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The primary etiology of emphysema is long-term exposure to airborne irritants which damage the lungs and airways (Cleveland Clinic, 2021). Smoking is the number one cause of emphysema. Smoking irritates the airways and destroys lung tissue, causing inflammation, which leads to swollen airways and causes shortness of breath (Sarkar et al., 2019). In HG’s case, he has smoked cigarettes for 45 years and this is the contributing cause to his emphysema and COPD diagnoses.
Expected findings during inspection for COPD/emphysema patients could include: accessory muscle use during respirations, purse-lip breathing, wheezing, nail clubbing, blue lips or nails, cough, exaggeration inward movement of lower ribs during inspiratory (Hoover’s sign), or barrel-shaped chest. Patients with COPD can also have peripheral edema and can indicate right-sided heart failure or can be a result of hypercapnia (Sarkar et al., 2019). During palpation, one will notice a decreased tactile fremitus, due to the hyperinflation of the lungs (Sarkar et al., 2019). While percussing a patient with emphysema, one will note hyperresonance. During auscultation, expected findings include diminished breaths sounds and wheezing.
HG’s presentation would include subjective findings such as, smoking history, feeling of chest tightness or shortness of breath, complaints of cough or sputum (Anderson et al., 2017). Objective findings would include, wheezing, accessory muscle use, vital signs (decreased oxygen saturation, tachycardia), increased pCO2 on ABG, blue lips or fingernails, barrel-chest, peripheral edema, or congestion on an X-ray.
References
Anderson, W. H., Ha, J. W., Couper, D. J., O’Neal, W. K., Barr, R. G., Bleecker, E. R., Carretta, E. E., Cooper, C. B., Doerschuk, C. M., Drummond, M. B., Han, M. L. K., Hansel, N. N., Kim, V., Kleerup, E. C., Martinez, F. J., Rennard, S. I., Tashkin, D., Woodruff, P. G., Paine, R., & Kanner, R. E. (2017). Variability in objective and subjective measures affects baseline values in studies of patients with COPD. PLOS ONE, 12(9). https://doi.org/10.1371/journal.pone.0184606
Cleveland Clinic. (2021). Emphysema: Causes, symptoms, diagnosis & treatments. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9370-emphysema.
Sarkar, M., Bhardwaz, R., Madabhavi, I., & Modi, M. (2019). Physical signs in patients with chronic obstructive pulmonary disease. Lung India: Official Organ of Indian Chest Society, 36(1), 38–47. https://doi.org/10.4103/lungindia.lungindia_145_18
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