Emphysema (cont.)
How is emphysema diagnosed?
As is the case with most illnesses, the healthcare provider will take a
careful history to learn about the lung and breathing symptoms.
- How long has the shortness of breath been present?
- What makes it better?
- What makes it worse?
- Has there been an infection recently?
- Have the symptoms been getting more severe?
- Does the patient smoke?
- Does the patient have exposure to secondhand smoke or other toxic fumes?
- Is there a family history of lung disease?
Physical examination
Physical examination will concentrate on the lung findings, but may also
include the heart and the circulatory system.
- Is there an increased respiratory rate?
- Is the patient short of breath just sitting in the examination room?
- Is the patient using accessory muscles to breathe, in addition to the rib
muscles and the diaphragm?
- Is the chest cavity enlarged or barrel-shaped?
- Does the chest cavity sound hollower than it should?
- Does exhalation take longer than it should?
- Is the movement of the diaphragm decreased?
- Is the patient cyanotic (having a blue tinge to the skin color signifying
lack of oxygen in the blood)?
- Listening to the lungs, are there wheezes present, especially if the
patient is asked to exhale quickly?
Exams and tests
Oximetry
Oxygenated blood is a brighter red and becomes purpler in color when oxygen
is removed. The oximeter is a device usually placed on a finger and detects the
pulse of blood. A light is transmitted through the tissue, and the amount of the
brighter red color is determined, enabling a measure of oxygen saturation, a
measure of hemoglobin oxygen content. This value is usually greater than 90%.
Blood Tests
A complete blood cell count (CBC) may be performed to check for an increase
in the number of red blood cells. In response to lower blood oxygen
concentrations, the body manufactures more red blood cells to try to deliver as
much oxygen as possible to cells.
Alpha 1-antitrypsin levels may be measured to look for any genetic
predisposition to emphysema.
An arterial blood gas test will measure the amount of oxygen and carbon
dioxide in the blood and combined with other measurements can help the healthcare provider decide whether the body has been able to adapt to the lower oxygen
concentrations in the body. In some laboratories, the arterial blood gas result
will include a carbon monoxide percentage, most often found in the body because
of smoking. For each hemoglobin molecule that has carbon monoxide attached,
there is one less that can carry oxygen.
Radiology
A plain chest x-ray may show lungs
that have become too inflated and too
lucent, signs that lung tissue destruction has occurred.
Pulmonary Function Tests
A variety of lung functions can be measured and may include how much air the
lungs can hold and empty with each breath, the degree of airflow obstruction,
the available surface for exchange of carbon dioxide and oxygen, the amount of
trapped gases, and how elastic the lungs are with inspiration and expiration. By
comparing results to a "normal" person of the same age, sex and size,
estimations can be made as to the severity of the emphysema.
Next: What is the treatment for emphysema? »
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