NON-MEDICAL MANAGEMENT OF EMPHYSEMA (SURGICAL AND ENDOBRONCHIAL)

Abstract

Emphysema is pathologically defined as an abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of alveolar walls and without obvious fibrosis. The risk factors thought to be responsible for the development of COPD are cigarette smoking, next are cigars and pipe smoke, occupational, inhalational, and environmental exposures, including biomass fuel cooking. Severe AAT deficiency predisposes to unopposed elastolysis with the clinical sequelae of an early onset of pan-acinar emphysema. Deficiency of AAT is inherited as an autosomal codominant condition. Most patients seek medical attention late in the course of their disease. Patients will adapt and modify their lifestyles in order to minimize dyspnea and ignore cough and mucus production. Thoracic examination reveals a 2:1 increase in anterior to posterior diameter “barrel chest”, diffuse or focal wheezing, diffusely diminished breath sounds, hyperresonance upon percussion, prolonged expiration, and/or hyperinflation on chest radiographs.

Chest radiographs reveal signs of hyperinflation, High-resolution CT scanning is more sensitive than standard chest radiography. HRCT scanning is highly specific for diagnosing emphysema and outlines bullae that are not always observed on radiographs.

Various surgical approaches to improve symptoms and restore function in patients with emphysema have been described. These should be offered to carefully selected patients as they may provide great benefit.

Lung volume reduction surgery attempts to decrease hyperinflation by surgically resecting the most diseased parts of the lung. This improves airflow by increasing the elastic recoil of the remaining lung and the mechanical efficiency of the respiratory muscles to generate expiratory pressures. Removal of giant bullae has been a standard approach in selected patients for many years.