema is also a factor of aging. As the lungs age, the elastic properties decrease, and the tensions that develop can result in small areas of emphysema.
In underdeveloped countries, a common cause of emphysema is indoor air pollution. In these populations, it is quite common to have indoor stoves in the house. The smoke from cooking can result in the damage to the lungs.
Less Common Factors
1) Intravenous drug use in which some of the non-drug additives like corn starch can be toxic and leaded to degraded lung tissue
2) Immune deficiencies in which infections like Pneumocystis carinii can cause inflammatory changes in the lung
3) Connective tissue illnesses in which abnormal elastic tissue in the body can cause alveoli to fail
Quitting Smoking
Quitting smoking does not rehabilitate the lungs or respiratory system but it can slow the damage to the lungs caused by emphysema.
Smoking cessation drugs
Drugs such as bupropion hydrochloride (Zyban) and varenicline (Chantix) may be prescribed to help cessation of smoking.
May be helpful in treating any bacterial infections associated with emphysema such as acute bronchitis or pneumonia
May relieve coughing, shortness of breath and trouble breathing by widening constricted airways. This is all done through the use of corticosteroid (steroids) which are a man made drug that closely resembles a hormone produced by the adrenal gland.
These drugs are however not always effective.
Smoking cessation improves the early course of disease. Long-term oxygen improves the length and quality of life in selected patients with hypoxemia. Surgery benefits a select few. Today, COPD is a steadily growing global healthcare problem, with increasing morbidity (frequency) and mortality. Early identification and prevention, and treatment of emerging stages of disease through smoking cessation and a growing number of bronchoactive drugs promises to change the outcome.
Rehabilitation programs may teach breathing techniques and exercises to help with shortness of breath and improve the ability to exercise. Nutritional advice is also crucial in pulmonary rehabilitation. In the early stages many people need to lose weight while later on they will need to gain weight.
Pulmonary Rehabilitation
Long term use may result in weakened bones, increased risk of high blood pressure, cataracts and diabetes
Tony Gomes (general surgeon) \ Louise Gomes (Local family doctor)

Is emphysema common?
Louise Gomes : Emphysema is a common disease, especially for smokers. It’s also often found in elderly people. Emphysema is not only a smoker disease it can be also found in third world countries because of the indoor cooking and pollution.

What is the most common cure?
Louise Gomes: There really is no cure for emphysema. There are medications that can improve the symptoms but emphysema is a long-term disease. Certain antibiotics can prevent bacterial infections. It is also common for patients to use oxygen therapy. The dysfunctional alveolar sacs caused by emphysema leave patients with low levels of oxygen in their bloodstream, and oxygen-starved organs including the brain and heart. Administration of oxygen therapy increases patients' blood oxygen levels, alleviating many symptoms.

Is lung transplant common?
Tony Gomes: I have never done a lung transplant. In Canada only 10 to 40 lung transplants are done every year. It is a very complex surgery and it takes many hours. The only place’s in Canada where the lung transplant surgery is preformed is in Vancouver, Edmonton and Toronto. For the lung transplant to take place, the lungs must be removed almost instantly as the person dies. Unlike the heart, the lungs cannot be kept cold for 5 to 7 hours. The surgery must be done immediately after their removal from the cadaver.

Have you ever diagnosed hereditary emphysema?
Louise Gomes: I my whole carrier I have never even seen hereditary emphysema. It is extremely rare. I only have ever diagnosed smoker’s emphysema, which is very common. For short we call emphysema COPD, chronic obstructive pulmonary disease.

Is emphysema often a cause of death?
Tony Gomes: Emphysema can be the cause of death but because most people with emphysema are smokers they often have many other issues that are the cause of death.

How does emphysema affect your tidal breathing?
Tony Gomes: Emphysema damages the walls of the alveoli, which cause them to reduce the surface area if the lungs. Patients will not be able to fully use there lungs and breathing is labored.

How do you diagnose emphysema?
Louise Gomes: To diagnose emphysema I look for rapid breaths, wheezing, change in breathing pattern and if the patient has a smocking history.
Lung transplant

-2005 United States the most common reasons for lung transplant
-27% chronic obstructive pulmonary disease (COPD), including
-16% idiopathic pulmonary fibrosis;
-14% cystic fibrosis;
-12% idiopathic (formerly known as "primary") pulmonary
-2% replacing previously transplanted lungs that have since
-29% other causes
Requirements to become a candidate for lung transplant

-Serious lung disease
-Other therapies were unsuccessful
-No other chronic medical conditions (e.g. heart, kidney, liver)
-No current infections or recent cancer
-No HIV or hepatitis
-No alcohol, smoking, or drug abuse
-In weight criteria
-In age criteria depending if its a single vs. double replacement
-Mentally prepared
-Has social support system;
-Financially able to pay for expenses (depending your choice of location for surgery, where medical care is paid for directly by the patient)
Medical tests for potential transplant candidates

-To become a candidate for a lung transplant you are required to undergo many extensive medical tests to evaluate the patients overall health status and if they’re suitable for an organ transplant.
-Blood typing: the patient’s blood type must match the donor's. A mismatch of blood type will likely lead to strong response by the immune system and untimely cause rejection of the transplanted organs.
-Tissue typing: preferably the donor and the patients should
have similar tissue typing but depending on the urgency of the
transplant in is not completely necessary.
-Chest X-ray: to check the size of lungs and the lung cavity
-Pulmonary function tests: measuring lung function, volume of
lungs (inhaled exhaled)
-CT Scan (High Resolution Thoracic & Abdominal) : demonstrate
volume and gives some what of a 3D image
-Bone mineral density scan: density of bones and fracture risk
-MUGA (Gated cardiac blood pool scan) : evaluate left and right function of the ventricles in heart and diagnosing the risk of heart failure.
-Cardiac stress test : hearts ability to respond do external cardiac stress such as exercise and drug stimulation.
Types of lung transplant

A lobe transplant is a surgery where a portion of the donor’s lung is replaces the patients damaged portion of his/her lung. This procedure will improve the patients quality of life despite the will never obtain full lung surface area.

It is common to only replace one diseased lung for a healthy lung. The single healthy lung often comes from a donor who is pronounced brain-dead.

Sometimes patients can require both lungs to be replaced. This is especially the case for people with cystic fibrosis, because the even if one if lungs are healthy the bacteria can spread to the transplanted lung. Therefore, there is less of a risk of getting infected if you transplant both lungs.

Respiratory patients can have cardiac disease as well, which can cause
the need for a heart transplant along with the lung transplant.
How to quit smoking?

Make the conscious decision that this something you want to do. Smoking will not only have negative affects on your health but on others around you.

-Do not smoke. (Not even one puff)
-Keep active and busy (try learning new hobbies to take your mind off smoking)
-Keep hydrated
-Begin using nicotine replacement to aid with cravings
-Attend stop-smoking class (quitting with others is more inspiring)
-Do your best to avoid situation where you’re tempted to smoke (low stress level)
-Avoid people who are smoking.
-Consume less alcohol or avoid it completely
-Think about how you can change your routine. Doing this will take your mind off smoking and help you suppress any urges to smoke
How emphysema affects daily life

Emphysema is a long-term disease and will have and enormous impact on quality of life. It can make it difficult to breath and therefore physical activity can be a challenge. Not only is it hard to breath but also to help with symptoms an oxygen tank is recommend which can limit activity.
Because it is so hard to breath traveling is not recommended. In third world countries pollution is common and will worsen the symptoms.
Risks of a lung transplant
With every surgical procedure comes the risk of bleeding and infection. Even is the lung transplant surgery is flawless there is still a chance that the newly transplanted lung may fail. Because the internal parts of the body have been exposed to air it may have negative reactions, although the medications aid in preventing. Also the body may have negative reactions to the drugs that have been injected in their system.Rejection of the transplant is the main concern. It is essential to supervise the newly implanted lungs for the rest of the patient’s life. Rejection is very serious and needs to be treated immediately. This can cost the patient their lives.
Signs of rejection:

-Flu-like symptoms (including chills, dizziness, nausea, general
feeling of illness, night sweats)
-Increased difficulty in breathing;
-Fluctuating in test results
-Chest is in pain and tender
-Change in body weight (2-3 kilos)
Socioeconomic factors
A study by leading charity, Education for Health (EFH) shows the economic effect COPD in general has had on the economy. The study shows that patients of working age are losing on average $1800 a year. This amounts to roughly $20,000 in a lifetime. The study also showed that 1 in 5 people suffering from COPD between the ages of 45-68 years old are forced to retire prematurely.
According to the National Heart and Lung institute the annual projected cost of COPD in 2010 was $49.9 billion. This includes direct expenditures, indirect morbidity costs (lost productivity due to illness) and indirect mortality costs (lost productivity due to early death.
COPD stands for chronic obstructive pulmonary disease. It is a degenerative disease that effects the lungs long term and is often brought on by smoking. Emphysema and chronic bronchitis are the two diseases that fall under this title. They are classified together because they are closely related and often patients will suffer from both.

*NOTE* - Some of our statistics are from COPD and not solely emphysema. This is because many of the studies done for emphysema are done more broadly to include chronic bronchitis as well.
Alternative Medicine
The following are some examples of alternative medicines that some emphysema patients use to help relieve their symptoms.

Qing Qi Hua Tan Wan
This Chinese medicine helps to clear heat and phlegm while Qi, a circulating force, is pushed downwards to stop a patients coughing.

- Equal parts of carrot juice, parsnip juice, watercress juice and potato juice
- Equal parts of orange juice and lemon juice, diluted half and half with a strong decoction of rosehip tea.

Aromatherapy is the practice of circulating potent plant essential oils in the body through the use of massage. Since the beneficial qualities of the oils are circulated through the air this is thought to be more beneficial in patients with respiratory problems. Balsam, Tea tree oil, Niaouli and Rose damascena are all said to help with respiratory issues.

Naturopathic medicine works with the idea that the body has the ability to heal itself. By eating the proper foods and providing your body with the fuel it needs, it is believed that your body will regenerate and become well again. This type of treatment has been known to help slow the progression of emphysema.
Socioeconomic Factors
What is Emphysema
What is COPD
Stage 1 In the first stage of emphysema symptoms are very mild and often undetectable. Possible symptoms include a mild cough and a small amount of mucus production. Stage 2 The second stage of emphysema is still considered moderate. Symptoms may worsen slightly. Coughing may get worse while mucus production can increase. Some people start to notice that they become winded easier. Ex. Walking up the stairs. Stage 3 At this point emphysema is considered to be severe. Symptoms worsen and breathing difficulties become more apparent. Strenuous activity is generally the cause of these airflow difficulties. Stage 4 The fourth stage of emphysema is by far the most severe. Symptoms continue to worsen and breathing difficulties increase tremendously. Patients become short of breath and winded with no clear onset and little activity.
The 4 stages
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