Emphysema (Lung Condition) (cont.)
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
George Schiffman, MD, FCCP
Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
In this Article
- Emphysema facts
- What is emphysema?
- What are the stages of emphysema?
- What causes emphysema?
- What are the risk factors for emphysema?
- What are the signs and symptoms of emphysema?
- How is emphysema diagnosed?
- What is the treatment for emphysema?
- Quitting smoking
- Emphysema medications
- Surgery for emphysema
- Pulmonary rehabilitation for emphysema
- What is the life expectancy and outlook for someone with emphysema?
- COPD (Chronic Obstructive Pulmonary Disease) FAQs
- Find a local Pulmonologist in your town
How is emphysema diagnosed?
As is the case with most illnesses, the health-care professional will take a careful history to learn about the lung and breathing symptoms.
- How long has the shortness of breath been present?
- What makes it better?
- What makes it worse?
- Has there been an infection recently?
- Have the symptoms been getting more severe?
- Does the patient smoke?
- Does the patient have exposure to secondhand smoke or other toxic fumes?
- Are there other exposures of diseases that may be contributing to the shortness of breath?
- Is there a family history of lung disease?
Physical examination will concentrate on the lung findings, but may also include the heart and the circulatory system.
- Is there an increased respiratory rate?
- Is the patient short of breath just sitting in the examination room?
- In addition to the ribs and the diaphragm, is the patient using the intercostal muscles (those between the ribs) and neck muscles to breathe? When used, accessory muscles cause the appearance of indrawing, where there is observable sucking in of muscles during the breathing cycle. This is normally seen in people who have just exerted themselves as the body recovers from exercise or work. In patients with emphysema it may be observed at rest.
- Does the chest appear enlarged or barrel-shaped?
- Does the chest cavity sound hollower than it should?
- Does exhalation take longer than it should? Since the elasticity of the lung has been lost, it takes longer for air to be forced out in the breathing cycle.
- Is the movement of the diaphragm decreased?
- Is the patient cyanotic (having a blue tinge to the skin color signifying lack of oxygen in the blood)?
- When listening to the lungs, are there wheezes present, especially if the patient is asked to exhale quickly?
- Is clubbing present? This is a characteristic change in the fingernails and tips of the fingers associated with lung disease and chronic hypoxia.
Exams and tests
Oximetry is a non-invasive test, in which a sensor is taped or clipped onto a finger or earlobe to measure the percentage of red blood cells that have oxygen. This value is usually greater than 92%. Results less than 90% may signal the need for supplemental oxygen for home use.
A complete blood cell count (CBC) may be performed to check for an increase in the number of red blood cells. In response to lower blood oxygen concentrations, the body manufactures more red blood cells to try to deliver as much oxygen as possible to cells.
Alpha-1 antitrypsin levels may be measured to look for the genetic form of emphysema.
An arterial blood gas test will measure the amount of oxygen and carbon dioxide in the blood and combined with other measurements can help the healthcare provider decide whether the body has been able to adapt to the lower oxygen concentrations in the body. In some laboratories, the arterial blood gas result will include a carbon monoxide percentage, most often found in the body because of smoking. For each hemoglobin molecule that has carbon monoxide attached, there is one less available that can carry oxygen.
The arterial blood gas can also give parameters to establish the diagnosis of chronic respiratory failure. The diagnosis of chronic respiratory can be made when the measured oxygen level drops below 60 mmHg (millimeters of mercury) and the carbon dioxide level rises above 50 mm Hg, the diagnosis of chronic respiratory failure can be made.
A plain chest X-ray may show lungs that have become too inflated and have lost normal lung markings, consistent with destruction of alveoli and lung tissue.
A CT scan can reveal more detail regarding the amount of lung destruction but is not a normal part of the evaluation of patients with emphysema.
Pulmonary function tests
Pulmonary function tests or spirometry can measure the air flow into and out of the lungs and be used to predict the severity of emphysema. By blowing into a machine, the amount of air that is moved and how quickly it moves can be calculated and provides information about lung damage. Results are compared to a "normal" person of the same age, sex, and size.
Some measurements include:
- FVC (forced vital capacity): the amount of air that can be forcibly exhaled after the largest breath possible.
- FEV1 (forced expiratory volume in 1 second): the amount of air that is forcibly exhaled in 1 second. Even though total air exhalation may be less affected, as the lung loses its elasticity, it takes longer for the air to get out and FEV1 becomes a good marker for disease severity.
- FEV (forced expiratory volume): can be measured throughout the exhalation cycle often at 25%, 50%, and 75% to help measure function of different sized bronchi and bronchioles.
- PEF (peak expiratory flow): maximal speed of air during exhalation.
- DLCO (diffusion capacity): measures how much carbon monoxide can be inhaled and absorbed into the bloodstream within a period of time. A small amount of tracer carbon monoxide is inhaled and then quickly exhaled. The amount of carbon monoxide in the exhaled air is measured and determines how well the lungs work in absorbing the gas. This helps determine and measure lung function.
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