♦ Chronic lung disease characterized by permanent enlargement of air spaces distal to the terminal bronchioles and by exertional dyspnea
♦ One of several diseases usually labeled collectively as chronic obstructive pulmonary disease or chronic obstructive lung disease
♦ Genetic deficiency of alpha1-antitrypsin
♦ Cigarette smoking
♦ Shortness of breath
♦ Chronic cough
♦ Anorexia and weight loss
♦ Barrel chest
♦ Pursed-lip breathing
♦ Use of accessory muscles
♦ Clubbed fingers and toes
♦ Decreased tactile fremitus
♦ Decreased chest expansion
♦ Decreased breath sounds
♦ Inspiratory wheeze
♦ Prolonged expiratory phase with grunting respirations
♦ Distant heart sounds
♦ Arterial blood gas analysis shows decreased partial pressure of oxygen; the partial pressure of carbon dioxide is normal until late in the course of disease.
♦ The red blood cell count shows an increased hemoglobin level late in the course of disease.
♦ Chest X-ray may show:
– a flattened diaphragm
– reduced vascular markings at the lung periphery
– overaeration of the lungs
– a vertical heart
– enlarged anteroposterior chest diameter
– a large retrosternal air space.
♦ Pulmonary function tests typically show:
– increased residual volume and total lung capacity
– reduced diffusing capacity
– increased inspiratory flow.
♦ Electrocardiography may show tall, symmetrical P waves in leads II, III, and aVF; a vertical QRS axis; and signs of right ventricular hypertrophy late in the course of disease.
♦ Chest physiotherapy
♦ Possible transtracheal catheterization and home oxygen therapy
♦ Adequate hydration
♦ High-protein, high-calorie diet
♦ Activity, as tolerated
♦ Insertion of a chest tube for pneumothorax
♦ Lung volume reduction surgery for patients who meet criteria
♦ Give prescribed drugs.
♦ Provide supportive care.
♦ Help the patient adjust to lifestyle changes that are necessitated by a chronic illness.
♦ Encourage the patient to express his fears and concerns.
♦ Perform chest physiotherapy.
♦ Provide a high-calorie, protein-rich diet.
♦ Give small, frequent meals.
♦ Encourage daily activity and diversional activities.
♦ Provide frequent rest periods.
♦ Be sure to cover:
– the disorder, diagnosis, and treatment
– medication and potential adverse reactions
– when to notify the physician
– the importance of avoiding smoking and areas where smoking is permitted
– the need to avoid crowds and people with known infections
– home oxygen therapy, if indicated
– transtracheal catheter care, if needed
– coughing and deep-breathing exercises
– the proper use of handheld inhalers
– the importance of a high-calorie, protein-rich diet
– adequate oral fluid intake
– avoidance of respiratory irritants
– signs and symptoms of pneumothorax.
Urge the patient to notify the physician if he has sudden onset of worsening dyspnea or sharp pleuritic chest pain that’s exacerbated by chest movement, breathing, or coughing.
♦ Refer the patient to a smokingcessation program if indicated.
♦ Refer the patient for influenza and pneumococcal pneumonia immunizations as needed.
♦ Refer the family of a patient with familial emphysema for screening for alpha1-antitrypsin deficiency.