Introduction
Emphysema and chronic bronchitis are the two main conditions that occur under the umbrella of Chronic Obstructive Pulmonary Disease (COPD). Both diseases involve airflow obstruction, which interferes with the normal breathing process in the lungs. Chronic bronchitis and emphysema are the most important diseases of COPD. According to the American Lung Association [ALA] (2013), COPD is the third leading cause of death in the United States, and therefore, it is a major health concern as well as an economic issue.
Additionally, out of the six leading causes of death in the U.S., COPD stands out as the only one that prevails steadily with over 12 million people affected by the year 2008 (ALA, 2010). Chronic bronchitis affects more people than emphysema considering that it affects 9.8 million people compared to 3.8 million people. Several predisposing factors that cause both diseases exist, but the primary factor is cigarette smoking. This paper compares and contrasts the pathophysiology, clinical manifestations, medical management, and the prognosis of emphysema and chronic bronchitis.
Pathophysiology
Chronic bronchitis is characterized by an increased cough production occurring for several days and extends for more than three months. It also involves uncontrolled breathing for two years. The other characteristics of chronic bronchitis include inflammation and thickening of the bronchial tubes (airways), which lead to excessive production of mucus. As a result, there is an obstruction of the airways because of the excess mucus, which in turn leads to difficulty in breathing in patients. As noted earlier, cigarette smoking is the primary cause of chronic bronchitis, and this involves both active and passive smoking.
Other triggers include exposure to pollutants, infections such as bacterial and viral infections, dust, and irritating fumes. Most people do not realize that they have chronic bronchitis until it causes lung damage. This leads to a lack of proper treatment and escalation of symptoms, which in turn lead to high mortality rates as shown earlier. According to ALA (2013), chronic bronchitis affects more women than men.
On the other hand, emphysema traditionally affected more men compared to women, although the gap continues to narrow down over time. Emphysema leads to the inelasticity of the alveoli walls. This causes the alveoli to become stiff and weak leading to their destruction. As a result, there is impairment of the air sacks, which become incapable of engaging in the exchange of oxygen and the elimination of carbon dioxide. Compared to chronic bronchitis, the leading cause of emphysema is also cigarette smoking. Moreover, air pollution from other quarters such as occupational exposure also leads to the development and progression of the disease.
Additionally, emphysema occurs due to a genetic factor, which is Alpha-1 antitrypsin deficiency. Alpha-1 antitrypsin is a protein molecule whose main purpose is to protect the lung walls from destruction by enzymes such as proteases. The white blood cells produce these enzymes as part of the body’s defensive mechanism together with toxins to kill pathogens that invade the lungs. However, besides killing the pathogens, the enzymes damage the lungs in the process.
Moreover, Alpha-1 antitrypsin plays an essential role in inactivating the enzymes released by the body’s white blood cells thus offering protection to the lungs. As a result, persons with Alpha-1 antitrypsin deficiency are at high risk of developing emphysema without cigarette smoking. Moreover, such individuals have a high chance of developing the disease in the presence of cigarette smoke because smoking increases the risk of developing emphysema (Mattison & Christensen, 2006).
Clinical Manifestations
The clinical manifestations of the two diseases are well known. Accordingly, emphysema leads to the destruction of the air sacks and it is irreversible. On the other hand, chronic bronchitis is similarly irreversible Unlike acute bronchitis, which is reversible. Both emphysema and chronic bronchitis can occur in the same person concurrently, and both lead to difficulty in breathing. In both conditions, coughing is a common symptom.
Additionally, emphysema is characterized by symptoms such as limited exercise tolerance, shortness of breath, wheezing, loss of appetite, an extended cough that may or may not involve sputum production. On the other hand, chronic bronchitis patients experience other symptoms such as problematic breathing, extended coughs, and excessive mucus production. The diagnosis of chronic bronchitis and emphysema entails the examination of physical characteristics, the history of the patient, and other tests involving the functioning of the lungs.
Nursing Care/Medical management
Since both emphysema and chronic bronchitis involve irreversible lung damage, the patient of either of these conditions’ experiences deterioration of the quality of life as the disease progresses (ALA, 2010). Consequently, there is the need to slow down the progress of these conditions. Moreover, considering that the most important risk factor for both conditions is cigarette smoking, it is necessary to advise patients on the benefits of smoking cessation.
According to Parker and Eaton (2012), about 70% of smokers visit their doctor annually, meaning that these health professionals have the opportunity to help their patients to quit smoking. Further, Parker and Eaton (2012) note that physicians and other health care professionals can contribute to their patients’ successful cessation of smoking by providing various interventions considering that higher quit rates occur when the health professional intervenes than when the smoker initiates the intervention.
Additionally, Parker and his colleague outline a five-step program developed by the U.S. Department of Health and Human Services (DHHS), which is a strategic plan meant for primary care settings to help smokers to quit smoking. These steps involve enquiring if the patient uses tobacco, providing advice to the patient to quit smoking, and assessing the patient’s willingness to cease smoking. Further, health care providers are supposed to help those who are willing to stop smoking by setting a quit date, referring the smokers for counseling, or offering first-line drugs. Finally, the fifth step involves follow up either in person or through telephone contact to ensure that the patient does not return to the habit of smoking. For the patients who are unwilling to quit smoking, designing a motivational intervention is necessary.
Treatment/ Prognosis
Treatment of emphysema and chronic bronchitis is relatively hard, especially if the two conditions are at an advanced stage and remain uncontrolled for a long time. According to the West Virginia Department of Health and Human Resources [WVDHHR] (2006), smoking cessation is the most effective way of reducing emphysema and chronic bronchitis because it halts the development of the two diseases. Passive smoking should also be avoided as well as controlling air pollution from the environment is the most effective way of preventing the diseases. Moreover, health care practitioners should design rehabilitative counseling programs that target emphysema and chronic bronchitis patients.
On the other hand, WVDHHR (2006) notes that no medication is available that is effective in reversing the effects of emphysema or chronic bronchitis. However, some drugs can be useful in reducing complications and managing the symptoms. Here, the main goal of treating chronic bronchitis is to ease the opening of airways as well as eradicate lung infections to avoid further complications. Moreover, the management of chronic bronchitis entails the use of bronchodilators, corticosteroids, antibiotics in situations where there is a bacterial infection, and chest physiotherapy. On the other hand, the main aim of treating emphysema is to slow down disease progression and to enhance the welfare of the patients.
Additionally, there is a need to manage the airways to ensure there is an exchange of gases in the lungs. Similarly to chronic bronchitis, the management of emphysema involves the use of bronchodilators, corticosteroids, and antibiotics. The bronchodilators used in the treatment of the two conditions fall into two classes, which are beta-2-agonists that relaxes the muscles around the airways, and anticholinergics that decrease mucus production and play the role of blocking chemicals produced by the human body that cause contraction of the airways. Moreover, WVDHHR (2006) asserts that the concurrent administration of the two bronchodilators enhances their efficacy.
On the other hand, corticosteroids reduce inflammation and mucus secretion. However, steroids are useful in mild to moderate cases of emphysema and chronic bronchitis, but they can cause adverse effects in advanced disease stages. The use of antibiotics becomes necessary in cases of bacterial infections. In severe emphysema or chronic bronchitis cases, it is important to use long-term oxygen therapy. Some severe cases of emphysema require surgical procedures to improve symptoms and alleviate complications.
In conclusion, both emphysema and chronic bronchitis are the main COPD diseases, and they are preventable. The primary risk factor for both conditions is cigarette smoking including both active and passive. Therefore, health care professionals need to help their patients to quit cigarette smoking since this is the most effective yet cost-effective way of managing both COPD diseases.
References
American Lung Association, [ALA]. (2013). Trends in COPD (Chronic bronchitis and emphysema): Mortality and morbidity. Web.
American Lung Association, [ALA]. (2010). Chronic Obstructive Pulmonary Disease (COPD). Web.
Mattison, S., & Christensen, M. (2006). The pathophysiology of emphysema: considerations for critical care nursing practice. Elsevier, 22, 329-337.
Parker, D. R., & Eaton, C. B. (2008). Chronic obstructive pulmonary disease and smoking ceasation. American Journal of Lifestyle Medicine, 6(2), 159-166.
West Virginia Department of Health and Human Resources, [WVDHHR]. (2006). Chronic lower respiratory disease: A national burden. Web.