Specific approaches to pulmonary emphysema and its therapy
Pulmonary emphysema comes under the general category of lung disorders referred to as chronic obstructive airways disease and is the end result of a number of diseases which include pulmonary emphysema, chronic bronchitis and bronchiectasis. The characteristic feature of pulmonary emphysema is the destruction of the normal architecture of the lung, resulting in enlargement of the air spaces with a consequent reduction in the surface area of the lungs available for air exchange. Irreversible damage to the architecture of the lung results in enlargement of the air spaces and pulmonary emphysema. The introduction of adenoviruses has resulted in a number of attempts at gene therapy which are trophic for respiratory epithelium. The interaction between enzyme and inhibitor is the subject of much debate. A docking process establishes interactions between residues in the exposed loop of the inhibitor and the primary and secondary binding sites on the enzyme.
Measurement of the lung's ability to transfer gas from the alveoli to the circulation is a fundamental respiratory function test, as it measures directly what the lung really does in life. Gas transfer indices provide a window on the blood-gas barrier and are relatively easy to measure in the lab. K CO is the primary measurement which is made of gas transfer. The alveolar volume is the volume of the lungs available for gas exchange, calculated by gas dilution using an inert gas in the test gas mixture. The physiology of pulmonary gas exchange is governed by Fick's law of passive diffusion. Because there are more physiological variables affecting the measurement of gas transfer than other lung function tests, results are subject to a wider range of normal variability than many other lung function tests. Pulmonary emphysema leads to destruction of alveolar septae, which reduces the surface area for gas exchange, but not the lung volume.
Ageing, Dementia, and Palliative Care
This chapter describes that during the terminal stages of the common illnesses associated with ageing such as chronic cardiac disease, long-standing emphysema, and Alzheimer's disease, the care provided needs to be informed by sound palliative practice. It argues that the extension of palliative care to these groups will raise distinctive and often novel issues, especially in the case of the frail aged with dementia. The chapter discusses: communication and planning; the nurse's role as story-teller; whose voice will be heard? Problems with communication; and when 'enough is enough'. It discusses that effective, efficient, and timely communication is the keystone of all good nursing care and is also true in the kinds of cases. The pain relief received can be dependent on a particular nurse's interpretation of the language of the patient, especially if that person has dementia. Communication and explanation with family and friends is vital to ensure that the planned approach can be implemented smoothly.
Plasma sphingomyelin and longitudinal change in percent emphysema on CT. The MESA Lung study
Published in Biomarkers, 2014
Context: Ceramide causes endothelial apoptosis and emphysema-like changes in animal models. Objectives: Test if plasma sphingomyelin, a major precursor of ceramide, would predict longitudinal increase in the percentage of emphysema-like lung on computed tomography (CT). Materials and methods: 3840 participants had their plasma sphingomyelin measured at baseline examination and their pulmonary emphysema measured on cardiac CT scans at baseline and on follow-up visits. Mixed effects models were used to adjust for potential confounders. Results: One standard deviation increase in sphingomyelin predicted a 0.12% per year (95% CI: 0.02–0.22; p = 0.019) greater increase of percent emphysema. Discussion and conclusion: Higher plasma levels of sphingomyelin predicted greater annual increase in quantitatively measured percent emphysema.
Emphysematous Phenotype is Characterized by Low Blood Eosinophils: A Cross-Sectional Study
Published in COPD: Journal of Chronic Obstructive Pulmonary Disease, 2017
Andriana I. Papaioannou, Konstantinos Kostikas, Anastasia Papaporfyriou, Leonidas Angelakis, Evgenia Papathanasiou, Georgios Hillas, Argyro Mazioti, Petros Bakakos, Nikolaos Koulouris, Spyros Papiris, Stelios Loukides
Sputum and blood eosinophils are proposed as candidate biomarkers for the identification of chronic obstructive pulmonary disease (COPD) patients at risk for exacerbation and treatment response. In this study, we evaluated the associations of eosinophils with the presence of emphysema in COPD patients. Induced sputum and blood eosinophil measurements were performed in consecutive COPD patients. Patients underwent lung function testing and high resolution computed tomography (HRCT) of the chest and the presence of emphysema was quantified. Patients with emphysematous lesions in ≥15% of the pulmonary parenchyma were considered having significant emphysema. Ninety-eight patients were included in the study. Patients with significant emphysema had lower blood eosinophil counts compared to patients without emphysema [median (IQR) 34.6 (0.0, 63.0) vs. 169.0 (110.0, 260.0) cells/µL, p < 0.001]; similar results were observed for the percentage (%) of blood eosinophils, but no difference was observed for sputum eosinophils. The differences were evident in frequent and non-frequent exacerbators and irrespective of the use of inhaled corticosteroids (ICS). Patients with significant emphysema in HRCT present lower levels of blood eosinophils and these differences were present irrespective of the frequent exacerbator history or the use of ICS. Blood eosinophils may not represent a clinically relevant biomarker in the presence of emphysema.
Visual Recovery after Evacuation of Orbital Emphysema
Published in Orbit, 2007
Orbital emphysema due to orbital trauma is a well-known occurrence. Visual loss due to orbital emphysema, however, is an uncommon phenomenon. A case of unilateral orbital emphysema following door-handle trauma with subsequent proptosis, painful ophthalmoplegia and compressive optic neuropathy resulting in compromised vision is presented in an 8-year-old male child. Conservative management, including intravenous corticosteroids, failed to resolve the patient's symptoms and compressive optic neuropathy. Surgical intervention to evacuate orbital emphysema resulted in prompt resolution of symptoms, including recovery of vision. A review of the medical literature revealed that only few isolated cases of orbital emphysema with compressive optic neuropathy have been reported previously, with no reports due to door-handle trauma.