Emphysema Treatment

Emphysema Notes

Write a short note on emphysema.

Answer. It is defined as the distention of the air spaces distal to the terminal bronchiole with the destruction of alveolar septa.

Predisposing Factors/etiology emphysema.

1. Smoking
2. Environmental pollution
3. Genetic predisposition due to alpha-I antitrypsin deficiency
4. Bacterial
5. Occupational exposure.

Types Of Emphysema

1. Centri-acinar: Presence of destruction and enlargement of the central or proximal part of the respiratory unit. Predominant involvement of upper lobe and apices. Commonly seen in male smokers.
2. Pan-acinar: Presence of uniform destruction and enlargement of acinus. It is predominant in lower basal zones. It is associated with alpha-1 antitrypsin defiiency.
3. Paraseptal: It involves only distal acinus. Found near the pleura often causes spontaneous pneumothorax
4. Irregular: There is an irregular type of acinus with scarring involvement.

Read And Learn More: General Medicine Question And Answers

Clinical Features emphysema.

There are two types of patients suffering from emphysema.

1. Type A refers to pink puffers who have minimal cough and expectoration while dyspnea is prominent and Type B refers to blue bloaters.
2. In this, patients have marked blood gas abnormalities though the pulmonary diffusing capacity is within the normal limits

Treatment emphysema.

1. Chronic sources of infection in the upper respiratory airway be removed.
2. Patients should be taken away from cold climate
3. Smoking in any form must be stopped
4. Breathing exercises be advised
5. Respiratory infection be prevented and prompt antibiotic treatment, e.g. ampicillin, amoxicillin.
6. B bronchodilators are used, i.e. theophylline and salbutamol.
7. In severe respiratory insufficiency, corticosteroids are useful prednisolone
8. Oxygen inhalation, intermittently is useful in case of emphysema.

Tuberculous Pleural Effsion

Pleural effusion: Abnormal accumulation of fluid in pleural spaces.

1. When the amount of fluid is more than 300 mL.
2. Tubercularpleuraleffsionoccursduetotuberculosis.
3. In tubercular pleural effusion, the pleural fluid is exudative fluid mixed with the blood.

Clinical Features tuberculous pleural effusion.

1. Acute form comes in the form of acute pleurisy with constitutional symptoms such as fever, toxemia, loss of appetite, and ill health.
2. Acutely developing effusion will produce breathlessness and a dry cough.
3. Chronic forms of pleurisy present with the picture of chronic ill health, low-grade fever, and loss of appetite.

Physical signs tuberculous pleural effusion.

On Inspection

1. Presence of bilaterally symmetrical chest.
2. Restrictions of movements of the chest on the side of effusion.

On Palpation

1. Shifting of trachea and mediastinum to the opposite side on pushing.
2. Diminishing of expansion of the chest on the involved side.
3. Absence of vocal fremitus on the involved side.

On Percussion Stony has a dull percussion note on the involved side.

On auscultation

1. Absence of breath sounds or diminishing of breath sounds over an area of pleural effusion.
2. Amphoric bronchial breathing can be heard at the apex of pleural effusion at the interscapular region over the involved side.
3. Absence of vocal resonance.

Investigations tuberculous pleural effusion.

1. Examination ofpleural flid:
   • Pleural fluid is serous or straw-colored and forms cobwebs on standing.
   • Fluid is exudates in nature.
   • On microscopic examination, a prominent cell type in the fluid is a lymphocyte.
2. The Tuberculin test is positive.
3. Pleural biopsy show granulomatous lesion.
4. The culture for acid­fast bacilli is positive.
5. Polymerase chain reaction (PCR) test for tuberculosis is positive.
6. X­ray chest shows uniform dense opacity with an upward concavity in the lower and lateral part of the hemithorax pushing the lung medially. The sharp angle between the diaphragm and rib cage gets altered.
7. ESR is high in tubercular effusion.
8. Ultrasound localizes and detects the effusion.
9. Biochemical tests:
   • Lactate dehydrogenase gets increased in tubercular effusion.
   • Adenosine deaminase activity gets increased in tuberculous pleural effusion, i.e. it is more than 40 IU/L.
   • Interferon Gamma levels are more than 140 pg/mL.

Treatment of tuberculous pleural effusion.

In tuberculous pleural effusion, anti-tubercular therapy is started, i.e. all four drugs isonex, rifampicin, pyrazinamide, and ethambutol are given for the first three months, and then three drugs, i.e. Yonex, rifampicin, ethambutol for six months.

1. Aspiration of pleural fluid is done for diagnosis, for relieving dyspnea, and if fever and toxemia are not subsiding after 4 weeks of anti-tubercular therapy.
2. Chest physiotherapy is done to encourage expansion of the lower chest.