Emphysema: Assessment


Emphysema is a chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease (COPD) refers to a group of progressive respiratory diseases, including both chronic bronchitis and emphysema. More than 120,000 Americans die from COPD each year,making it the 3rd leading cause of death in the U.S.

U.S. COPD Statistics

Morbidity

  • Number of noninstitutionalized adults with diagnosed chronic Obstructive Pulmonary Disease in the past year: 6.8 million
  • Percent of noninstitutionalized adults with diagnosed chronic Obstructive Pulmonary Disease in the past year: 2.9%
  • Number of noninstitutionalized adults with diagnosed chronic bronchitis in the past year: 8.7 million
  • Percent of noninstitutionalized adults with diagnosed chronic bronchitis in the past year: 3.7%
  • Number of noninstitutionalized adults who have ever been diagnosed with emphysema: 4.1 million
  • Percent of noninstitutionalized adults who have ever been diagnosed with emphysema: 1.7%

Health care utilization: Ambulatory care

  • Number of visits to emergency departments with chronic and unspecified bronchitis as primary diagnosis: 294,000

Health care utilization: Assisted living and other residential care

  • Percent of residents with COPD: 10.8%

Health care utilization: Hospital inpatient care

  • Number of discharges with chronic bronchitis as first-listed diagnosis: 614,000
  • Average length of stay with chronic bronchitis as first-listed diagnosis: 4.5 days


In the early phase of COPD, patients may experience wheezing, chronic productive cough, and minimal shortness of breath. However, the person's quality of life decreases as COPD progresses. Later symptoms include increasing dyspnea, progressive exercise intolerance, periodic respiratory infections that occur with increasing frequency and severity, increasing cough, and purulent sputum.

Emphysema:  Caused by progressive destruction of pulmonary connective tissue, usually by an inflammatory process and/or cigarette smoking.  Air sacs distal to terminal bronchioles become permanently enlarged, and interalveolar walls are destroyed.  The result is airway obstruction, particularly upon expiration.  Lungs become hyperinflated, and lung volume increased.  The diagram above shows tissue destruction throughout the lung, and overdistended alveoli with destruction of septa.

Assessment findings include:

Inspection 

  • increased anterior-posterior diameter, or "barrel chest" 
  • use of accessory muscles to assist breathing 
  • tripod position
  • shortness of breath common, especially on exertion
  • tachypnea

Palpation 

  • tactile fremitus decreased
  • chest expansion decreased.

Percussion 

  • hyperresonant

Auscultation 

  • decreased vesicular breath sounds
  • may have prolonged expiration
  • muffled heart sounds from overdistention of lungs
  • usually no adventitious sounds; occasional wheeze

Emphysema is a chronic obstructive pulmonary disease (COPD). Visit the "therubins" website http://www.therubins.com/illness/respcopd.htm for indepth information about COPD.  

Look for the answer to this question: How many people in the US are affected by COPD?


From the University of Utah, slides of:


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The person with emphysema may assume a sitting position, leaning forward with arms braced against their knees, chair or bed ("tripod" position).
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