Pulmonary Emphysema—Prevention and Care

¹ Associate Professor of Internal Medicine and Markle Scholar State University of New York, Buffalo, New York
² Consultant in Medicine, Presbyterian Hospital, New York, New York
³ Professor of Clinical Anatomy and Surgery, University of Maryland, Baltimore, Maryland
⁴ Clinical Professor of Medicine, University of Southern California, Los Angeles, California

The consistent theme of the panel in relation to emphysema is to think of treatment of this disease in physiologic terms. Airway obstruction is a fundamental factor in both treatment and prevention. The importance of bronchospasm, retained secretions, mucosal and occult pulmonary edema all have their effects on heart failure, the elimination of carbon dioxide, the overdistended lung, and the "conditioning" of a patient . . . factors of special consideration by the individual members of the panel. The diagnosis of occult heart failure involves awareness that the usual symptoms of pulmonary edema may not be easily detected. However, compensation of the circulatory element can be quite effective in overall therapy. The specific determination of overdistention of the lungs from emphysema, localized or generalized, can determine possible surgical approaches to this disease. An understanding of the importance of carbon dioxide elimination can offer incentive and understanding of the physiologic management of ventilation in emphysema.

Much consideration has been given to the correlation of the recent pathologic concepts of centrilobular and panlobular emphysema. Attempts to correlate the physiologic findings with these concepts have offered difficulties. Finally, consideration of methods for the early detection of this disease as a possible means of preventing lung tissue destruction suggest that the same therapeutic measures for airway obstruction are equally effective in prevention. It is important for all physicians to get the concept of emphysema as a disease which can start with a chronic productive cough. When a patient comes in with such a cough, regardless of its etiology, cigarettes, sinusitis, chronic bronchitis or any of the other common causes, this is the time to start prevention of emphysema, for this is how emphysema starts.