Emphysema (폐기종)(Kor/Eng)

Emphysema  (폐기종)

English Version

1. Definition

Emphysema is a chronic lung disease and one of the two main types of COPD (Chronic Obstructive Pulmonary Disease).
It is characterized by destruction of the alveoli (air sacs), causing loss of lung elasticity and air trapping, which makes it difficult to exhale.

As the alveoli walls break down, the lung becomes overinflated, reducing surface area for gas exchange.

 

 

 

 

 

 

2. Causes (Etiology)

• Smoking (most common cause) – #1 risk factor
• Long-term exposure to:
  • Air pollution
  • Chemical fumes
  • Dust
• Alpha-1 antitrypsin deficiency (AATD) – genetic cause

3. Pathophysiology

• Alveolar walls break down → larger, less effective air spaces
• Loss of elastic recoil → air is trapped inside the lungs
• Lungs become hyperinflated (“barrel chest”)
• Decreased surface area → poor gas exchange
• Increased CO₂ retention → respiratory acidosis (in severe cases)

4. Symptoms

Classic symptoms:

• Progressive dyspnea (shortness of breath)
• Exertional dyspnea
• Pursed-lip breathing
• Barrel chest
• Use of accessory muscles
• Minimal cough (unlike chronic bronchitis)
• Thin or cachectic appearance
• Fatigue
• Wheezing

5. Main Characteristics

• “Pink puffer” appearance (normal oxygenation but hyperventilation)
• Hyperresonance on percussion
• Decreased breath sounds
• Air trapping (↑ residual volume)
• Decreased DLCO (diffusion capacity)

 

 

 

 

 

 

6. Diagnosis

• Pulmonary function test (PFT):
  • ↓ FEV₁
  • ↓ FEV₁/FVC ratio
  • ↑ Total lung capacity
  • ↑ Residual volume
• Chest X-ray: hyperinflated lungs, flattened diaphragm
• CT scan: bullae (air-filled spaces)
• ABG: may show ↑ CO₂ and ↓ O₂ in advanced disease

 

 

 

 

 

 

 

7. Treatment / Therapy

There is no cure — treatment focuses on symptom control and preventing progression.

Medications:

• Bronchodilators (albuterol, ipratropium, tiotropium)
• Inhaled corticosteroids
• Combination inhalers
• Phosphodiesterase inhibitors
• Oxygen therapy (for severe cases)
• Antibiotics for infections

Non-pharmacologic:

• Smoking cessation (MOST important)
• Pulmonary rehabilitation
• Breathing techniques: pursed-lip breathing
• Exercise and nutrition support

Surgical options:

• Lung volume reduction surgery (LVRS)
• Bullectomy
• Lung transplant (severe cases)

 

 

 

 

 

 

8. Nursing Considerations

• Teach pursed-lip breathing
• Encourage small frequent meals (large meals worsen dyspnea)
• Monitor for:
  • Hypoxemia
  • CO₂ retention
  • Respiratory acidosis
• Position in high Fowler’s
• Encourage vaccination: influenza, pneumococcal
• Smoking cessation counseling

 

 

 

 

 

 

 

폐기종 (Emphysema)

1. 정의

폐기종은 **COPD(만성 폐쇄성 폐질환)**의 주요 형태 중 하나로, **폐포(alveoli)**가 파괴되어 폐 탄성이 감소하고 공기 포획(air trapping) 이 발생하는 질환입니다.
이로 인해 숨을 내쉬기 어려워지고, 폐가 과도하게 부풀게 됩니다.

 

 

 

 

 

 

 

2. 원인 (Etiology)

• 흡연 (가장 흔한 원인)
• 장기간의 공기오염 노출
• 화학물질, 산업 분진 노출
• 알파-1 항트립신 결핍증 (유전적 원인)

 

 

 

 

3. 병태생리 (Pathophysiology)

• 폐포벽 파괴 → 가스 교환 면적 감소
• 폐 탄성 감소 → 공기 배출 어려움
• 폐 과팽창 → 배럴 가슴(barrel chest)
• CO₂ 배출 장애 → 고탄산혈증, 호흡성 산증

 

 

 

 

 

4. 증상

• 호흡곤란 특히 운동 시 (exertional dyspnea)
• pursed-lip breathing(입 오므리고 호흡)
• 배럴 가슴
• 조용하고 얕은 호흡
• 체중 감소, 피로
• 천명음(wheezing)
• 기침은 거의 없음 (만성기관지염과의 차이점)

 

 

 

 

5. 주요 특징

• “핑크 퍼퍼(Pink Puffer)” 외모
• 청진 시 호흡음 감소
• 과공명음 (percussion hyperresonance)
• 공기 포획 증가
• 폐 확산능(DLCO) 감소

 

 

 

6. 진단

• 폐기능검사(PFT):
  • FEV₁ 감소
  • FEV₁/FVC 비율 감소
  • 잔기량 증가
  • 총폐용량 증가
• X-ray: 과팽창, 편평한 횡격막
• CT: bullae 확인
• ABG: 고탄산혈증, 저산소증 가능

 

 

 

7. 치료

완치는 없으며, 증상 관리와 악화 방지가 목표입니다.

약물 치료

• 기관지확장제(알부테롤, 이프라트로피움, 티오트로피움)
• 흡입 스테로이드
• 복합 흡입제
• 산소 요법
• 폐 감염 시 항생제

비약물 치료

• 흡연 중단(가장 중요)
• 폐 재활
• 호흡기 운동 (pursed-lip breathing)
• 규칙적 운동, 영양관리

수술 치료

• 폐 용적 감소 수술
• Bullae 절제술
• 폐 이식

 

 

 

 

 

 

 

8. 간호 중재

• 고좌위(High Fowler’s)로 호흡 보조
• pursed-lip breathing 교육
• 저산소증, 고탄산혈증 관찰
• 작은 양의 식사, 자주 섭취
• 감염 예방 교육 (독감, 폐렴 백신)
• 금연 교육 필수