Emphysema is a progressive lung disease that is included in the form of COPD (Chronic Obstructive Pulmonary Disease). The Global Initiative for chronic obstructive lung disease has defined COPD as a common, preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation caused by airway and/or alveolar abnormalities usually caused by significant exposure to particles or gases. dangerous.
Emphysema is a primary pathological diagnosis affecting the airways distal to the terminal bronchioles. It is characterized by permanent, abnormal enlargement of the lung air spaces with damage to the lung walls without fibrosis and damage to the lung parenchyma and accompanied by loss of elasticity of the lung walls.
Types of Emphysema
Based on its location, emphysema can be divided into three subtypes, namely:
- Centrilobular (proximal acinar)
This is the most common type and is associated with smokers - Panacinar
This is the most common type seen with alpha one antirypsin deficiency - Paraseptal (acinar distal).
This type may occur singly or in association with other types. When occurring singly, this type is generally associated with spontaneous pneumothorax in young adults.
The clinical manifestations of emphysema result from injury to the airways distal to the terminal bronchi, including the respiratory bronchioles, alveolar sacs, alveolar ducts, and alveoli, collectively known as the acini. In cases of emphysema, there is permanent abnormal dilatation of the air sacs and damage to the lung walls. This results in a decrease in alveolar and capillary surface area, thereby reducing gas exchange.
Causes of Emphysema
Emphysema is caused by significant exposure to toxic gases over a long period of time, such as cigarette smoke which is one of the main causes. Several other factors that can cause emphysema are passive smoking, lung infections and allergies.
The Process of Emphysema
Emphysema is caused by significant exposure to toxic gases over a long period of time. After exposure to toxic gases, inflammatory cells such as macrophages, neutrophils and T lymphocytes are recruited. Macrophages will be activated early and release neutrophil chemotactic factors such as leukotrin B4 and interleukin-8. When neutrophils are recruited together with macrophages, the release of proteinase will occur and will cause mucus hypersecretion. Elastin is an important component of the extracellular matrix required to maintain the integrity of the lung parenchyma and small airways. An elastase/anti-elastase imbalance increases increasing susceptibility to lung damage leading to air space expansion. Cathepsins and neutrophil-derived proteases (i.e. elastase and proteinase) act against elastin and destroy the connective tissue of the lung parenchyma. Cytotoxic T cells release TNF-a and perforin, which destroy the epithelial cells of the alveolar wall.
Smoking not only causes mucus hypersecretion and release of neutrophilic proteolytic enzymes, but also inhibits anti-proteolytic enzymes and alveolar macrophages. Genetic polymorphisms play a role in inadequate antiprotease production in smokers. All of this contributes to the development of emphysema. The lung parenchyma produces alpha one antitrypsin (AAT), which inhibits trypsinize and neutrophil elastase in the lung. AAT deficiency can cause panacinar emphysema.
Signs and Symptoms of Emphysema
- Cough
- There is shortening of breath
- Exertional dyspnea with some specific physical activities
- Significant weight loss
- The appearance of pink puffers
The Role of Physiotherapy in Emphysema Cases
Physiotherapy plays an important role in the management of emphysema, especially to help manage symptoms and speed recovery. Depending on the severity, physiotherapy services that can be provided include:
- Active cycle breathing technique
- Postural drainage
- Effective cough technique
- Breathing technique
- Manual techniques, such as percussion and vibration
- Education
- Aerobic and resistance exercise programs
Also read: Pneumonia – Penatalaksanaan Fisioterapi
Reference :
1. Pahal P, Avula A, Sharma S. Emphysema. [Updated 2023 Jan 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482217/
2. Respiratory Physiotherapy Ireland. Emphysema. diakses pada 25 Januari 2024 pada https://respphysio.ie/conditions-we-treat/emphysema/
