Pathophysiology
Emphysema and bronchitis are lung conditions that constitute chronic obstructive pulmonary disease (COPD). Airway obstruction is the primary indication in both illnesses. Consequently, emphysema and bronchitis affect normal breathing, in addition to causing other pulmonary complications (Kim & Criner, 2013). According to Hassan and Abo-Elhamd (2014), clinicians often find it difficult to differentiate between these lung infections because they frequently co-exist. Despite this limitation, the implications of emphysema and bronchitis on the lungs distinguish the two maladies (Kim et al., 2013).
Emphysema causes the progressive destruction of the alveoli (sacs of air found in the lungs). Washko (2012) has asserted that this obliteration causes the alveoli to lose their capacity to recoil and stretch (elasticity). As emphysema progresses, the alveoli become weaker and stiff. The air sacs can break; thus, creating irreversible perforations in the tissues underlying the lower lungs. These openings enlarge the alveoli, which trap air more efficiently (Hassan & Abo-Elhamd, 2014). Washko has identified chronic, active smoking as the primary cause of emphysema.
On the other hand, bronchitis causes the inflammation of the bronchioles, which increases the concentration of mucus in the lungs (Kim & Criner, 2013). Bacterial lung infections are prevalent in patients with bronchitis because the mucus provides a suitable environment for bacteria to thrive (Kim et al., 2013). The two forms of bronchitis are acute and chronic bronchitis. Productive and long-term coughing differentiates chronic bronchitis from acute one. Although active smoking is the leading cause of chronic bronchitis, passive smoking and air pollution exacerbate the risk (Rabe et al., 2007).
Both emphysema and bronchitis cause breathlessness (dyspnea) and reduced ventilation. The accumulation of thick mucus in the lungs contributes to labored breathing in bronchitis. The patient coughs persistently in an attempt to restore the airway patency (Kim & Criner, 2013). Unlike bronchitis, the loss of lung elasticity due to the inflammation of the alveoli instigates expiration difficulties in emphysema (Washko, 2012). Consequently, Rabe et al. have indicated that emphysema and chronic bronchitis are underlying risk factors for cardiac complications.
Clinical Manifestations
Patients are usually asymptomatic during the initial development of emphysema and bronchitis. Nonetheless, shortness of breath and chronic cough are frequent in both bronchitis and emphysema (Hassan & Abo-Elhamd, 2014). The cough is initially minor with the production of minimal sputum. A productive and recurrent cough that lasts three months annually for two consecutive years confirms the diagnosis of chronic bronchitis (Kim & Criner, 2013). The persistent clearing of the throat and increased production of mucus are common manifestations of chronic bronchitis. Conversely, the unique symptom of emphysema is exercise intolerance (Washko, 2012).
The initial signs of breathlessness occur on exertion in both bronchitis and emphysema. As the progress of the condition, the exercise capacity deteriorates slowly and gradually. The affected patients eventually experience breathing difficulties even at rest (Kim et al., 2008). Emphysematous patients do not produce sounds while breathing because this disease does not increase airway resistance (Hassan & Abo-Elhamd, 2014). According to Washko (2012), pulse-lipped breathing exerts a positive pressure on the bronchial tree to prevent airway collapse in emphysema. By contrast, individuals suffering from chronic bronchitis experience noisy breathing owing to the accumulation of thick mucus in the lungs (Kim & Criner, 2013).
Patients with bronchitis and emphysema have an increased risk of chest infections and pneumonia. These individuals may require hospitalization for intensive treatment since chest infections increase the severity of symptoms (Garvey & Ortiz, 2012). The acute episodes of emphysema and chronic bronchitis include hypoxia and edema (especially in the lower extremities). The insufficient supply of oxygen to the heart and cardiac overload causes fatigue even with minimal activity (Kent et al., 2011). Rabe et al. (2007) have indicated that the rising demand for myocardial oxygen amplifies the risk of myocardial damage.
Nursing/Medical Management
The deleterious health effects of bronchitis and emphysema make it difficult to restore normal functioning. As such, the aim of pharmacological and non-pharmacological interventions is to reduce the exacerbation of symptoms (Rabe et al., 2007). The effectual management of interrelated conditions in both bronchitis and emphysema is imperative to enhance the patients’ quality of life (Kim et al., 2013). Thus, the management of chronic bronchitis and emphysema focuses on medication adherence, oxygen therapy, and smoking cessation (Hassan & Abo-Elhamd, 2014).
Firstly, bronchodilators play a fundamental role in relaxing the muscles surrounding the bronchi to facilitate the efficient exchange of gasses. A metered-dose inhaler is used to administer bronchodilators (Kim & Criner, 2013). On the other hand, corticosteroids suppress the inflammatory reactions that are common in chronic bronchitis. The objective of corticosteroids is to reduce the secretion of mucus and bronchi swelling (Kim et al., 2013). Rabe et al. (2007) have noted that over-the-counter drugs are also essential for expectoration and in repressing cough reflexes.
Secondly, emphysema and bronchitis decrease tissue perfusion. The acute exacerbation of emphysema and chronic bronchitis require adequate ventilation to prevent hypoxia (Kent et al., 2011). Oxygen therapy is elemental to diffuse carbon dioxide from the lungs. Findings from a study conducted by Kim et al. (2008) have shown that patients with severe hypoxia and airway obstruction benefit from long-term oxygen therapy. In addition, controlled ventilation can also help individuals who have refrained from smoking cigarettes (Rabe et al., 2007).
Thirdly, smoking cessation is a significant nursing strategy for reducing disease onset in both conditions. The problem with smoking is that it induces irreversible changes to the pulmonary system (Kim et al., 2013). Patients who stop smoking experience a decline in respiratory function at a rate that is comparable to that observed in non-smokers (Rabe et al., 2007). Garvey and Ortiz (2012) have asserted that smoking cessation relieves chronic coughing. Conversely, the patients who have stopped smoking cigarettes need nicotine replacement strategies, support groups, and training on behavior medication (Hassan & Abo-Elhamd, 2014).
Prognosis
Although chronic bronchitis does not contribute to significant mortalities, symptoms can persist for a prolonged period. Patients can experience permanent or severe lung damage if they neither treat nor manage their bronchitis adequately. Some patients may experience repeated exacerbations, which worsen the symptoms progressively (Kim et al., 2013). Kim and Criner (2013) have blamed viral infections for the debilitating effects of chronic bronchitis. The primary concern is that the mild flu or could worsen the symptoms of chronic bronchitis (Garvey & Ortiz, 2012). The presence of other complications (particularly heart failure) influences the prognosis. Death may occur if there is a decline in lung function owing to infective exacerbations (Rabe et al., 2007).
Emphysema has no cure, but the efficient management allows patients to live a normal life (Hassan & Abo-Elhamd, 2014). Multiple variables affect the prognosis of emphysema. For instance, Washko (2012) has asserted that the ability to quit smoking reduces the progression of emphysema. In both chronic bronchitis and emphysema, the strict adherence to prescribed medications and smoking cessation determine the overall prognosis. Patients who cease smoking and continue receiving oxygen therapy improve their survival rates (Kim et al., 2008). Just like chronic bronchitis, Washko (2012) has found out that pulmonary function also determines the prognosis of emphysema.
References
Garvey, C., & Ortiz, G. (2012). Exacerbations of chronic obstructive pulmonary disease. Open Nursing Journal, 6, 231-237.
Hassan, W. A., & Abo-Elhamd, E. (2014). Emphysema versus chronic bronchitis in COPD: Clinical and radiologic characteristics. Open Journal of Radiology, 4, 155-162.
Kent, B., Mitchell, P. D., & McNicholas, W. T. (2011). Hypoxemia in patients with COPD: Causes, effects and disease progression. International Journal of Chronic Obstruction Pulmonary Disease, 6, 199-208.
Kim, V., & Criner, G. J. (2013). Chronic bronchitis and chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 187(3), 228-237.
Kim, V., Benditt, J. O., Wise, R. A., & Sharafkhaneh, A. (2008). Oxygen therapy in chronic obstructive pulmonary disease. Proceedings of the American Thoracic Society, 5(4), 513-518).
Kim, V., Sternberg, A. L., Washko, G. R., Make, B. J., Han, M. K., Martinez, F., & Criner, G. J. (2013). Severe chronic bronchitis in advanced emphysema increases mortality and hospitalization. Journal of Chronic Obstructive Pulmonary Disease, 10(6), 667-678.
Rabe, K. F., Hurd, S., Anzueto, A., Barnes, P. J., Buist, S. A., Calverley, P., … Zielinski, J. (2007). Global strategy for the diagnosis management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. American Journal of Respiratory and Critical Care Medicine, 176(6), 532-555.
Washko, G. R. (2012). Rate of decline in FEV1: Is emphysema the culprit? American Journal of Respiratory and Critical Care Medicine, 185, 2-3.