Shortness of breath is the outstanding symptom reported by individuals suffering from this disorder. Other symptoms include:

  • a chronic cough

  • a bluish coloration of the skin (caused by lack of oxygen)

  • shortness of breath with mild exertion

  • wheezing

Additional symptoms that may be associated with this disease:

  • nasal flaring

  • eyes bulging

  • dizziness

  • difficulty breathing, lying down

  • anxiety, stress and tension

  • ankle, feet and leg swelling

  • unintentional weight loss

  • headache (may be worse in the morning)

  • fatigue

  • impaired ability to concentrate

  • Awakening many times at night

  • Awakening from sleep not rested

  • memory loss

  • clubbing of the fingers or toes

PHYSICAL EXAMINATION

A physical examination will show decreased breath sounds, wheezing and rales (crackles) and prolonged exhalation. It will take an emphysema patient twice as long to exhale as it does to inhale, as they have a hard time getting the air out of their lungs. The chest may be enlarged on the right side, or there may be an increased front to back diameter of the chest (called a barrel shaped chest). Patients generally look very tired, these are all signs of insufficient oxygen.

 

SOME COMMON MISCONCEPTIONS

Because emphysema patients usually look just fine, caregivers have a hard time realizing that they need help with so many simple things. When a patient with emphysema is eating, they are using all their accessory muscles to breath. A person that does not have emphysema uses only the chest muscles and their accessory muscles can be used to lift and pull. This is not so in the patient with emphysema. This is why eating is so difficult, they are using their muscles for a duel purpose and they will tire very easily. If they eat a large meal, their diaphragm is lifted, and they are unable to take deep breaths, and they need to do this to function. So, eating is a very difficult task for a resident with emphysema.

Bathing requires this same muscle usage as breathing (accessory muscles). When bathing they are moving around and using their upper body, the same muscles they use to breathe, and are in a moist atmosphere which causes more coughing and increased shortness of breath. All these things for an ordinary person are easy, yet for a resident with emphysema, this is very difficult and can be exhausting.

Most patients with emphysema will sleep with two or more pillows, this makes breathing easier, and as the disease progresses they may even need to sleep in a hospital bed or a recliner as this upright position helps them to breath easier.

Many residents with emphysema seem short-tempered but this is not always the case. It is much easier for them to say a few words and get a point across than it is to elaborate and become so short of breath that they cannot finish what they want to say without stopping a few times. This happens with a lot of residents, and they fail to say "please", or to make long narrative sentances They are not demanding or short tempered, they do this because it is much easier and they really don't have the breath.

Some of the things that you may be able to do to help a respiratory patient with emphysema is to ask questions that require a yes or no answer. Try and schedule meals and bath with time between so that they can rest before the next task. Offer small meals more frequently so they don't get quite as full at one sitting. All of these things will help the resident and the caregiver have a much better understanding of each other.

Tests that help confirm the diagnosis:

arterial blood gases ( this shows how much oxygen is in the blood and will be reduced in
patients with emphysema.

Serum alpha-1 antitrypsin ( showing a deficiency)

Chest X-ray

Pulmonary function tests (which will show a decrease in the lung capacity, the inability
to take in and blow out a normal breath).