9432 0
IN last years In connection with the use of new X-ray methods, X-ray diagnostics of pulmonary emphysema plays a very important role and in many cases makes it possible to judge the degree of functional disorders. When selecting patients for surgical treatment It is especially important to accurately interpret radiographic findings.
X-ray changes in pulmonary emphysema were described in detail by Yu. N. Sokolov, E. V. Neshel, W. Frich a. ass., W. Fray, G. Simon, etc. With widespread emphysema, skeletal changes can be detected chest, but they do not have much diagnostic value.
The most characteristic sign of diffuse emphysema is an increase in the pulmonary fields, mainly due to their vertical size (drooping of the diaphragm, widening of the intercostal spaces) and transverse (more horizontal course of the ribs and protrusion of the sternum). The latter causes the expansion of the retrosternal and retrocardial space, which is clearly visible even on exhalation.
The diaphragm is lowered in emphysema. Its right dome is located at the neck of the 10-11th rib (normally on the ninth). The height of the diaphragm dome is usually 2-3 cm (normal according to W. Frick is at least 4 cm). Flattening of the diaphragm leads to an increase in the size of the lateral and costophrenic sinuses. A lateral sinus greater than 45° indicates emphysema. With severe emphysema, the diaphragm takes on the shape of a tent, “scalloping”, “stepping” appears, which may be associated with adhesions or exposure of the places where the diaphragm attaches to the ribs as it flattens.
Yu. N. Sokolov discovered this symptom in healthy individuals with well-defined diaphragmatic breathing, but in patients with pulmonary emphysema, the diaphragm is little mobile: in a severe form of the disease, the dome moves less than the height of one intercostal space, and in very severe cases, vibrations of the diaphragm are barely noticeable, or it makes paradoxical movements (when inhaling, it rises, following the ribs).
Due to the low position of the diaphragm, the heart appears narrow. Even with right ventricular hypertrophy, its diameter does not exceed 11-11.5 cm.
The diplogram (or bigram) allows you to judge the degree of expansion of the chest. One of the pictures is taken while inhaling, the other – while exhaling (possibly on the same film) and, combining them, the dilatation coefficient is determined. According to W. Fray, the inhalation-exhalation area ratio normally does not exceed 72 (according to E.V. Neshel - 65-75). With initial pulmonary emphysema it is equal to 70-80, with emphysema of the second degree - 80-90, with emphysema of the third degree - more than 90. Using the bigram, you can also determine VA L. Pulmonary volumes are also calculated using an x-ray kymogram (V.I. Sobolev, E. S. Mutina), which clearly reveals a slower exhalation (the exhalation knee is elongated and deformed) with emphysema.
Changes in the transparency of the pulmonary fields in different phases of breathing reflect the ventilation function of the lungs. The methods of this test were developed by Yu. N. Sokolov, E. V. Neshel, A. I. Sadofyev and others. In severe emphysema, the transparency of the pulmonary fields in different phases of breathing almost does not change. Increased transparency of the lungs alone does not indicate emphysema, because it may be due to decreased blood supply to the pulmonary vessels or atrophy chest wall when exhausted. Against the background of increased transparency of the pulmonary fields, an increase in the pulmonary pattern in the root area and its depletion in the periphery, characteristic of emphysema, appears, which reflects a decrease in blood supply to the peripheral parts of the lungs and an increase in resistance to blood flow in the pulmonary circle.
Tomography and angiopulmonography play an important role in judging the state of pulmonary circulation. The latter in most cases makes it possible to judge the localization, prevalence and extent of the disease. This method requires special equipment and clinical practice not yet widespread. I. A. Shekhter, M. I. Perelman, F. A. Astrakhaitsev, M. Z. Upinger discovered vasoconstriction in the area of emphysematous fields. They are spread apart, have few vascular branches, which do not extend at an acute angle, as usual, but at a right angle.
A. L. Vilkovsky and Z. M. Zaslavskaya, K. Jensen a. ass., G. Scarow, G. Lorenzen, G. Simon, H. Khuramovich, on angiograms of patients with emphysema, they found dilation of the hilar and lobar arteries, reflecting an increase in vascular resistance, narrowing of blood vessels from the center to the periphery with a very poor vascular network in areas of emphysema. K. Semish also revealed a slowing of capillary flow and arteriovenous anastomoses. M. A. Kuznetsova (1963) discovered similar changes in blood vessels on X-ray tomograms, and V. Lopez-Majano a. ass. - on scangrams.
Changes in the vascular bed increase as the disease progresses. According to L. Read, on angiograms the process seems more widespread than it is revealed at autopsy, which reflects the presence of vasospasm, which, like bronchospasm, plays a significant role in the progression of the disease.
Blistering areas may not be detected on a regular radiograph, especially with peripheral subpleural localization of bullae. Sometimes they are recognized as finely defined ring-shaped shadows or an avascular zone with a cellular pattern and deviation of the shadows of the vascular and bronchial branches. They are visible better on tomograms.
Bronchography for diffuse emphysema has not become widespread - it is difficult to tolerate in this group of seriously ill patients, and the contrast, due to the ineffectiveness of coughing, lingers in the respiratory tract for a long time.
Lung functions in patients with widespread emphysema are noticeably impaired. According to our observations, ventilation is the first to change. IN initial period the disturbances are minor and are manifested by a moderate limitation of vital capacity, MMOP and respiratory reserves, an increase in residual air and MOP. Tidal volume may even increase during the first period of illness.
An increase in the minute volume of respiration at the onset of the disease ensures sufficient saturation of the blood with oxygen and the removal of carbon dioxide; in some patients, hypocapnia is detected. During exercise, especially if it is accompanied by a bronchospastic reaction, ventilation disturbances become more pronounced, may be accompanied by reduced saturation of arterial blood with oxygen and level off not in 2-3 minutes, as in healthy people, but much later.
Ventilation disturbances increase as emphysema progresses, which is most often associated with an exacerbation of infection - an outbreak of bronchitis or pneumonia. At the same time, shortness of breath and cough intensify, body temperature may rise, weakness, sweating, and severe fatigue may appear. The sputum often becomes purulent in nature and, along with various infectious agents, a large number of neutrophils are found in it.
Exacerbation of infection always worsens bronchial patency due to the accumulation of secretions, swelling of the bronchi and bronchioles, bronchospasm leads to complete or partial destruction of the alveoli and an increase in the area of emphysema.
The deterioration of bronchial obstruction is reflected in ventilation indicators: vital capacity decreases, especially the one-second volume (B. E. Votchal and T. I. Bibikova propose to determine the forced vital capacity in 2 seconds), the power of the air stream and the ratio of MMOD to vital capacity sharply decrease. This indicates increased resistance to air flow in the respiratory tract. An increase in anatomical and especially functional dead space, uneven ventilation (not all areas are affected equally and disruption of air flow does not occur simultaneously) leads to alveolar hypoventilation.
Accordingly, the work of the respiratory muscles increases. Additional muscles that enhance inhalation are located mainly in upper section chest (sternocleidomastoid, scalene, trapezius), muscles that enhance exhalation - in the lower. Discoordination of respiratory movements or a pathological upper thoracic type of breathing develops. This additionally loads the respiratory muscles, making them less efficient and increasing the energy costs of breathing. Therefore, although the minute volume of breathing is increased, most of energy goes to ensure the functioning of the respiratory muscles.
External respiration no longer ensures sufficient saturation of the blood with oxygen and removal of carbon dioxide. However, there is no complete correspondence between the severity of the disease and the degree of impairment of ventilation parameters. But an approximate conclusion about the degree of gas exchange disturbances can be made based on the study of external respiration indicators (residual air, MOP, FVC, MMOD, ventilation reserves and expiratory power). J. Hamm determined the severity of the disease using spirometric indicators in 155 patients with emphysema and bronchial asthma and obtained results that corresponded to the clinic.
Changes in blood gases are indicative. Gas exchange disorders are caused by ventilation disorders, increased work of breathing and desolation of part of the capillary bed. The diffusion of gases through the alveolar-capillary membrane in emphysema without concomitant pneumosclerosis changes little (mainly due to swelling of the alveoli during an exacerbation of bronchorespiratory infection). The difference in oxygen tension in the alveoli and in the arterial blood during emphysema can be increased by 8-10 mmHg compared to the norm. Most often this is due to uneven ventilation (H. Marx, P. Rossier, etc.).
Gas exchange disorders are detected, as a rule, if the volume of residual air is more than 45% and MMOD is less than 50 l/min. Our observations confirm the data of other authors (V. G. Uspenskaya, N. N. Savitsky, N. Marx, etc.) that the severity of the disease is most correlated with indicators of arterial blood oxygen saturation and, to a lesser extent, with the oxygen content in arterial blood.
Oxygen capacity reflects the ability to transport oxygen by hemoglobin. It increased moderately in only 1/3 of our patients with hypoxemia. According to V.G. Uspenskaya, in the early stages of the disease, oxygen capacity decreased, but in general its changes were small.
The presence of hypercapnia always indicates an unfavorable prognosis and a very severe phase of the disease. If a patient with emphysema has hypercapnia due to a hypoventilation crisis against the background abdominal surgery or an exacerbation of a bronchorespiratory infection, then after the crisis is eliminated, the carbon dioxide content in the blood can again become normal. But chronic hypercapnia is always accompanied by a sharp and persistent depression of ventilation.
Functional studies after exercise allow a more accurate assessment of the extent of the disease, reserves and prognosis. Exercise tolerance in patients with pulmonary emphysema is significantly less than in patients with heart disease. With moderately severe emphysema, a small load may initially lead to an increase in blood oxygen saturation, as the minute volume of respiration increases. In healthy people, MOD increases to 100-130 liters per minute, further increase in ventilation is useless, everything is spent on the work of breathing. In patients with emphysema, MOD, in which further increase in ventilation is useless, is achieved much earlier (especially in those patients in whom MOD at rest is significantly increased). Similar conditions are apparently created at a respiratory rate of 45 per minute.
In seriously ill patients, exercise testing is risky. N. Marx considers exercise tests contraindicated in cases of circulatory decompensation, prolonged and severe bronchospasm, exacerbation of bronchorespiratory infection, if MMOD is less than 30 l/min, vital capacity is less than 2 liters, 1" volume is less than 50% of vital capacity, residual volume is more than 50% of the total capacity, O2 tension in arterial blood is less than 70 mm Hg, arterial CO2 is more than 45 mm Hg.
To judge the degree of bronchospasm, spirographic studies can be performed after using bronchodilator drugs.
We observed mainly 2 types of disease:
1.
Slowly progressive, when the clinical picture increases over many years, often unnoticed by the patient, symptoms are limited for a long time to ventilation disturbances and moderate hypoxemia, exacerbations of bronchorespiratory infection are sluggish, with normal temperature bodies. Patients usually seek medical help 1-2 times a year; they are often treated themselves with various antibiotics and bronchodilators and may retain limited ability to work for a long time.
2.
A rapidly progressing type of course, which is usually observed in younger people and is characterized by frequent, rapidly flowing periods of exacerbation of bronchorespiratory infection. Hypoxemia develops quickly, and in the next 2-3 years hypercapnia also develops, that is, global P. Rossier deficiency is formed, from which patients cannot be completely eliminated. In such patients, as a rule, more pronounced disturbances in the blood supply to the lungs are observed in the section and the blistering form of emphysema is more common.
Emphysema is a nonspecific chronic disease, the characteristic feature of which is the irreversible expansion of the air space of the bronchioles with changes in the walls of the alveoli. The prevalence of the disease is less than 5% of all patients; it is 2 times less common among women. Patients with COPD (chronic obstructive pulmonary disease) have a significantly higher risk of developing emphysema than relatively healthy people. The peculiarity of the disease is that this severe pathology greatly affects the patient’s ability to work. In addition, the resulting bronchopulmonary syndrome in some cases can even lead to disability.
Emphysema occurs in only 5% of patients
Causal factors leading to the development of emphysema
Almost any impact leading to chronic inflammation in the alveoli stimulates the development of emphysema. The development of this pathology is more likely in the presence of certain factors:
- COPD and bronchial;
- Inflammatory phenomena in the respiratory bronchi and alveoli;
- Deterioration of microcirculation in the lung tissues;
- Congenital deficiency of the enzyme α-1 antitrypsin;
- Surfactant-related disorders;
- Occupational hazards (constant increase in air in the alveoli and bronchi);
- Chronic intoxication (tobacco smoke and other pollutants).
The influence of these factors leads to damage to the elastic tissue, reduction and/or loss of the ability to fill with air and its collapse. Lungs that are overfilled with air lead to ventilation pathologies such as obstruction and sticking together of small-caliber bronchi during exhalation. Overstretching of the lung tissue, its swelling, as well as a bull (air cyst) occurs due to the formation of a valve mechanism. Thus, obstructive pulmonary emphysema occurs. The danger of bullae lies in the fact that their rupture is accompanied by spontaneous pneumothorax, which is prone to relapse.
Due to the fact that emphysema is characterized by severe enlargement of the lung, it looks like a sponge with large pores. At microscopic examination lung tissue reveals destruction of the alveolar septa.
Smoking is one of the common causes of emphysema Classification
Emphysema is classified as:
- Primary (congenital) – an independent pathological process;
- Secondary (acquired) - as a consequence of other lung pathologies, for example, obstructive or bronchial.
By prevalence pathological process There are different forms:
- Diffuse pulmonary emphysema;
- Localized.
Based on the involvement of changes in the acinus (structural unit of the lungs), emphysema can be:
- Panlobular or panacinar - the acinus is completely affected;
- Centrilobular or centriacinar - the acinus is affected in the central section;
- Perilobular or periacinar - the acinus is affected in the distal part;
- Peri-scar or irregular, that is, uneven;
- Bullous pulmonary emphysema - if bullae are found.
Note! Also separately noted are congenital lobar emphysema and McLeod syndrome - a unilateral lesion with an unknown cause.
Symptoms of emphysema
The main signs of pulmonary emphysema:
- Expiratory (difficulty breathing) shortness of breath. Depends on the degree respiratory failure;
- A significant expansion of the chest with a decrease in its respiratory movements (barrel chest) is visually determined;
- The intercostal spaces are enlarged;
- The supraclavicular areas are smoothed;
- Cyanosis. Blue tint of the nasolabial triangle due to oxygen deficiency.
- “Pink puffer” - that’s what it’s called appearance patient with this pathology. The facial skin is pink, the patient is in a forced orthopneic position (the body is tilted forward, the legs are lowered, the arms are supported in front of the body).
With emphysema, a person's skin turns pink - Thickening of the fingers like “drumsticks”.
- Loss of body weight.
Complications
Untreated emphysema can lead to severe and pathological changes in the cardiopulmonary system. Capillary disorders lead to hypertension in the pulmonary circulation with an increase in the load on the heart, in particular the right sections. In this case, right ventricular failure with edema and enlarged liver may develop. It is also possible that emergency condition spontaneous pneumothorax, which requires mandatory medical care.
Diagnostics
The diagnosis must be made. He can make a primary diagnosis based on complaints, examination and examination. These are the simplest and most basic methods to determine the disease, but they are not exhaustive. Therefore, additional methods are used to make an accurate clinical diagnosis. First of all, this is an x-ray of the lungs. An X-ray machine allows you to determine the density of the tissue and differentiate it from other changes in the lungs. Spirometry is always used, this allows you to determine the degree of impairment in lung function. The most accurate but expensive method () can also be used.
Chronic intoxication of the body leads to emphysema Current treatment methods
No specific therapy for pulmonary emphysema has been developed at this time. First of all, it is necessary to completely eliminate those factors that lead to the development of this disease. That is, you definitely need to give up habitual intoxications. If severe emphysema is observed, it may even be necessary to change jobs if the patient is exposed to toxic effects that lead to the development of the disease.
Often this disease does not require hospitalization of the patient if he is in satisfactory condition. Treatment is carried out on an outpatient basis with the mandatory supervision of the attending physician or therapist. The patient is hospitalized in the pulmonology department of the hospital only if an infectious component has appeared or a complication has developed. Because these conditions require urgent measures, which should be carried out by a highly specialized specialist in a hospital setting.
If you detect the first symptoms of pulmonary emphysema, you should immediately consult a pulmonologist Treatment of emphysema, like any other disease, should be carried out comprehensively. To achieve the best result, it should consist of the following components:
- Diet therapy. The patient's diet must be correct and balanced. It is advisable to follow a low-calorie diet high in raw fruits and vegetables. It is necessary to reduce consumption, since these elements can lead to a lack of oxygen in the patient’s body, which will further aggravate his condition.
- Medicines. Treatment is mainly symptomatic. In case of exacerbation of the process, the patient is prescribed therapy with antibacterial agents. wide range actions. Also, if the patient suffers from a chronic form of the disease, then he must use bronchi dilating drugs on an ongoing basis. Such drugs include salbutamol, theophylline, which can be either in tablet form or in the form of inhalation. If there are problems with sputum discharge, patients should use a mucolytic agent.
- Oxygen therapy. Used to improve gas exchange in the lungs. The procedure involves the patient inhaling an air mixture with a reduced amount of oxygen, and then breathing air with a normal oxygen content. Such procedures should be carried out in cycles of 15-20 days. This therapy is especially indicated if emphysema occurs in children.
Methods that alleviate the general condition of the patient
There are many techniques that help alleviate the condition of a patient with emphysema, the main ones are:
- Massage. Classic, segmental, acupressure and drainage massages can be performed. With the help of these massages, the bronchial system expands and this facilitates easy discharge of mucus. Besides, massotherapy promotes excellent relaxation of the entire muscle frame, which leads to improved external respiration.
- Physical therapy complex. Helps prevent overstrain of the muscular system, because with emphysema the muscular frame is in constant tone. Exercise therapy contains a simple set of exercises that anyone can repeat. Exercises can be used to create positive exhalation, as well as complexes for training diaphragmatic breathing and its rhythm. Such breathing exercises in case of pulmonary emphysema, it must be carried out under the supervision of a specialist in medical rehabilitation.
When treating pulmonary emphysema, it is necessary to engage in physical therapy (physical therapy) Treatment with folk remedies
It should be remembered that the means for traditional treatment are auxiliary and in no case should be monotherapy. Nowadays the following recipes are very common:
- Using wild rosemary for inhalation. First, pour boiling water over the plant and leave for 15 minutes. Inhalations are carried out 2 times a day.
- Mix licorice root, marshmallow root, sage and anise in equal proportions. A tablespoon of this collection should be brewed in a glass of boiling water and left for an hour. This tincture should be consumed 3 times a day, 3 ml.
Depending on what means and how to treat this disease, the prognosis of the patient’s life will directly depend. If therapy is started on time and carried out in full, it can significantly improve the patient’s quality of life and save him long time from relapses of the disease.
Emphysema occurs when the alveoli of the lung tissue stretch beyond acceptable limits and lose the ability to contract back. This disrupts the normal flow of oxygen into the blood and the removal of carbon dioxide from the body, which leads to heart failure.
In accordance with the modern classification, diffuse and bullous pulmonary emphysema are distinguished. The first form involves complete tissue damage. Bullous emphysema is diagnosed when swollen (widened) areas are adjacent to normal lung tissue.
Causes of emphysema
The disease often manifests itself as a consequence of chronic bronchitis or bronchial asthma. The bullous form can also occur under the influence of hereditary factors and certain lung diseases, in particular tuberculosis. In addition, the development of the disease is influenced by factors such as smoking and excessive air pollution, which is especially typical for large cities.
Emphysema - symptoms
Severe shortness of breath up to suffocation, widening of the intercostal spaces, barrel-shaped chest, weakened breathing, decreased mobility of the diaphragm, increased transparency of the pulmonary fields with x-ray examination- these are the symptoms of pulmonary emphysema. Treatment of the disease depends on the severity of the symptoms and clinical picture.
The primary stage of development of pulmonary emphysema is characterized by: severe shortness of breath, rapid fatigue during any physical activity, the effect of the so-called “puffing”, disturbance of the blood gas composition and collapse of the small bronchi.
As the condition of the lung tissue deteriorates, the transparency of the lung fields increases, the diaphragm shifts and other changes interfere with normal gas exchange.
Emphysema - treatment and prognosis
In the treatment of pulmonary emphysema, the main measures are aimed at eliminating respiratory failure and treating the disease under the influence of which a person developed the disease. Treatment folk remedies shows quite effective results, however, we under no circumstances recommend abandoning traditional medicinal methods.
Basic principles of treatment of emphysema:
- Quitting smoking is one of the most important steps on the road to recovery. Let us note that a sharp, immediate reduction in the number of cigarettes smoked has a much greater effect than a gradual cessation of tobacco;
- appointment antibacterial drugs– the main medications are anticholinergics (Berodual, Atrovent), beta-2 sympathomimetics (Berotec, Salbutamol) and theophyllines (Euphylline, Teopec). The choice of drug and the intensity of therapy depend on the severity of the symptoms that emphysema manifests itself. Treatment with antibacterial complexes is combined with the use of expectorants;
- breathing exercises to improve gas exchange. As a rule, patients are prescribed atmospheric air with reduced oxygen content for 5 minutes. The patient breathes normal air for the next 5 minutes. The cyclic pattern is repeated 6-7 times during 1 session. The full course of treatment lasts about 3 weeks;
- Pulmonary emphysema, the symptoms of which are associated with severe respiratory failure, is treated with low-flow oxygen therapy. It can also be used at home, using compressed gas cylinders or special concentrators as oxygen sources;
- In recent years, doctors have been actively using aeroion therapy, which shows good results in eliminating respiratory failure. The course of treatment lasts 15-20 days;
- Special breathing exercises and training programs aimed at enabling a person to control his breathing are also effective;
- For better sputum removal, positional drainage is used - the patient takes a certain position in which the cough reflex and viscous sputum cause the least inconvenience. In this case, you can combine drainage treatment of emphysema with the use of expectorant herbs and infusions, for example, thermopsis, wild rosemary, plantain or coltsfoot.
Is there a permanent cure for emphysema? Forecasts are individual in each specific case and depend on how fully patients follow all the recommendations of the attending physician, and whether they are willing to make certain sacrifices for the sake of their health. Also a huge impact The treatment process is influenced by timely detection and adequate treatment of the disease that led to emphysema.
Emphysema - treatment with folk remedies
Home remedies:
- drink green potato tops juice with a daily increase in dose until the volume of juice reaches half a glass;
- inhalation of jacket potato vapors;
- applying pieces of pre-boiled potatoes to the chest.
Herbal infusions:
- Add three tablespoons of buckwheat flowers to 500 ml of boiling water. Infuse the mixture in a thermos for two hours. Take half a glass 3-4 times a day;
- Take one part each of juniper fruit and dandelion root, add two parts of birch leaf to them and pour boiling water over the resulting mixture. The broth is infused for three hours, after which it is filtered and poured into a suitable container. The infusion should be consumed 2-3 times a day. Standard dosage – 1/3 cup;
- a teaspoon of potatoes is poured into a glass of boiling water, left for one hour and filtered. Take half a glass of infusion 40 minutes before meals for one month.
Video from YouTube on the topic of the article:
Emphysema – chronic illness lungs, characterized by expansion of small bronchioles (final branches of the bronchi) and destruction of the partitions between the alveoli. The name of the disease comes from the Greek emphysao - to swell. Air-filled voids form in the lung tissue, and the organ itself swells and increases significantly in volume.
Manifestations of emphysema– shortness of breath, difficulty breathing, cough with a small amount of mucous sputum, signs of respiratory failure. Over time, the chest expands and takes on a characteristic barrel shape.
Reasons for development emphysema divided into two groups:
- Factors that impair the elasticity and strength of lung tissue are inhalation of polluted air, smoking, congenital deficiency of alpha-1-antitrypsin (a substance that stops the destruction of the walls of the alveoli).
- Factors that increase air pressure in the bronchi and alveoli are chronic obstructive bronchitis, blockage of the bronchus by a foreign body.
Risk of developing the disease some categories are higher than other people:
- Congenital forms of pulmonary emphysema associated with whey protein deficiency are more often detected in residents of Northern Europe.
- Men get sick more often. Emphysema is detected at autopsy in 60% of men and 30% of women.
- U smoking people the risk of developing emphysema is 15 times higher. Passive smoking is also dangerous.
Anatomy of the lungs
Lungs- paired respiratory organs located in the chest. The lungs are separated from each other by the mediastinum. It consists of large vessels, nerves, trachea, and esophagus.Each lung is surrounded by a two-layer membrane, the pleura. One of its layers fuses with the lung, and the other with the chest. Between the sheets of pleura there remains a space - the pleural cavity, in which there is a certain amount of pleural fluid. This structure helps the lungs stretch during inhalation.
Due to anatomical features, the right lung is 10% larger than the left. The right lung consists of three lobes, and the left lung has two. The lobes are divided into segments, which in turn are divided into secondary lobules. The latter consist of 10-15 acini.
The hilum of the lung is located on the inner surface. This is the place where the bronchi, arteries, and veins enter the lung. Together they form the root of the lung.
Lung functions:
- ensure blood saturation with oxygen and removal of carbon dioxide
- participate in heat exchange due to liquid evaporation
- secrete immunoglobulin A and other substances to protect against infections
- participate in the transformation of the hormone angiotensin, which causes vasoconstriction
- bronchi, through which air enters the lungs;
- alveoli, where gas exchange occurs;
- blood vessels that carry blood from the heart to the lungs and back to the heart;
- Trachea and bronchi- called the respiratory tract.
The trachea at the level of 4-5 vertebrae is divided into 2 bronchi - right and left. Each of the bronchi enters the lung and forms there bronchial tree. The right and left are the bronchi of the 1st order; at the place of their branching, the bronchi of the 2nd order are formed. The smallest are bronchi of the 15th order.
Small bronchi branch, forming 16-18 thin respiratory bronchioles. Alveolar ducts depart from each of them, ending in thin-walled vesicles - alveoli.
Bronchial function– ensure the passage of air from the trachea to the alveoli and back.
Structure of the bronchi.
- Cartilaginous base of the bronchi
- large bronchi outside the lung consist of cartilaginous rings
- large bronchi inside the lung - cartilaginous connections appear between the cartilaginous half-rings. Thus, the lattice structure of the bronchi is ensured.
- small bronchi - cartilage looks like plates, the smaller the bronchus, the thinner the plates
- the terminal small bronchi do not have cartilage. Their walls contain only elastic fibers and smooth muscles
- Muscular layer of the bronchi– smooth muscles are arranged circularly. They provide narrowing and expansion of the lumen of the bronchi. At the site of the branching of the bronchi there are special bundles of muscles that can completely block the entrance to the bronchus and cause its obstruction.
- ciliated epithelium, lining the lumen of the bronchi, performs a protective function - protects against infections transmitted by airborne droplets. Small villi remove bacteria and small dust particles from distant bronchi into larger bronchi. From there they are removed when coughing.
- Lung glands
- single-celled glands that secrete mucus
- small lymph nodes connected to larger lymph nodes in the mediastinum and trachea.
- Cartilaginous base of the bronchi
- Alveolus – a bubble in the lungs, entwined with a network of blood capillaries. The lungs contain more than 700 million alveoli. This structure allows you to increase the surface area in which gas exchange occurs. Atmospheric air enters the bubble through the bronchi. Oxygen is absorbed into the blood through the thinnest wall, and carbon dioxide is released into the alveoli during exhalation.
The area around the bronchiole is called the acinus. It resembles a bunch of grapes and consists of branches of the bronchioles, alveolar ducts and the alveoli themselves
- Blood vessels. Blood enters the lungs from the right ventricle. It contains little oxygen and a lot of carbon dioxide. In the capillaries of the alveoli, the blood is enriched with oxygen and releases carbon dioxide. After this, it collects in the veins and enters the left atrium.
Causes of emphysema
The causes of emphysema are usually divided into two groups.
- Impaired elasticity and strength of lung tissue:
- Congenital α-1 antitrypsin deficiency. In people with this abnormality, proteolytic enzymes (whose function is to destroy bacteria) destroy the walls of the alveoli. While normally α-1 antitrypsin neutralizes these enzymes within a few tenths of a second after their release.
- Birth defects lung tissue structure. Due to their structural features, the bronchioles collapse and the pressure in the alveoli increases.
- Inhalation of polluted air: smog, tobacco smoke, coal dust, toxic substances. The most dangerous in this regard are cadmium, nitrogen and sulfur oxides emitted by thermal power plants and transport. Their smallest particles penetrate the bronchioles and are deposited on their walls. They damage the ciliated epithelium and vessels feeding the alveoli and also activate special cells, alveolar macrophages.
They help increase the level of neutrophil elastase, a proteolytic enzyme that destroys the walls of the alveoli.
- Hormonal imbalance. An imbalance between androgens and estrogens impairs the ability of bronchiole smooth muscles to contract. This leads to stretching of the bronchioles and the formation of cavities without destruction of the alveoli.
- Respiratory tract infections: chronic bronchitis, pneumonia. Immune cells, macrophages and lymphocytes, exhibit proteolytic activity: they produce enzymes that dissolve bacteria and the protein that makes up the walls of the alveoli.
In addition, clots of sputum in the bronchi allow air into the alveoli, but do not release it in the opposite direction.
This leads to overfilling and overstretching of the alveolar sacs.
- Age-related changes associated with poor circulation. In addition, older people are more sensitive to toxic substances in the air. With bronchitis and pneumonia, lung tissue recovers worse.
- Increased pressure in the lungs.
- Chronic obstructive bronchitis. The patency of the small bronchi is impaired. When you exhale, air remains in them. With a new breath, a new portion of air enters, which leads to overstretching of the bronchioles and alveoli. Over time, disturbances occur in their walls, leading to the formation of cavities.
- Occupational hazards. Glassblowers, wind players. A feature of these professions is an increase in air pressure in the lungs. The smooth muscles in the bronchi gradually weaken, and blood circulation in their walls is disrupted. When you exhale, all the air is not expelled; a new portion is added to it. A vicious circle develops, leading to the appearance of cavities.
- Blockage of the lumen of the bronchus a foreign body leads to the fact that the air remaining in the segment of the lung cannot escape out. Developing acute form emphysema.
Mechanism of lung damage in emphysema- Stretching of bronchioles and alveoli - their size doubles.
- Smooth muscles are stretched, and the walls of blood vessels become thinner. The capillaries become empty and the nutrition in the acinus is disrupted.
- Elastic fibers degenerate. In this case, the walls between the alveoli are destroyed and cavities are formed.
- The area in which gas exchange occurs between air and blood decreases. The body experiences oxygen deficiency.
- The enlarged areas compress healthy lung tissue, further impairing the ventilation function of the lungs. Shortness of breath and other symptoms of emphysema appear.
- To compensate and improve the respiratory function of the lungs, the respiratory muscles are actively involved.
- The load on the pulmonary circulation increases - the vessels of the lungs become overfilled with blood. This causes disturbances in the functioning of the right side of the heart.
Types of emphysema
There are several classifications of pulmonary emphysema.According to the nature of the flow:
- Acute. Develops during an attack of bronchial asthma, entering the bronchi foreign object, sharp physical activity. Accompanied by overstretching of the alveoli and swelling of the lung. This condition is reversible but requires urgent medical attention.
- Chronic. Develops gradually. On early stage the changes are reversible. But without treatment, the disease progresses and can lead to disability.
By origin:- Primary emphysema. An independent disease that develops in connection with the congenital characteristics of the body. It can even be diagnosed in infants. It progresses quickly and is more difficult to treat.
- Secondary emphysema. The disease occurs against the background of chronic obstructive pulmonary diseases. The onset often goes unnoticed; symptoms intensify gradually, leading to decreased ability to work. Without treatment, large cavities appear that can occupy an entire lobe of the lung.
By prevalence:
- Diffuse form. The lung tissue is uniformly affected. Alveoli are destroyed throughout the lung tissue. In severe forms, a lung transplant may be required.
- Focal form. Changes occur around tuberculosis foci, scars, in places where a blocked bronchus approaches. Manifestations of the disease are less pronounced.
- Panacinar emphysema(vesicular, hypertrophic). All acini in the lung lobe or the whole lung are damaged and swollen. There is no healthy tissue between them. Connective tissue does not grow in the lung. In most cases there are no signs of inflammation, but there are manifestations of respiratory failure. Formed in patients with severe emphysema.
- Centrilobular emphysema. Damage to individual alveoli in the central part of the acinus. The lumen of the bronchioles and alveoli expands, this is accompanied by inflammation and mucus secretion. On the walls of damaged acini develops fibrous tissue. Between the changed areas, the parenchyma (tissue) of the lungs remains intact and performs its function.
- Periacinar(distal, perilobular, paraseptal) - damage to the extreme parts of the acinus near the pleura. This form develops with tuberculosis and can lead to pneumothorax - rupture of the affected area of the lung.
- Okolorubtsovaya– develops around scars and areas of fibrosis in the lungs. Symptoms of the disease are usually mild.
- Bullous(bubble) shape. In place of the destroyed alveoli, bubbles form, ranging in size from 0.5 to 20 cm or more. They can be located near the pleura or throughout the lung tissue, mainly in the upper lobes. Bullae can become infected, compress surrounding tissue, or rupture.
- Interstitial(subcutaneous) - characterized by the appearance of air bubbles under the skin. The alveoli rupture, and air bubbles rise through the lymphatic and tissue gaps under the skin of the neck and head. Bubbles may remain in the lungs, and when they rupture, spontaneous pneumothorax occurs.
- Compensatory– develops after removal of one lobe of the lung. When healthy areas swell, trying to take up the vacant space. Enlarged alveoli are surrounded by healthy capillaries, and there is no inflammation in the bronchi. The respiratory function of the lungs does not improve.
- Senile– caused by age-related changes in the vessels of the lungs and the destruction of elastic fibers in the wall of the alveoli.
- Lobarnaya– occurs in newborns, more often boys. Its appearance is associated with obstruction of one of the bronchi.
Symptoms of emphysema
Diagnosis of emphysema
Examination by a doctor
If symptoms of pulmonary emphysema appear, consult a therapist or pulmonologist.
Instrumental methods for diagnosing pulmonary emphysema
- Radiography- study of the condition of the lungs using x-rays, as a result of which an image is obtained on film (paper) internal organs. A general X-ray of the chest is taken in a direct projection. This means that the patient faces the device during the shooting. An overview image allows you to identify pathological changes in the respiratory system and the extent of their distribution. If the image shows signs of disease, then additional tests are prescribed: MRI, CT, spirometry, peak flowmetry.
Indications:
- Once a year as part of a preventive examination
- prolonged cough
- dyspnea
- wheezing, pleural friction noise
- decreased breathing
- pneumothorax
- suspected emphysema, chronic bronchitis, pneumonia, pulmonary tuberculosis
- breastfeeding period
- the lungs are enlarged, they compress the mediastinum and overlap each other
- affected areas of the lung appear excessively transparent
- expansion of intercostal spaces during active muscle work
- the lower edge of the lungs is drooping
- low aperture
- reduction in the number of blood vessels
- bullae and areas of tissue airing
- Magnetic resonance imaging (MRI) of the lungs- a study of the lungs based on the resonant absorption of radio waves by hydrogen atoms in cells, and sensitive equipment records these changes. MRI of the lungs provides information about the condition of large bronchi, vessels, lymphoid tissue, the presence of fluid and focal formations in the lungs. Allows you to obtain sections 10 mm thick and view them from different positions. To study the upper parts of the lungs and areas around the spine, a contrast agent called gadolinium is injected intravenously.
Disadvantage: air prevents accurate visualization of small bronchi and alveoli, especially at the periphery of the lungs. Therefore, the cellular structure of the alveoli and the degree of destruction of the walls are not clearly visible.
The procedure lasts 30-40 minutes. During this time, the patient must lie motionless in the magnetic tomograph tunnel. MRI does not involve radiation, so the study is permitted for pregnant and breastfeeding women.
Indications:
- there are symptoms of the disease, but x-ray changes cannot be detected
- tumors, cysts
- suspicion of tuberculosis, sarcoidosis, in which small focal changes are formed
- increase in intrathoracic lymph nodes
- abnormal development of the bronchi, lungs and their vessels
- presence of a pacemaker
- metal implants, staples, fragments
- mental illness that do not allow lying for a long time without moving
- patient weight over 150 kg
- damage to the alveolar capillaries at the site of destruction of lung tissue
- circulatory disorders in small pulmonary vessels
- signs of compression of healthy tissue by expanded areas of the lung
- increase in pleural fluid volume
- increase in the size of the affected lungs
- cavities-bulls of different sizes
- low aperture
- Computed tomography (CT) of the lungs allow you to obtain a layer-by-layer image of the structure of the lungs. CT is based on the absorption and reflection of X-rays by tissues. Based on the data obtained, the computer creates a layer-by-layer image with a thickness of 1mm-1cm. The study is informative in the early stages of the disease. When a contrast agent is administered, CT provides more complete information about the state of the pulmonary vessels.
During a CT scan of the lungs, the X-ray emitter rotates around the patient lying motionless. The scan lasts about 30 seconds. The doctor will ask you to hold your breath several times. The whole procedure takes no more than 20 minutes. Using computer processing, X-ray images taken from different points are summarized into a layer-by-layer image.
Flaw– significant radiation exposure.
Indications:
- if symptoms are present, no changes are detected on the x-ray or they need to be clarified
- diseases with the formation of foci or diffuse damage lung parenchyma
- chronic bronchitis, emphysema
- before bronchoscopy and lung biopsy
- decision on the operation
- allergy to contrast agent
- extremely serious patient condition
- severe diabetes mellitus
- renal failure
- pregnancy
- patient weight exceeding the capabilities of the device
- an increase in the optical density of the lung to -860-940 HU – these are airy areas of the lung
- expansion of the roots of the lungs - large vessels entering the lung
- dilated cells are noticeable - areas of alveolar fusion
- reveals the size and location of bullae
Lung scintigraphy – injection into the lungs of labeled radioactive isotopes followed by taking a series of images with a rotating gamma camera. Preparations of technetium - 99 M are administered intravenously or in the form of an aerosol. The patient is placed on a table around which the sensor rotates.
Indications:
- early diagnosis vascular changes in emphysema
- monitoring the effectiveness of treatment
- assessment of lung condition before surgery
- suspicion of oncological diseases lungs
- pregnancy
- compression of lung tissue
- disturbance of blood flow in small capillaries
- Spirometry – functional study of the lungs, study of the volume of external respiration. The procedure is carried out using a spirometer device, which records the amount of air inhaled and exhaled.
The patient puts into his mouth a mouthpiece connected to a breathing tube with a sensor. A clamp is placed on the nose to block nasal breathing. The specialist tells you what breathing tests need to be performed. A electronic device converts sensor readings into digital data.
Indications:
- breathing disorder
- chronic cough
- occupational hazards (coal dust, paint, asbestos)
- smoking experience over 25 years
- lung diseases (bronchial asthma, pneumosclerosis, chronic obstructive pulmonary disease)
- tuberculosis
- pneumothorax
- hemoptysis
- recent heart attack, stroke, abdominal or chest surgery
- increase in total lung capacity
- increase in residual volume
- decreased vital capacity of the lungs
- reduction in maximum ventilation
- increased resistance in the airways during exhalation
- reduction in speed indicators
- decreased compliance of lung tissue
Peak flowmetry - measurement of maximum expiratory flow to determine bronchial obstruction.Determined using a device - a peak flow meter. The patient needs to tightly clasp the mouthpiece with his lips and exhale as quickly and forcefully as possible through his mouth. The procedure is repeated 3 times with an interval of 1-2 minutes.
It is advisable to carry out peak flowmetry in the morning and evening at the same time before taking medications.
Disadvantage: the study cannot confirm the diagnosis of pulmonary emphysema. The exhalation rate decreases not only with emphysema, but also with bronchial asthma, pre-asthma, and chronic obstructive pulmonary disease.
Indications:
- any diseases accompanied by bronchial obstruction
- evaluation of treatment results
Symptoms of emphysema:
- reduction in expiratory flow by 20%
- Determination of blood gas composition – an arterial blood test during which the pressure of oxygen and carbon dioxide in the blood and their percentage are determined, acid-base balance blood. The results show how effectively the blood in the lungs is cleared of carbon dioxide and enriched with oxygen. For research, a puncture is usually done ulnar artery. A blood sample is taken from a heparin syringe, placed on ice, and sent to the laboratory.
Indications:
- cyanosis and other signs oxygen starvation
- breathing disorders due to asthma, chronic obstructive pulmonary disease, emphysema
- oxygen tension in arterial blood is below 60-80 mmHg. st
- blood oxygen percentage less than 15%
- increase in carbon dioxide tension in arterial blood over 50 mmHg. st
- General blood analysis - a study that includes counting blood cells and studying their characteristics. For analysis, blood is taken from a finger or from a vein.
Indications- any diseases.
Contraindications does not exist.
Deviations for emphysema:
- increased number of red blood cells over 5 10 12 / l
- increased hemoglobin level over 175 g/l
- increase in hematocrit over 47%
- decreased erythrocyte sedimentation rate 0 mm/hour
- increased blood viscosity: in men over 5 cP, in women over 5.5 cP
Treatment of emphysema
Treatment of pulmonary emphysema has several directions:- improving the quality of life of patients - eliminating shortness of breath and weakness
- prevention of the development of heart and respiratory failure
- slowing the progression of the disease
- complete cessation of smoking
- physical exercise to improve lung ventilation
- taking medications to improve the condition of the respiratory tract
- treatment of the pathology that caused the development of emphysema
Treatment of emphysema with medications
| Group of drugs | Representatives | Mechanism of therapeutic action | Mode of application |
| α1-antitrypsin inhibitors | Prolastin | The introduction of this protein reduces the level of enzymes that destroy the connective fibers of lung tissue. | Intravenous injection at the rate of 60 mg/kg body weight. 1 time per week. |
| Mucolytic drugs | Acetylcysteine (ACC) | Improves the removal of mucus from the bronchi, has antioxidant properties - reduces the production of free radicals. Protects the lungs from bacterial infection. | Take 200-300 mg orally 2 times a day. |
| Lazolvan | Liquefies mucus. Improves its removal from the bronchi. Reduces cough. | Used orally or inhaled. Orally during meals, 30 mg 2-3 times a day. In the form of inhalations using a nebulizer, 15-22.5 mg, 1-2 times a day. |
|
| Antioxidants | Vitamin E | Improves metabolism and nutrition in lung tissues. Slows down the process of destruction of the walls of the alveoli. Regulates the synthesis of proteins and elastic fibers. | Take 1 capsule per day orally. Take courses for 2-4 weeks. |
| Bronchodilators (bronchodilators) Phosphodiesterase inhibitors Anticholinergics | Teopek | Relaxes the smooth muscles of the bronchi, helps to expand their lumen. Reduces swelling of the bronchial mucosa. | The first two days take half a tablet 1-2 times a day. Subsequently, the dose is increased - 1 tablet (0.3 g) 2 times a day every 12 hours. Take after meals. The course is 2-3 months. |
| Atrovent | Blocks acetylcholine receptors in the bronchial muscles and prevents their spasm. Improves external respiration indicators. | In the form of inhalations, 1-2 ml 3 times a day. For inhalation in a nebulizer, the drug is mixed with saline solution. | |
| Theophyllines | Long-acting theophylline | Has a bronchodilator effect, reducing systemic pulmonary hypertension. Increases diuresis. Reduces fatigue of the respiratory muscles. | The initial dose is 400 mg/day. Every 3 days it can be increased by 100 mg until the required therapeutic effect appears. Maximum dose 900 mg/day. |
| Glucocorticosteroids | Prednisolone | Has a strong anti-inflammatory effect on the lungs. Promotes the expansion of bronchi. | Used when bronchodilator therapy is ineffective. At a dose of 15–20 mg per day. Course 3-4 days. |
Therapeutic measures for emphysema
- Transcutaneous electrical stimulation diaphragm and intercostal muscles. Electrical stimulation with pulsed currents with a frequency of 5 to 150 Hz is aimed at facilitating exhalation. At the same time, the energy supply to the muscles, blood and lymph circulation improves. In this way, fatigue of the respiratory muscles, followed by respiratory failure, is avoided. During the procedure, painless muscle contractions occur. The current strength is dosed individually. The number of procedures is 10-15 per course.
- Oxygen inhalation. Inhalation is carried out for a long time, 18 hours a day. In this case, oxygen is supplied to the mask at a rate of 2–5 liters per minute. In case of severe respiratory failure, helium-oxygen mixtures are used for inhalation.
- Breathing exercises- training of the respiratory muscles, aimed at strengthening and coordinating muscles during breathing. All exercises are repeated 4 times a day for 15 minutes.
- Exhale with resistance. Exhale slowly through a cocktail straw into a glass filled with water. Repeat 15-20 times.
- Diaphragmatic breathing. On the count of 1-2-3, take a strong, deep breath, drawing in your stomach. On the count of 4, exhale - inflating your stomach. Then tense your abdominal muscles and cough loudly. This exercise helps to expel mucus.
- Lying push-up. Lying on your back, bend your legs and clasp your knees with your hands. As you inhale, draw in lungs full of air. As you exhale, stick your stomach out (diaphragmatic exhalation). Straighten your legs. Tighten your abs and cough.
When is surgery needed for emphysema?
Surgery emphysema is not often required. It is necessary when the lesions are significant and drug treatment does not reduce the symptoms of the disease. Indications for surgery for emphysema:
- shortness of breath leading to disability
- bullae occupying more than 1/3 of the chest
- complications of emphysema - hemoptysis, cancer, infection, pneumothorax
- multiple bullae
- permanent hospitalizations
- diagnosis of severe pulmonary emphysema
- inflammatory process – bronchitis, pneumonia
- asthma
- exhaustion
- severe deformation of the chest
- age over 70 years
Types of operations for emphysema
- Lung transplant and its variants: lung transplantation together with a heart; transplantation of a lung lobe. Transplantation is performed in case of large diffuse lesions or multiple large bullae. The goal is to replace the diseased lung with a healthy donor organ. However, the waiting list for transplantation is usually too long and problems with organ rejection may arise. Therefore, such operations are resorted to only as a last resort.
- Reduced lung volume. The surgeon removes the most damaged areas, approximately 20-25% of the lung. At the same time, the function of the remaining part of the lung and respiratory muscles improves. The lung is not compressed, its ventilation is restored. The operation is performed in one of three ways.
- Minimally invasive technique (thoracoscopy) under the control of video equipment. 3 small incisions are made between the ribs. A mini-video camera is inserted into one, and surgical instruments are inserted into the others. The affected area is removed through these incisions.
- Bronchoscopic surgery. A bronchoscope with surgical equipment is inserted through the mouth. The damaged area is removed through the lumen of the bronchus. Such an operation is possible only if the affected area is located near large bronchi.
Opening the chest. The doctor removes the affected lobe and places stitches to seal the lung. Then a suture is placed on the chest.
Is hospitalization necessary to treat emphysema?
In most cases, patients with emphysema are treated at home. It is enough to take medications according to the schedule, adhere to a diet and follow the doctor’s recommendations.Indications for hospitalization:
- sharp increase in symptoms (shortness of breath at rest, severe weakness)
- the appearance of new signs of illness (cyanosis, hemoptysis)
- ineffectiveness of the prescribed treatment (symptoms do not decrease, peak flow measurements worsen)
- severe concomitant diseases
- newly developed arrhythmias
- difficulties in establishing a diagnosis;
Nutrition for emphysema (diet).
Therapeutic nutrition for pulmonary emphysema is aimed at combating intoxication, strengthening the immune system and replenishing the patient’s high energy costs. Diets No. 11 and No. 15 are recommended. Basic principles of diet for emphysema
- Increasing calorie content to 3500 kcal. Meals 4-6 times a day in small portions.
- Proteins up to 120 g per day. More than half of them should be of animal origin: animal and poultry meat, liver, sausages, fish of all kinds and seafood, eggs, dairy products. Meat in any culinary processing, excluding excessive frying. All complications of pulmonary emphysema are life-threatening. Therefore, if any new symptoms appear, you should urgently seek help. medical care.
- Pneumothorax. Rupture of the pleura surrounding the lung. In this case, air escapes into the pleural cavity. The lung collapses and becomes unable to expand. Around him in pleural cavity Liquid accumulates and needs to be removed. Appears strong pain in the chest, worsening with inhalation, panic fear, rapid heartbeat, the patient takes a forced position. Treatment must be started immediately. If the lung does not expand within 4-5 days, surgery will be required.
- Infectious complications. Decreased local immunity increases the sensitivity of the lungs to bacterial infections. Severe bronchitis and pneumonia often develop, which progress to chronic form. Symptoms: cough with purulent sputum, fever, weakness.
- Right ventricular heart failure. The disappearance of small capillaries leads to an increase in blood pressure in the vessels of the lungs - pulmonary hypertension. The load on the right parts of the heart increases, which become overstretched and wear out. Heart failure is the leading cause of death in patients with emphysema. Therefore, at the first signs of its development (swelling of the neck veins, pain in the heart and liver, swelling), it is necessary to call an ambulance.
The prognosis for pulmonary emphysema is favorable under a number of conditions:- complete cessation of smoking
- prevention of frequent infections
- clean air, no smog
- good nutrition
- good sensitivity to drug treatment bronchodilators.
Doctors call pulmonary emphysema a disease of the respiratory tract, characterized by the development of a pathological process in the lungs, which causes a strong expansion of the distal bronchioles, accompanied by a disruption of the gas exchange process and the development of respiratory failure.
Today, the frequency of development of this disease has increased significantly, and if previously it was found mainly among people of retirement age, today people over the age of 30 suffer from it (men suffer from emphysema twice as often). Moreover, the disease (in combination with asthma and bronchial asthma) belongs to the group of chronic lung diseases, which have a progressive course, often cause temporary disability of patients or lead to their early disability. At the same time, a disease such as pulmonary emphysema is characterized by the fact that it can be accompanied by fatal, so everyone should know its symptoms and basic principles of treatment.
Etiology, pathogenesis and types of disease
One of the features of pulmonary emphysema is that, as a separate nosological form, it occurs only in a small percentage of patients. In most cases, pulmonary emphysema is the final pathological process that occurs against the background of severe morphological lesions of the bronchopulmonary system, which appear after diseases such as:
- silicosis;
- obstructive bronchitis;
- bronchiectasis;
- anthracosis
In addition, pulmonary emphysema can be contracted as a result of prolonged smoking or inhalation of certain toxic compounds of cadmium, nitrogen, or dust particles that float in the air (for this reason, this disease is often found among construction workers).
Mechanism of disease development
IN normal conditions gas exchange in the human body takes place in the alveoli - these are small “bags” penetrated by a large number of blood vessels, located at the end of the bronchi. During inhalation, the alveoli fill with oxygen and swell, and when exhaling, they contract. However, with pulmonary emphysema, certain disturbances occur in this process - the lungs stretch too much, their tissue becomes denser and loses its elasticity, which leads to an increase in the concentration of air in the lungs and causes a disruption in their functioning. Over time, emphysema progresses, which is manifested by the development of respiratory failure, so it should be treated as early as possible.
Classification of the disease
Depending on the reasons that lead to the development of the pathological process in the lung tissue, pulmonary emphysema is classified into:
- primary (diffuse), which is caused by tobacco smoke, dust or inhalation of nitric oxide - characterized by loss of elasticity of the lung tissue, morphological change respiratory department of the lungs and increased pressure in the alveoli;
- secondary (obstructive) – occurs against the background of stretching of the alveoli and respiratory bronchioles caused by airway obstruction;
- vicarious - it is a kind of compensatory reaction of one lung to some changes (and sometimes absence) of the other, as a result of which a healthy lung increases in volume, but only in order to ensure normal gas exchange in the human body (vicarious pulmonary emphysema occurs only within one lung and is not considered a pathological process, the prognosis is favorable).
There is also bullous pulmonary emphysema, which is distinguished by the fact that it occurs unnoticed, is often detected already at the stage of pneumothorax (accumulation of air in the pleural cavity) and requires immediate surgical intervention, the prognosis is unfavorable (often leading to the death of the patient).
Clinical picture of the disease
When talking about the main symptoms of pulmonary emphysema, doctors first of all mention:
- shortness of breath;
- visual enlargement (expansion) of the chest against the background of a decrease in its excursion during breathing (emphysema can be determined by a photo that shows that the chest appears to be in the deep inspiration phase);
- cyanosis (blue tint) of the tongue, nails and lips, occurs against the background of oxygen starvation of tissues;
- expansion of intercostal spaces;
- smoothing of the supraclavicular areas.
At the very beginning, pulmonary emphysema manifests itself as shortness of breath, which initially occurs when playing sports (mainly in winter) and is inconsistent, and then bothers the person at the slightest physical effort. TO characteristic features The disease can be attributed to the fact that patients take short breaths with closed lips and puffed out cheeks, and you should also pay attention to the fact that during inhalation the neck muscles are activated (in a normal state this should not happen). Emphysema is also accompanied by cough, chest pain and weight loss (the latter is explained by the fact that patients spend too much energy maintaining the normal functioning of the respiratory muscles).
Patients often take a forced position on their stomach (head down), because this position brings them relief, but this is in the first stages of the disease. As emphysema progresses, changes in the chest prevent patients from being in a horizontal position, resulting in them even sleeping in a sitting position (this makes it easier for the diaphragm to work).
Basic methods for diagnosing pulmonary emphysema
The diagnosis of pulmonary emphysema must be carried out exclusively by a pulmonologist, who makes a primary diagnosis based on examination of the patient and auscultation of pulmonary breathing using a phonendoscope. These are the main diagnostic methods, but they do not allow a complete clinical picture of the disease to be drawn, so additional research methods include:
- X-ray of the lungs (shows the density of the lung tissue);
- computed tomography (considered one of the most precise methods diagnosis of pulmonary emphysema);
- spirometry (examination of respiratory function to determine the degree of impairment of lung function).
How to treat?
The main methods of treating pulmonary emphysema include:
- quitting smoking (this is a very important issue to which doctors pay increased attention, because if the patient does not stop smoking, it will be impossible to cure pulmonary emphysema even with the help of the most effective medications);
- oxygen therapy (intended to saturate the patient’s body with oxygen, since the lungs cannot cope with this function);
- gymnastics (breathing exercises “strengthen” the work of the diaphragm and help get rid of shortness of breath, which is the main symptom of emphysema);
- conservative treatment of concomitant diseases ( bronchial asthma, bronchitis, etc.), causing emphysema, the symptoms of which are determined by the doctor; When an infection occurs, antibiotic therapy is added to the main treatment of emphysema.
Surgical treatment of pulmonary emphysema is indicated only if the disease occurs in a bullous form, and it comes down to removing bullae - thin-walled air-filled blisters that can be localized in any part of the lung (they are almost impossible to see in the photo). The operation is performed using classical and endoscopic methods. The first method involves surgically opening the chest, and during the second, the surgeon performs all the necessary manipulations using special endoscopic equipment through small incisions in the skin. The endoscopic method of removing bullae from pulmonary emphysema will be more expensive, but such an operation has a shorter rehabilitation period.
Basic quantity conservative methods Treatment of this disease is characterized by low effectiveness, because, unlike bronchitis, pulmonary emphysema causes irreversible structural changes in the lung tissue. The prognosis depends on the timeliness of treatment, compliance with the doctor’s recommendations and the correct method. drug therapy both the main and concomitant diseases.
In any case, the treatment of pulmonary emphysema should be carried out exclusively by a doctor. The disease is considered chronic and patients must take medications throughout their lives that support basic functions respiratory system. The life expectancy of people with pulmonary emphysema depends on the degree of damage to the lung tissue, the age of the patient and individual characteristics his body.
Is everything in the article correct from a medical point of view?
Answer only if you have proven medical knowledge
Diseases with similar symptoms:
Pulmonary failure is a condition characterized by the inability of the pulmonary system to maintain normal blood gas composition, or it is stabilized due to severe overstrain of the compensatory mechanisms of the external respiration apparatus. The basis of this pathological process is a violation of gas exchange in the pulmonary system. Because of this, the required volume of oxygen does not enter the human body, and the level of carbon dioxide constantly increases. All this causes oxygen starvation of organs.
