Clinical features of Emphysema

Symptoms

• Emphysema develops gradually over a period of years.
• People with emphysema have great difficulty in exhaling (breathing out). Symptoms such as shortness of breath (sometimes associated with wheeze) occur initially on exertion and then as the disease progresses, with little exertion and ultimately at rest. The person eventually may not be able to carry out basic activities in a normal fashion. At end-stage disease the person may be dependent on oxygen for several hours a day.
• Weight loss caused by reduced eating and interest in eating because of poor breathing ability.
• Feeling of tiredness because of chronic lack of oxygen in the body. Other symptoms may be impaired memory and concentration, irritability and excessive daytime sleepiness.

Signs

A barrel-shaped chest, which is a sign of over-inflation of the lungs and trapped air in the lungs. Horizontal ribs with prominent sternal angle and increased diameter from front to back. The liver may be displaced downwards.

The "Pink Puffer" is often representative of a person with emphysema.

Respiratory drive is preserved, and the following features are evident:

• Severe breathlessness with pursed-lip breathing
• Thin, and often elderly
• Heart failure uncommon but is usually terminal
• Near normal blood gas (O2 and CO2) values
• Very severe airways obstruction
• Reduced gas transfer factor
• Increased total lung capacity
• Absence of cyanosis (blue lips)
• Tachypnoea (fast breathing)
• Over-inflated chest
• Reduced breath sounds especially over bullae