Emphysema is a type of chronic obstructive pulmonary disease. The air sacs in the lungs become damaged and stretched. This results in a chronic cough and difficulty breathing.




Treat any trigger, especially pneumonia or heart failure. Nonsteroidal anti-inflammatory drugs or opioids can aid the pleuritic pain. Thoracentesis can aid in therapy in a patient with respiratory or cardiac distress and can be used as symptomatic treatment in patients with dyspnea. The definitive treatment of an empyema is drainage and antibiotics.1

Initial antibiotic therapy for empyema targets the presumptive underlying pneumonia, lung abscess, or bronchiectasis. Recommended therapy includes piperacillin-tazobactam 3.375 to 4.5 grams every 6 hours IV or imipenem 0.5 to 1.0 gram IV every 6 hours. Add vancomycin for methicillin-resistant Staphylococcus aureus in those at risk. Those at risk for methicillin-resistant S. aureus include patients recently hospitalized, patients who have an invasive medical device, and patients residing in a long-term care facility. Those at risk of community-acquired methicillin-resistant S. aureus include participants in contact sports, those who live in crowded or unsanitary conditions, and men who have sex with men. Tailor antibiotics once culture results are available and the clinical course is apparent.1

Treat exudative empyema with chest tube thoracostomy in addition to antibiotics.5 Consider intrapleural fibrinolytic agents for empyema in the fibropurulent stage in consultation with a thoracic surgeon or pulmonologist. Streptokinase, urokinase, and more recently, deoxyribonuclease (either streptococcal deoxyribonuclease or human recombinant deoxyribonuclease) and alteplase all have some reported success.5,6 The decrease in the percentage of hemothorax occupied by pleural fluid is significantly greater for tissue plasminogen activator plus deoxyribonuclease (29.7%) versus tissue plasminogen activator alone (15.1%), saline (17%), or deoxyribonuclease alone (17.1%).7Video-assisted thoracoscopic surgery is useful in the treatment of loculated empyemas.5 Surgical removal of the fibrous peel is required to treat empyema in the organizational stage.



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