Emphysema

Definition

Emphysema is a chronic obstructive lung disease characterized by destruction of alveolar walls, enlargement of air spaces, loss of elastic recoil, and air trapping. It is part of the COPD spectrum and frequently coexists with chronic bronchitis.

Causes

• Cigarette smoking (most common)
• Alpha-1 antitrypsin deficiency (genetic; consider in younger patients)
• Occupational exposures

Clinical Features

Classic 'pink puffer' appearance: thin, barrel chest, tripod positioning, pursed-lip breathing, minimal cough. Dyspnea on exertion progressing to rest. Prolonged expiration, decreased breath sounds, hyperresonance on percussion, reduced diaphragmatic excursion.

Nursing Interventions

Low-flow oxygen (1 to 2 L/min) titrated to SpO2 88 to 92%, pursed-lip and diaphragmatic breathing, bronchodilators (SABA/LABA, tiotropium), inhaled corticosteroids, annual flu and pneumococcal vaccinations. Smoking cessation is the single most effective intervention to slow progression.

NCLEX Relevance

High-flow O2 may suppress hypoxic drive (titrate carefully). Barrel chest is the classic cue.