Introduction:
Emphysema is a progressive lung disease that makes breathing hard. It usually develops over time and is strongly linked to chronic smoking (over many years). In the United States, over three million have been affected by emphysema. Emphysema and chronic bronchitis (inflammation of the windpipe branches in the lungs) belong to a group of lung diseases known as a chronic obstructive pulmonary disease (COPD).
The lung consists of several tiny air sacs (alveoli) in which the gas exchange occurs. At the alveoli, the oxygen is absorbed from the inhaled air into the blood, and carbon dioxide is released from the blood to exhale. There are about 300 million air sacs or alveoli in the lungs. In emphysema, the lung tissue and the alveoli get gradually damaged. The tiny functional air sacs rupture and large air pockets are formed that trap air in the lung. This enlargement of lung air spaces is irreversible and prevents sufficient oxygen entry into the blood. In addition, this blockage causes the lungs to slowly overfill. This makes breathing difficult. Emphysema is now one of the leading causes of death worldwide.
What Are the Signs and Symptoms of Emphysema?
Emphysema is a progressive disease of the lung, and thus, the symptoms may take years to develop. The most common symptoms include:
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Breathing difficulties (shortness of breath).
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Coughing (usually with mucus).
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Wheezing (abnormal high-pitched sounds during breathing).
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A feeling of tightness in the chest.
Do not ignore the symptoms. It is important to check with the doctor if anyone experiences breathing difficulties for several weeks or months that are worsening or interfering with day-to-day activities. Though the disease is irreversible, the symptoms can be managed with appropriate treatment.
When to Seek Emergency Care For Emphysema?
The symptoms can get worse (acute exacerbations) and can even be life-threatening without emergency care. Call for emergency medical services or rush to the hospital if the following occurs:
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Severe breathing difficulty (not able to climb stairs).
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On exertion, the fingernails or lips turn gray or blue (it could indicate that the oxygen level in the blood has dropped severely).
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A person is not mentally alert (or not able to concentrate or think clearly).
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Unconsciousness.
How Are Acute Exacerbation of Emphysema Treated?
Emphysema or chronic obstructive pulmonary disease is managed with medications and interventions to treat the chronic stable disease. Acute exacerbation of the disease can be life-threatening, requiring immediate medical attention and emergency care. In most cases, the cause of the acute exacerbation is unknown. Bacterial or viral infections, smoking, exposure to inhalation irritants, and pollution can worsen emphysema. The primary goals of emergency management are to ensure adequate oxygen levels in the blood, maintain the blood acid-base levels, clear the airway, reverse obstruction in the airway, and treat the underlying cause. The emergency treatment of emphysema involves the following:
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Oxygen supplementation (to increase blood oxygen levels).
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Ventilatory assistance with intubation or other non-invasive techniques (to help the patient breathe if needed).
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Medications such as:
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Bronchodilators - To relax and widen the small windpipe branches in the lung or bronchi.
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Corticosteroids - To reduce the inflammation in the lungs and the branches of the windpipe.
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Antibiotics - To treat infection in the lungs.
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Surgical interventions (such as lung-volume reduction surgeries) are used after the patient is stabilized during emergencies.
If the exacerbation of emphysema is mild, it is treated on an outpatient basis with home support. Older patients, those with comorbidities, patients with a history of respiratory failure, and critically ill patients with low blood oxygen levels are usually admitted to the hospital for treatment. Suppose the patient shows life-threatening signs and symptoms of emphysema, such as severely low blood oxygen levels, increased lung acid levels (respiratory acidosis), irregular heart rhythm, or worsening lung function despite hospital treatment. In that case, they are admitted to the intensive care unit for close observation and frequent monitoring of their respiratory status.
How Is Oxygen and Ventilation Assistance Provided in Emphysema Emergencies?
Most patients with acute exacerbation of emphysema require oxygen supplementation (even those who do not need it at home). Oxygen is administered through the following:
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Bag-Mask Ventilation - Oxygen is pumped through a bag attached to the mask.
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Nasal Prongs or Venturi Masks - These are specifically used to closely monitor patients prone to respiratory acidosis (increased lung acid levels and bicarbonate levels in the blood).
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Intubation - Tubes are inserted into the airway to supply oxygen to the lungs.
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High-Flow Nasal Oxygen Therapy - Used in case of acute lung failure.
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Non-invasive Positive Pressure Ventilation (NPPV) - Mild air is blown into the airway to keep it open using tubes or masks. This type of ventilation decreases the need for using tubes (intubation). It also reduces the length of hospital stay and improves the patient's survival rate in acute emphysema emergencies.
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Tracheostomy - A surgical hole is made in the patient’s windpipe (trachea) to supply oxygen. Tracheostomy is usually indicated for patients who require prolonged intubation (for more than two weeks).
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Ventilator - A machine that helps to support breathing and provides oxygen to the lungs.
Some patients might require oxygen at home after discharge for 30 days or more.
What Are the Medications Used to Treat Acute Emphysema Emergencies?
Medications such as bronchodilators (beta-agonists such as Albuterol and anticholinergics such as Ipratropium) are the first line of treatment used in acute emphysema emergencies. In addition, corticosteroids that reduce the inflammation in the lungs are used. The medications are administered concurrently with oxygen to reverse airflow obstruction. Antibiotics are administered to treat lung infections. The type of antibiotic used depends on the infection-causing agent and the severity of the infection. Other drugs to treat the symptoms, such as cough, are also administered.
Conclusion:
Emphysema is a chronic progressive lung disease that can cause fatal lung emergencies. One must be on the watch for the life-threatening warning signs of emphysema if the person has chronic stable emphysema. If one suspects acute exacerbation of emphysema, immediately call for emergency medical services or rush to the nearest emergency department to initiate treatment. Emphysema health emergencies are treated with oxygen administration, ventilatory assistance (to enable breathing), and medications such as bronchodilators, corticosteroids, and antibiotics.
