End-Stage Emphysema - Essay Example

"End-Stage Emphysema" is a perfect example of a paper on the respiratory system. 
Emphysema is a respiratory problem. It is a disease characterized by chronic lung damage. The damage occurs when the air sacs within the lungs and the surrounding tissues are destroyed. The air sacs are the sites for gas exchange within the lungs. The damage occurs either due to a collapse or the over-inflation of the air sacs. It leads to an airflow limitation through the lungs causing the breathing troubles for the patient.

Emphysema may not be completely reversible most of the time (1). It commonly affects males more than females. In the beginning, it involves only the lungs, but with the progression of the disease, other parts of the body also get affected, mainly due to a lack of oxygenation. Such complications eventually lead to other diseases like diabetes or heart failure (2).

STAGES OF EMPHYSEMA:

There are four stages of emphysema:

1. At-risk emphysema,
2. Mild emphysema,
3. Moderate emphysema and
4. Severe or end-stage emphysema (3).

END STAGE EMPHYSEMA:

The end-stage emphysema can be described as a stage when a person suffering from emphysema has increased difficulty in breathing and in performing the daily routine works. He becomes in need of oxygenation. At this stage, the patient even feels difficulty in breathing while at rest. This leads to damage to other vital organs as well as the heart (2).

CAUSES:

The major causes of emphysema include:

1. Cigarette smoking or
2. In association with other diseases like chronic bronchitis and asthma.
3. Air pollution
4. Exposure to noxious gases.

Emphysema is grouped together with chronic bronchitis and asthma. All these three are called ‘Chronic Obstructive Pulmonary Disease also known as COPD. All these conditions are worsened by cigarette smoking (1).

Emphysema may also be caused by an inadequate amount of protein, as well as connective tissue disorders and HIV (2).

SYMPTOMS:

Some of the common symptoms include severe wheezing and breathlessness. This occurs even with the smallest amount of activity. The patient feels an increased feeling of chest tightness. Painful and difficult coughing is another feature.

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There is an increased appetite. The weight is reduced. Progressively increasing fatigue also shows a progression of the disease.

The fingernails as well as the lips develop a bluish discoloration due to the lack of oxygen. This also is a sign of immediate medical attention.

Another symptom as described by the patients of end-stage emphysema is that the sputum changes its color from transparent to yellow or green (2).

DIAGNOSIS:

Emphysema and other chronic obstructive pulmonary diseases require lung function tests for their diagnosis. These lung function tests include:

1. Spirometry,
2. Response to bronchodilators and corticosteroids,
3. Static lung volumes and lung compliance,
4. Gas transfer,
5. Pulse oximetry and
6. Arterial blood gases.

MANAGEMENT:

There are three main surgical treatments described for the end-stage emphysema:

1. Giant bullectomy,

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1. Lung volume reduction surgery (LVRS) and
2. Lung transplantation.

Indications:

1. Giant bullectomy:

It is offered to the patients having a localized disease, manifesting as a giant bulla. Such a lesion also compresses the adjacent healthy tissue. Such patients are indicated for the bullectomy.

1. Lung volume reduction surgery (LVRS):

It is indicated for the patients having a diffuse disease.

1. Lung transplantation:

It is also offered to the patients having a diffuse emphysematous disease.

These surgical treatments are performed after considering several factors like:

1. Age,
2. Lung function parameters,
3. Lobar predominance and
4. Uni or bilateral disease (4).

MEDICAL MANAGEMENT OF END STAGE EMPHYSEMA:

The medical management of end-stage emphysema often does not do well for the patient. It often revolves around the end of life support, including discussions about the ventilator support.

These discussions should take place when the patient is still stable.

The bronchodilators provide the symptom relief, especially when combined with the inhaled corticosteroids.

Long term oxygen therapy for such patients become mandatory.

The only hope for the patients of end-stage emphysema lies in the surgical treatment, and not the medical one. The medical management only improves the symptoms mildly but does not give any long term benefit at this stage of disease (5).

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CONCLUSION:

The end-stage emphysema is a ‘no turning back’ disease, which often progresses instead of reversing to better health. There are four stages of emphysema and the end stage, as the name shows is the last one. By the time this stage reaches, the patient already has developed other complications due to the lack of oxygen and is at risk of developing heart failure.

There are surgical managements that can cure the patient a bit and can lead to a better prognosis, at least to improve the life expectancy a little bit. But this also requires the decision for the surgical treatment to be made in proper time, rather than at a time, when even surgery becomes impossible for the patient.