What the Heck Is Emphysema?

The breakdown of lung tissues, destruction of the alveolar-capillary wall, narrowing of the airways, and reduction in the elastic properties of the alveoli, causes permanent enlargement of the respiratory unit. All this together causes, “air trapping” in the lung, resulting in a respiratory disease called emphysema.

The elastic is attached to the outer surface of the airways which keeps them open and prevents bronchioles from collapsing. Due to hyperinflammation and destruction of the elastin, the recoiling of alveoli is reduced, the air cannot get out of the lungs, causing an increase in transverse and anterior-posterior diameter of the chest representing a barrel chest. The diaphragm flattened and descend, and the heart gets boot-shaped when viewed in a chest X-ray.

Small bronchioles become obstructed because of muscle spasm and mucus which later forms the site of infection. Recurrent infection stimulates the production of neutrophils and macrophages which releases elastase and free radicals causing further damage to the alveolar walls.

Inspiration is an active process, 760 mmHg of air inhaled through the nasal cavity reaches trachea via pharynx and larynx. The trachea then bifurcates into two bronchi/bronchus having a terminal bronchiole (acinus), each having an air sac (alveoli) for gaseous exchange with the capillaries. The O2 gets absorbs in the capillary while CO2 is eliminated via expiration, a passive process. When the mucus is secreted, it causes the narrowing of the bronchioles and the CO2 cannot escape out. A person has shallow, pursed-lip breathing, with increased heart rate, ventricular rate (tachypnoea), cardiac output, and blood pressure. Forced expiratory causes huffing (open glottis) and coughing (close glottis).

There are changes in the ABG (Arterial Blood Gas) and pH. In early-stage pH will increase and PaCO2, HCO3-, and PaO2 will decrease and in the later stage pH value will be normal, PaCO2 and HCO3- will increase and PaO2 will decrease. Eventually, it leads to cyanosis and turns into severe hypoxemia.

Diminished breath sounds, heart sounds, and distended neck veins are observed; person starts using their accessory muscles for respiration. Clubbing of digits is one of its clinical manifestations.

Smoking is one of the major causes of emphysema leading to centriacinar emphysema (upper lobes of lungs), and alpha -1 antitrypsin deficiency leading to panacinar emphysema (complete lung mostly the lower lobes).

The physiotherapeutic management for emphysema mainly focuses on breathing exercises like expiratory exercises where person breathe for 2 seconds from the nose with mouth closed and breathe out for 4 seconds through pursed lips. Autogenic drainage where a person itself clears out the mucus secretion through a longer period of exhalation. The active cycle of breathing techniques comprises three phases combining different breathing techniques:

1. Breathing control

2. Thoracic expansion exercises

3. Forced expiratory technique

The first phase pays attention to breathing control where airways and muscles tend to relax. A person is asked to breathe through his / her nose, if unable to breathe through nose pursed-lip breathing through the mouth is performed along with eyes closed and ease down the shoulder and tension from the body.

The second phase is thoracic expansion exercises where the breath is held (inspiratory hold) before expiration for 2 – 3 seconds in the lungs and then exhaled out (4 – 5 repetitions).

The last phase is forced expiratory technique by practicing huffing to clear out sputum without pain like in coughing. Small volume huffing helps to clear lower airways secretion and deep volumes huffing clears upper airways secretion.

Postural drainage is performed to drain the mucus by PT positioning the patient’s chest lower than the hip (18 – 20 inches up) in the line of gravity.

Percussion method is contraindicated in emphysema because it increases inflammation and breaks down bullae formation in the lungs causing a pneumothorax.

SHUBH SHREE

BPT 4th year

Amity University, Noida

References :

Davidson’s Principle and Practice of Medicine 20th ed.

Handbook of toxicology Pathology 2nd edition

Derakhtanjani AS, Jaberi AA, Haydari S, Bonabi TN.

Comparison of the Effect of Active Cyclic Breathing Technique and Routine Chest Physiotherapy on Pain and Respiratory Parameters After Coronary Artery Graft Surgery: A Randomized Clinical Trial. Anesthesiology and Pain Medicine. 2019 Oct;