What is emphysema. Emphysema of the lungs: symptoms and treatment. Is hospitalization necessary for the treatment of emphysema?
The term "emphysema" refers to pathological processes in the lungs, characterized high content air in the lung tissue, this is a chronic lung disease characterized by impaired breathing and gas exchange in the lungs. The name of the disease comes from the Greek. emphysao - "to inflate", "to inflate".
In recent years, the incidence of emphysema has been increasing, especially among the elderly.
A significant prevalence of this disease, a progressive course, temporary disability and early disability of patients due to the development respiratory failure And cor pulmonale cause significant economic damage. Pulmonary emphysema, along with chronic obstructive bronchitis, belongs to the group of chronic obstructive pulmonary diseases (COPD). All these diseases are accompanied by a violation of bronchial patency, which is why there is some similarity between them. clinical picture. However, each form of COPD has its own specific features, and the correct, timely diagnosis of these diseases allows for targeted prevention and rational therapy.
Causes of emphysema
The main cause of the disease is chronic, which implies a chronic infection. Chronic bronchitis usually develops between the ages of 30 and 60 and is much more common in men than in women. In fact, the result of chronic bronchitis is the formation of emphysema.
In the development of bullous emphysema important role hereditary factors play, as well as past lung diseases (etc.).
Smoking, air pollution with various dust particles, and certain working conditions associated, for example, with the constant inhalation of coal dust or asbestos and silicon particles, also contribute to the development of the disease.
At the same time, emphysema, leading to severe respiratory failure, can develop without a previous disease. respiratory tract, that is, to be primary.
What happens in the lungs?
The development of emphysema is associated with irreversible changes in the wall of the bronchi and lungs under the influence of prolonged inflammation, prolonged narrowing of the airways. The elastic properties of the lungs are violated: after exhalation, more air begins to remain in them than should be normal, which causes overstretching (inflating) of the lungs. Such excess air is not involved in breathing and overstretched lung tissue does not work fully. Which, in turn, is accompanied by a loss of the ability to contract sufficiently and difficult exhalation, as a result of which the supply of oxygen to the blood and the removal of carbon dioxide from it are disturbed. Compensatory, in order to improve the excretion of carbon dioxide, shortness of breath occurs.
Also in the bronchi and lungs, the amount of connective tissue begins to progressively increase, which, as it were, "replaces" the air areas of the lung tissue, and also contributes to a long-term narrowing of the bronchi, regardless of the existing inflammation.
As a result of these changes, numerous air sacs of different sizes form in the lungs, which can be scattered throughout the lung (diffuse form of emphysema). Sometimes swollen areas of the lungs are combined with normal lung tissue (local form of emphysema). Bullous emphysema is also isolated separately (a bulla is an emphysematous (swollen) area larger than 1 cm).
Symptoms of emphysema
The "classic" manifestations of diffuse emphysema include:
- severe shortness of breath;
- cyanosis;
- increase in volume (barrel shape) chest and a decrease in her respiratory movements;
- expansion and sometimes bulging of the intercostal spaces;
- expansion or bulging of the supraclavicular areas.
In the early stages of emphysema, the main symptom is shortness of breath with physical activity. At first, it is fickle and more often manifests itself in winter, then at any time of the year. In the future, shortness of breath occurs at the slightest physical effort and, finally, can be noted at rest. Patients have a short, "sharp", "grabbing" breath and an extended exhalation. They exhale with closed lips, puffing out their cheeks ("puff"). The respiratory movements of the chest are reduced, additional muscles are involved in breathing: the chest and neck.
Shortness of breath, which for many years, not noticeably manifesting itself and gradually progressing, it turns into a condition life threatening sick.
Patients with emphysema in the initial stages of the disease take a forced position on the stomach with the head and shoulder girdle down, which brings them relief. However, in severe emphysema with pronounced changes in the chest and fatigue of the respiratory muscles, the horizontal position causes intense work of the diaphragm, so patients are even forced to sleep in a sitting position. Patients with emphysema often take a sitting position with their torso slightly tilted forward, leaning their hands on their knees or the edge of the bed, which allows them to fix the shoulder girdle and include additional muscles in the act of breathing.
In advanced cases, cyanosis appears: the tongue appears blue; lips and nails become bluish, especially after exercise.
Complications
Any of the complications leads to disability of the patient.
What can you do?
Treatment should begin at the stage of bronchitis, even before the development of emphysema. Since, most often, due to the patient's late visit to the doctor, by the time of the first visit, irreversible changes have usually already occurred in the lungs, which greatly complicates subsequent treatment.
It is necessary that the sick person takes a direct part in the treatment. He must understand and be aware of the seriousness of the disease and possible complications.
Quitting smoking is extremely important. It should take the first place in the treatment of this pathology. In this case, it is necessary to keep in mind the following: immediate cessation of smoking has a greater effect than a gradual reduction in the number of cigarettes smoked; high motivation to quit smoking is the main factor determining success; nicotine-containing chewing gums and skin applicators help reduce smoking urges, especially when used as part of a smoking cessation program.
What can your doctor do?
Your doctor (pulmonologist or therapist) will conduct the necessary examinations:
- examination, auscultation (listening), percussion (tapping) of the chest;
- lungs (characterized by swelling of the lung tissue and an increase in its airiness, a downward displacement of the diaphragm);
- computed tomography of the lungs, more often used to diagnose and determine the exact location of the bullae;
- study of the function of external respiration: allows you to identify the degree of impaired lung function (to reduce the amount of air that the patient is able to exhale).
The main methods of treatment for emphysema:
- smoking cessation: as already mentioned, the main method for the prevention and treatment of emphysema;
- oxygen therapy (inhalation of air with a high oxygen content, possibly at home);
- special breathing exercises;
- adequate and thorough treatment of the disease that led to emphysema (chronic bronchitis, bronchial asthma): antibiotics should be used in infectious processes and for their prevention. They also use drugs that reduce the amount of sputum and thin it, which facilitates expectoration; substances are also administered that dilate the bronchi and relieve spasm of the bronchial muscles.
With bullous emphysema, surgical treatment is recommended. The essence of the treatment is the removal of the bull. Such operations can be performed both using a classical approach with opening the chest, and endoscopically (using special instruments, through chest punctures). Timely removal of the bullae prevents the development of such a formidable complication as pneumothorax.
In any case, you can not self-medicate. If you suspect that you or your relative has pulmonary emphysema, you should immediately contact a specialist for timely diagnosis and start treatment. In the case of severe forms of the disease, your doctor may suggest the design of a disability group. But in order for the disease not to lead to complications and disability of the patient, you need to contact a specialist and be observed by him if you are sick chronic bronchitis, have bad habits or occupational hazards associated with the inhalation of coal dust or asbestos and silicon particles.
Emphysema, the symptoms of which are quite easy to recognize, can occur for many reasons. But only a doctor can correctly diagnose the disease and prescribe its treatment.
Due to the poor environmental situation on the planet, many people suffer from respiratory failure. Emphysema is a condition in which the tissue in the lungs is stretched and unable to contract. As a result, the removal of carbon dioxide from the blood and the flow of oxygen into it are significantly impaired. The tissues in the lungs feel oxygen starvation and begin to die. The disease can affect the lungs as a whole or only certain areas.
In order to understand the nature of the development of the disease, it is necessary to determine what form the disease has. Emphysema is either primary or secondary. In the first case, it develops as a separate disease, and in the second, as a complication after a lung disease. As a rule, the causes of secondary emphysema are Chronical bronchitis or bronchial asthma. play an important role in the development of the disease past illnesses lungs (tuberculosis), as well as smoking, working in heavily polluted rooms and a hereditary tendency.
Emphysema is a serous disease, and if treatment is not started on time, a person may develop not only respiratory, but also heart failure. The disease can go unnoticed for a long period, but then manifest itself in an advanced form, in which case without surgical intervention unlikely to get by. The risk of emphysema increases in people over 55 years of age, especially in men. Perhaps this gender susceptibility to the disease is due to the greater popularity of smoking among men than among women.
Symptoms of the disease
Many people do not even know about the existence of such a disease as emphysema until they themselves encounter it, and the symptoms and consequences of it are quite unpleasant. Symptoms of emphysema are always pronounced, and it is difficult to confuse them with the manifestation of any other disease.
Most patients claim that they began to recognize the signs of emphysema by the forced position of the body - on the stomach, which they had to accept in order to get relief from suffocation. A person who is sick with emphysema is forced to sleep while sitting, as the horizontal position brings discomfort and causes severe compression in the chest.
The main symptoms of emphysema are as follows:
- shortness of breath (if the disease is hereditary, then shortness of breath can occur even in young age for no reason)
- cyanosis (blue extremities and tongue);
- weakened breathing;
- weight loss;
- rapid fatigue and decreased performance;
- increase in the sternum in volume;
- expansion of intercostal spaces;
- swelling of the supraclavicular region.
The most important symptom of emphysema is shortness of breath, which usually appears after a short physical activity and is unstable at first.
With the development of the disease, it will become more frequent, and at the slightest exertion the patient will feel attacks of suffocation. People with emphysema often take sharp, gasping breaths and long exhalations. Sometimes, even with closed lips, they can feel the exhalation. Observing the patient's sternum, it can be noted that with the development of the disease, it takes less and less part in the respiratory process. In most cases, respiratory movement is carried out by additional muscles of the neck and chest.
Depending on the location of a disease such as emphysema, the symptoms may vary slightly. For example, if the disease affected pulmonary artery, the patient constantly feels sudden pain in the chest area, excessive sweating, low blood pressure, cough and hemoptysis. When emphysema is located in carotid artery, a person is accompanied by headaches and dizziness, coordination of movements is disturbed, clouding of consciousness and a speech defect may develop. If the mesenteric artery is involved in the disease, then the patient feels a burning pain in the abdomen, bloating, and liquid and bloody stools appear.
hurt renal artery leads to pain in the kidneys, red urine and oliguria (reduced amount of urine). The most terrible symptoms will be signs of damage to the disease of the artery of the limbs. As a result, a person will not be able to produce any physical actions affected limb, there may be signs of gangrene, dark spots or blisters with fluid will appear on the limbs.
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Diagnosis and treatment of the disease
If you suspect that you have emphysema, you need to contact a pulmonologist who, after taking an anamnesis, can make a diagnosis and prescribe a course of treatment.
Diagnosis of emphysema involves a set of procedures that will accurately determine the stage of the disease.
In addition to examining (listening and tapping the sternum), the doctor may prescribe the following studies:
- X-rays of light;
- CT scan of the lungs;
- computed tomography of the lungs;
- functional diagnostics;
- general analysis of blood, urine and feces;
- blood gas analysis and polycythemia.
The treatment of pulmonary emphysema consists in oxygen therapy, that is, inhalation of air with increased level oxygen, and, of course, breathing exercises.
Often the doctor prescribes to the patient antibacterial drugs:
- Atrovent;
- Berodual;
- Theopec;
- Eufillin;
- Salbutamol;
- Berotek.
The intensity of drug therapy directly depends on the symptoms, often antibacterial drugs can be combined with expectorants and methods traditional medicine. In advanced cases, doctors are forced to resort to surgical intervention.
Content
WHO statistics indicate that 4% of the population suffer from emphysema (emphysema) of the lungs. As a rule, the disease affects middle-aged and older than age. Allocate chronic, acute form, local (vicarious) or diffuse. The disease disrupts pulmonary ventilation, blood circulation, which leads to disability and a decrease in the comfort of life.
What is emphysema
This disease increases the amount of air in the alveolar tissue of the lungs more than normal. Excess gas that accumulates in the body can lead to a number of complications, for example, damage to the tissues of the bronchi. The disease of emphysema provokes an excess of gases not due to the addition of oxygen, but delays, accumulation of carbon dioxide and other impurities. This leads to disruption of the normal blood supply to the lung tissues, to their destruction. Pressure increases inside the organ, squeezing the nearest organs, arteries.
Species
This pathology is divided into several types and forms. Each of them has a specific symptomatology that can be detected during diagnosis and history taking. Emphysema of the lung can be in an acute, chronic state (the latter is extremely rare in children). Moreover, each of the forms has an unfavorable prognosis without proper therapy. Types of emphysema:
- paraseptal;
- diffuse;
- panlobular;
- bullous.
Why is emphysema dangerous?
The disease leads to irreversible changes structures of the tissues of the organ, which manifests itself in the form of pulmonary insufficiency. This is one of the points why emphysema is dangerous. Pulmonary hypertension leads to a significant increase in the load on the right sections of the myocardium. Because of this, some patients develop right ventricular heart failure, edema of the lower extremities, myocardial dystrophy, ascites, and hepatomegaly.
The timeliness of the detection of the disease directly affects the further prognosis. Ignoring the problem medical measures leads to the progression of the pathology, the loss of the patient's ability to work and further disability. In addition to the disease itself, complications of pulmonary emphysema pose a serious threat to human health.
life forecast
Emphysematous lungs are not completely curable. Even with treatment, there is a constant progression of the pathology. Timely admission to the hospital, compliance with all medical advice, therapeutic measures help to slow down the disease, improve the standard of living, delay disability, and reduce mortality. The prognosis of life with emphysema against the background of a congenital defect is usually unfavorable.
Emphysema - symptoms
The manifestations of the disease depend on the type and form of the pathology, but there are also the main signs of emphysema, which are always the same. TO general symptoms include:
- cyanosis;
- tachysystole;
- expiratory shortness of breath (exacerbation of inflammation of the organ, bronchitis occurs, often occurs with increased physical activity);
- cough (excruciating dry cough with a secondary type of pathology, scanty sputum);
- shortened neck size;
- bulging of the supraclavicular areas;
- increase in respiratory failure;
- weight loss;
- pathological changes in the chest, expansion of the intercostal space;
- diaphragm position;
- excessive fatigue;
- due to the expansion of the chest, there is a lack of its motor mobility (barrel chest);
- cervical veins swell during coughing;
- purplish complexion, the pattern of capillaries appears.
Bullous emphysema
Most experts agree that bullous disease is a manifestation of hereditary / genetic abnormalities. The pathogenesis and etiology of this form of the disease have not been fully elucidated. The pathology is characterized by the fact that bullae appear in the lungs (vesicles different size), they are localized more often in regional departments organ. Vesicles can be multiple or single, local or widespread. The diameter of the bulla ranges from 1 to 10 centimeters. With this form of the disease, respiratory failure develops at the first stage.
Paraseptal
With this pathology, the pulmonary alveoli expand so much that the destruction of the interalveolar septa occurs. Paraseptal emphysema leads to dysfunction of the lung tissue, but the risk lethal outcome extremely small. The body receives less oxygen than in a healthy state, but the lack is not so critical as to lead to death.
Vicar
This form of the disease is characterized by hypertrophy, expansion of the lung sections preserved after the operation, and increased blood supply. Vicarious emphysema is part of true emphysema. The organ does not lose elasticity, adaptive reactions cause functional changes. The air volume of the remaining lung increases, the bronchioles expand, this prevents the typical emphysematous lung exhalation from manifesting itself.
diffuse
Pathology can be secondary or primary. The last diffuse emphysema of the lungs is accepted as an independent nosological unit, which implies different variants course of the pathology. The disease belongs to the idiopathic type, because the causes have not been finally clarified. There is only a connection between obstructive bronchial diseases, which leads to the further development of emphysema. The secondary type of pathology often becomes a complication after chronic bronchial obstruction, bronchitis, pneumosclerosis.
Diagnostics
The main symptoms of pathology include shortness of breath, which occurs after exercise. Indicates the development of the disease by a decrease in the diffusion capacity of the lungs, which occurs due to a reduction in the respiratory surface of the organ. It develops against the background of a significant increase in ventilation. Used for diagnosis following methods examinations:
- Visible emphysema on x-ray (x-ray). The picture helps to identify possible pathologies, see the complete picture of the organ. There will be a noticeable narrowing of the cardiac shadow, it is stretched, an increase in the airiness of the pulmonary tract is noticeable.
- Computed tomography (CT). The study helps to see hyperairiness, bullae, increased density bronchial walls. CT provides an opportunity to detect the disease on early stage.
- External manifestations and symptoms. The appearance of shortness of breath at a young age may indicate a hereditary form of the disease. This is a serious reason for contacting a specialist and conducting an examination.
Emphysema of the lungs - treatment
Modern medicine offers several effective therapies that help slow down the progression process. Treatment of emphysema is carried out in the following areas:
- Performance breathing exercises. They are aimed at improving gas exchange in the lungs. The minimum course of treatment is 3 weeks.
- You should completely stop smoking, this is the most important factor if you want to effectively treat the pathology. After that, in many patients, shortness of breath, coughing disappears over time, breathing becomes easier, and overall well-being improves.
- Antibacterial drugs are usually anticholinergics. The dosage of the drug is prescribed by the doctor on an individual basis. This indicator is influenced by additional symptoms that accompany the disease. The general therapeutic effect is increased by drugs with an expectorant effect.
- Inhalations. This is an effective way to treat this disease, gives good results along with drug therapy. The minimum duration of the course of treatment is 20 days.
- Operational intervention. It is carried out only in the most severe cases, the chest is opened or with the help of endoscopy. Timely surgical intervention helps to avoid complications, for example, pneumothorax.
Folk remedies
Effective therapy will be only with an integrated approach to treatment. The disease cannot be cured only with tinctures at home. Treatment of emphysema with folk remedies can be carried out using the following recipes:
- Medicinal collection 2. You will need dandelion root, birch leaves, juniper fruit. Mix the ingredients in a ratio of 1:2:1. In a quarter liter of boiling water, you need to insist a tablespoon of this collection. Then filter the liquid through gauze and take 15 ml after meals, after 30 minutes.
- Ledum is used for inhalation or as a tincture. In the latter version, you need to insist 1 tsp for about an hour. crushed, dried plant in a half-liter jar with boiling water. You need to drink a remedy of 15 ml twice a day.
- Collection number 3. For it, you will need licorice roots, marshmallow, sage, anise, pine buds. Mix all chopped ingredients in equal proportions. Steep a tablespoon of the collection in a glass of boiling water. After 1-2 hours, the tincture will be ready, which must be poured into a thermos. During the day you need to drink the remedy 3 times 6 ml before meals.
Breathing exercises
This is one of the types of prevention and stages of treatment of the disease. Breathing exercises with emphysema, it improves gas exchange, it is especially successfully used in the initial stages of pathology. The therapy is carried out in medical institution, the essence of the method lies in the fact that the patient first inhales air with a low amount of oxygen for 5 minutes, then the same amount with a normal content. The session consists of 6 such cycles, the course, as a rule, is 20 days, 1 session per day.
Video
Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on individual characteristics specific patient.
Did you find an error in the text? Select it, press Ctrl + Enter and we'll fix it!Emphysema is a chronic disease that is accompanied by a change in the properties and structure of the alveoli. Such a disease is extremely dangerous. Why does it occur, what is it and what are its main symptoms? What treatments are used modern medicine? Can complications be avoided? These questions are very relevant.
what is it and what are its causes?
As already mentioned, this disease is associated with a change in the structure of the alveoli, as a result of which they are overstretched and lose their ability to contract. Indeed, this very dangerous emphysema develops slowly and imperceptibly, but leads to the same thing - the development
As for the causes of such pathological changes, they can be completely different. First of all, it is worth noting that emphysema is often the result of other diseases, in particular, tuberculosis, asthma, and chronic bronchitis. On the other hand, smokers suffer from the disease, as cigarette smoke gradually destroys the structure of the alveoli.
The risk factors include the features of some professions. In particular, emphysema is often found in industrial workers, builders, repairmen, etc. Constant inhalation of smoke, building dust and cement, chemically aggressive substances - all this eventually leads to the destruction of lung tissues. Currently, the list of causes of the disease under consideration also includes an unfavorable habitat.
Emphysema: what is it and what are its symptoms?
Stretching of the alveoli, loss of elasticity and contractility lead to disruption of normal functioning respiratory system. Therefore, the very first symptom of emphysema is shortness of breath. Patients also complain of a feeling of suffocation. And if at first shortness of breath appears only during physical exertion, then over time, breathing problems become a familiar companion of a sick person. Often deep breaths or exhalations are accompanied by wheezing.
As the disease progresses, even changes are observed human body, in particular, the chest becomes barrel-shaped, and the fingers thicken in the type
Due to the lack of oxygen, chronic fatigue develops - patients complain of drowsiness, fatigue, decreased performance. One of the symptoms of the disease is sudden loss weight.
Emphysema: what is it and how is it treated?
As already mentioned, the disease is fraught with serious complications. That is why treatment in this case is simply necessary. Of course, first of all, it is worth determining what caused the changes in lung tissues and eliminating the root cause. For example, smokers need to quit smoking habits as soon as possible, and workers exposed to hazardous substances should carefully monitor protection by using other devices.
Drug treatment is reduced to taking drugs that eliminate bronchospasm. A good therapeutic effect is acupressure. Breathing exercises for emphysema help eliminate the main symptoms and prevent further changes in the alveoli. Oxygen therapy is also considered effective, in which the patient alternately inhales normal air, and then breathes air with a reduced amount of this gas.
It is worth noting that with the right therapy, many people lead a completely normal life.
Emphysema- a chronic lung disease characterized by the expansion of small bronchioles (the terminal branches of the bronchi) and the destruction of the partitions between the alveoli. The name of the disease comes from the Greek emphysao - to inflate. Air-filled voids form in the lung tissue, and the organ itself swells and increases significantly in volume.
Manifestations of emphysema- shortness of breath, shortness of breath, cough with a slight secretion of mucous sputum, signs of respiratory failure. Over time, the chest expands and takes on a characteristic barrel shape.
Reasons for the development of emphysema divided into two groups:
- Factors that violate the elasticity and strength of the lung tissue - 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 - chronic obstructive bronchitis, blockage of the bronchus by a foreign body.
Disease risk some categories are higher than other people:
- Congenital forms of pulmonary emphysema associated with a deficiency of whey protein are more often detected in residents of Northern Europe.
- Men get sick more often. Emphysema is found at autopsy in 60% of men and 30% of women.
- People who smoke are 15 times more likely to develop emphysema. 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, esophagus.Each lung is surrounded by a two-layered pleura. One of its layers fuses with the lung, and the other with the chest. Between the sheets of the pleura there is a space - the pleural cavity, in which there is a certain amount of pleural fluid. This structure contributes to the expansion of the lungs during inspiration.
Due to the peculiarities of the anatomy, the right lung is 10% larger than the left. The right lung has three lobes and the left 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 inner surface. This is the place where the bronchi, arteries, and veins enter the lung. Together they make up the root of the lung.
Lung functions:
- provide blood oxygenation and removal of carbon dioxide
- participate in heat transfer due to the evaporation of liquid
- secrete immunoglobulin A and other substances to protect against infections
- involved in the transformation of the hormone - angiotensin, causing vasoconstriction
- bronchi, through which air enters the lungs;
- alveoli in which gas exchange occurs;
- blood vessels that carry blood from the heart to the lungs and back to the heart
- Trachea and bronchi are called the airways.
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 makes up the bronchial tree there. The right and left are the bronchi of the 1st order, in the place of their branching, the bronchi of the 2nd order are formed. The smallest are bronchi of the 15th order.
Small bronchi branch out, forming 16-18 thin respiratory bronchioles. Alveolar passages depart from each of them, ending in thin-walled vesicles - alveoli.
bronchial function- to ensure the conduction of air from the trachea to the alveoli and vice versa.
The structure of the bronchi.
- Cartilaginous base of the bronchi
- large bronchi outside the lung are made up of cartilage rings
- large bronchi inside the lung - cartilaginous connections appear between the cartilaginous half-rings. Thus, a lattice structure of the bronchi is provided.
- small bronchi - cartilages look 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.
- The muscular layer of the bronchi- smooth muscles are arranged circularly. They provide narrowing and expansion of the lumen of the bronchi. At 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 infectionstransmitted by airborne droplets. Small villi carry bacteria and small dust particles from distant bronchi to larger bronchi. From there they are expelled by coughing.
- lung glands
- unicellular glands that secrete mucus
- small lymph nodes associated with larger lymph nodes in the mediastinum and trachea.
- Cartilaginous base of the bronchi
- Alveolus - bubble, in the lungs, braided with a net blood capillaries. The lungs contain more than 700 million alveoli. This structure allows you to increase the surface in which gas exchange occurs. Atmospheric air enters the bubble through the bronchi. Through the thinnest wall, oxygen is absorbed into the blood, and carbon dioxide, which is excreted during exhalation, enters the alveoli.
The area around the bronchiole is called the acinus. It resembles a bunch of grapes and consists of branches of the bronchioles, alveolar passages 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 that, it is collected in the veins and enters the left atrium.
Causes of emphysema
The causes of emphysema are usually divided into two groups.
- Violation of elasticity and strength of lung tissues:
- Congenital deficiency of α-1 antitrypsin. In people with this anomaly, proteolytic enzymes (whose function is to destroy bacteria) break down the walls of the alveoli. Whereas normally α-1 antitrypsin neutralizes these enzymes in a few tenths of a second after their release.
- Congenital defects in the structure of the lung tissue. Due to the structural features of the bronchioles, they collapse, and the pressure in the alveoli increases.
- Inhalation of polluted air: smog, tobacco smoke, coal dust, toxic substances. Cadmium, oxides of nitrogen and sulfur emitted by thermal stations and transport are recognized as the most dangerous in this regard. Their smallest particles penetrate the bronchioles, deposited on their walls. They damage the ciliated epithelium and vessels that feed the alveoli and also activate special cells called alveolar macrophages.
They contribute to an increase in the level of neutrophil elastase, a proteolytic enzyme that destroys the walls of the alveoli.
- Hormonal imbalance. Violation of the ratio between androgens and estrogens disrupts the ability of the smooth muscles of the bronchioles to contract. This leads to stretching of the bronchioles and the formation of cavities without destroying the alveoli.
- Respiratory tract infections: chronic bronchitis, pneumonia. Immune cells macrophages and lymphocytes reveal proteolytic activity: they produce enzymes that dissolve bacteria and the protein that makes up the walls of the alveoli.
In addition, sputum clots in the bronchi let air into the alveoli, but do not release it in the opposite direction.
This leads to overflow and overstretching of the alveolar sacs.
- Age changes associated with poor circulation. In addition, older people are more sensitive to toxic substances in the air. With bronchitis and pneumonia, lung tissue is worse restored.
- 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, violations occur in their walls, leading to the formation of cavities.
- Professional hazards. Glassblowers, wind musicians. A feature of these professions is the increase in air pressure in the lungs. Smooth muscles in the bronchi gradually weaken, and blood circulation in their walls is disturbed. When exhaling, 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 foreign body leads to the fact that the air remaining in the segment of the lung cannot come out. Developing acute form emphysema.
Mechanism of lung injury in emphysema- Stretching of the bronchioles and alveoli - their size doubles.
- Smooth muscles are stretched, and the walls of blood vessels become thinner. The capillaries become empty and nutrition in the acinus is disturbed.
- Elastic fibers degenerate. In this case, the walls between the alveoli are destroyed and cavities are formed.
- The area in which gas exchange between air and blood is reduced. The body is deficient in oxygen.
- Expanded areas squeeze healthy lung tissue, which further disrupts 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 overflow with blood. This causes disturbances in the work of the right heart.
Types of emphysema
There are several classifications of emphysema.By the nature of the flow:
- Acute. It develops with an attack of bronchial asthma, a foreign object entering the bronchi, a sharp physical load. Accompanied by overstretching of the alveoli and swelling of the lung. This is a reversible condition, but requires urgent medical attention.
- Chronic. Develops gradually. At an early stage, the changes are reversible. But without treatment, the disease progresses and can lead to disability.
Origin:- Primary emphysema. Independent disease which develops in connection with congenital features organism. It can even be diagnosed in infants. It progresses rapidly and is more difficult to treat.
- Secondary emphysema . The disease occurs against the background of chronic obstructive pulmonary disease. The onset often goes unnoticed, the symptoms increase gradually, leading to a decrease in working capacity. Without treatment, large cavities appear that can occupy an entire lobe of the lung.
By prevalence:
- diffuse form. Lung tissue is evenly affected. Alveoli are destroyed throughout the lung tissue. In severe cases, a lung transplant may be required.
- focal form. Changes occur around tuberculous foci, scars, in places to which a clogged bronchus approaches. The manifestations of the disease are less pronounced.
- Panacinar emphysema(vesicular, hypertrophic). All acini in the lobe of the lung or the whole lung are damaged and swollen. Between them there is no healthy tissue. 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. The defeat of 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. Fibrous tissue develops on the walls of damaged acini. Between the altered areas, the parenchyma (tissue) of the lungs remains intact and performs its function.
- Periacinar(distal, perilobular, paraseptal) - damage to the extreme sections of the acinus near the pleura. This form develops with tuberculosis and can lead to pneumothorax - a rupture of the affected area of the lung.
- Perirubtsovaya- develops around scars and foci of fibrosis in the lungs. The 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 may 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 cracks under the skin of the neck and head. Bubbles can remain in the lungs, and when they break, spontaneous pneumothorax occurs.
- Compensatory- develops after the removal of one lobe of the lung. When healthy areas swell, trying to take 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
When symptoms of pulmonary emphysema appear, they turn to a general practitioner or pulmonologist.
Instrumental methods for diagnosing lung emphysema
- Radiography- a study of the state of the lungs using x-rays, as a result of which an image of the internal organs is obtained on a film (paper). An overview picture of the chest is made in a direct projection. This means that the patient is facing the machine during the exposure. An overview image reveals pathological changes in the respiratory organs and the degree of their distribution. If the picture shows signs of illness, then additional studies are prescribed: MRI, CT, spirometry, peak flowmetry.
Indications:
- Once a year as part of a preventive examination
- prolonged cough
- dyspnea
- wheezing, pleural friction noise
- weakening of breathing
- pneumothorax
- suspicion of emphysema, chronic bronchitis, pneumonia, pulmonary tuberculosis
- period of breastfeeding
- the lungs are enlarged, they compress the mediastinum and find each other
- affected areas of the lung look overly transparent
- expansion of the intercostal spaces with the active work of the muscles
- the lower edge of the lungs is lowered
- low stop aperture
- reduction in the number of blood vessels
- bullae and foci 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 captures these changes. MRI of the lungs provides information about the condition of the large bronchi of the vessels, lymphoid tissue, the presence of fluid and focal formations in the lungs. Allows you to get slices with a thickness of 10 mm and examine them from different positions. To study the upper parts of the lungs and areas around the spine, a contrast agent is injected intravenously - a preparation of gadolinium.
The disadvantage is that air interferes with accurate visualization of small bronchi and alveoli, especially in 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 tunnel of the magnetic tomograph. MRI is not associated with radiation, so the study is allowed for pregnant and lactating women.
Indications:
- there are symptoms of the disease, but x-ray no changes can be found
- tumors, cysts
- suspicion of tuberculosis, sarcoidosis, in which small focal changes
- increase in intrathoracic lymph nodes
- anomalies in the development of the bronchi, lungs and their vessels
- the presence of a pacemaker
- metal implants, staples, fragments
- mental illness that do not allow you to lie still for a long time
- patient weight over 150 kg
- damage to the alveolar capillaries at the site of destruction of the lung tissue
- circulatory disorders in small pulmonary vessels
- signs of compression of healthy tissue by enlarged areas of the lung
- increase in pleural fluid volume
- an increase in the size of the affected lungs
- cavities - bullae of different sizes
- low stop aperture
- Computed tomography (CT) of the lungs allow you to get a layered image of the structure of the lungs. CT is based on the absorption and reflection of X-rays by tissues. Based on the received data, the computer makes a layered image with a thickness of 1mm-1cm. The study is informative on early dates diseases. With the introduction of a contrast agent, CT provides more complete information about the state of the vessels of the lungs.
During a CT scan of the lungs, the x-ray emitter rotates around a patient lying still. Scanning takes about 30 seconds. The doctor will ask you to hold your breath several times. The whole procedure takes no more than 20 minutes. With the help of computer processing, X-ray images obtained from different points are summarized into a layered image.
Flaw- Significant radiation exposure.
Indications:
- in the presence of symptoms, no changes were detected on the x-ray, or they need to be clarified
- diseases with the formation of foci or with diffuse lesions of the lung parenchyma
- chronic bronchitis, emphysema
- before bronchoscopy and lung biopsy
- deciding on an operation
- allergy to the contrast agent
- critical condition of the patient
- severe diabetes mellitus
- kidney failure
- pregnancy
- patient weight exceeding the capacity of the device
- an increase in the optical density of the lung up to -860-940 HU - these are airborne areas of the lung
- expansion of the roots of the lungs - large vessels entering the lung
- enlarged cells are noticeable - areas of fusion of the alveoli
- reveals the size and location of the bullae
Lung scintigraphy - the introduction of labeled radioactive isotopes into the lungs, followed by a series of images with a rotating gamma camera. Technetium preparations - 99 M are administered intravenously or in the form of an aerosol. The patient is placed on a table around which the probe rotates.
Indications:
- early diagnosis vascular changes with emphysema
- monitoring the effectiveness of treatment
- assessment of the condition of the lungs before surgery
- suspected lung cancer
- pregnancy
- compression of lung tissue
- impaired blood flow in small capillaries
- Spirometry - functional study of the lungs, the study of the volume of external respiration. The procedure is carried out using a spirometer device that records the amount of inhaled and exhaled air.
The patient takes a mouthpiece connected to a breathing tube with a sensor in his mouth. A clip is put on the nose, which covers nasal breathing. The specialist tells you which breathing tests to perform. And the electronic device converts the sensor readings into digital data.
Indications:
- respiratory failure
- 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 lung capacity
- decrease in maximum ventilation
- increased expiratory airway resistance
- decrease in speed indicators
- decrease in lung tissue extensibility
Peak flowmetry - measurement top speed exhalation to determine bronchial obstruction.It is determined using a device - a peak flow meter. The patient needs to tightly clasp the mouthpiece with his lips and make the fastest and strongest possible exhalation through the mouth. The procedure is repeated 3 times with an interval of 1-2 minutes.
It is desirable to carry out peak flowmetry in the morning and in the evening at the same time before taking medications.
The disadvantage is that the study cannot confirm the diagnosis of emphysema. The expiratory rate is reduced not only with emphysema, but also with bronchial asthma, pre-asthma, chronic obstructive pulmonary disease.
Indications:
- any disease accompanied by bronchial obstruction
- evaluation of treatment outcomes
Emphysema symptoms:
- decrease in expiratory flow by 20%
- Determination of the gas composition of the blood - a study of arterial blood, during which the pressure in the blood of oxygen and carbon dioxide 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 of the ulnar artery is usually done. A blood sample is taken into a heparin syringe, placed on ice, and sent to the laboratory.
Indications:
- cyanosis and other signs of oxygen starvation
- respiratory disorders in asthma, chronic obstructive pulmonary disease, emphysema
- oxygen tension in arterial blood is below 60-80 mm Hg. st
- the percentage of oxygen in the blood is less than 15%
- an increase in the tension of carbon dioxide in arterial blood over 50 mm Hg. 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 disease.
Contraindications does not exist.
Deviations with emphysema:
- increased amount erythrocytes over 5 10 12 /l
- increased hemoglobin level over 175 g/l
- increase in hematocrit over 47%
- reduced erythrocyte sedimentation rate 0 mm/h
- increased blood viscosity: in men over 5 cP in women over 5.5 cP
Emphysema treatment
Treatment of emphysema has several directions:- improving the quality of life of patients - elimination of shortness of breath and weakness
- prevention of heart and respiratory failure
- slowing the progression of the disease
- complete cessation of smoking
- physical exercise to improve lung ventilation
- taking medicines that improve the condition of the respiratory tract
- treatment of the pathology that caused the development of emphysema
Treatment of emphysema with medicines
| Drug group | 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 the lung tissue. | Intravenous injection at the rate of 60 mg/kg of body weight. 1 time per week. |
| Mucolytic drugs | Acetylcysteine (ACC) | Improves the discharge of mucus from the bronchi, has antioxidant properties - reduces the production of free radicals. Protects the lungs from bacterial infection. | Take orally 200-300 mg 2 times a day. |
| Lazolvan | Liquefies mucus. Improves its excretion from the bronchi. Reduces cough. | Apply inside or inhalation. Inside during meals, 30 mg 2-3 times a day. In the form of inhalations on 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 orally 1 capsule per day. Take courses for 2-4 weeks. |
| Bronchodilators (bronchodilators) Phosphodiesterase inhibitors Anticholinergics | Teopak | Relaxes the smooth muscles of the bronchi, contributes to the expansion of their lumen. Reduces swelling of the bronchial mucosa. | The first two days take half a tablet 1-2 times a day. In the future, the dose is increased - 1 tablet (0.3 g) 2 times a day after 12 hours. Taken after meals. The course is 2-3 months. |
| Atrovent | It blocks acetylcholine receptors in the muscles of the bronchi and prevents their spasm. Improves external respiration. | In the form of inhalations, 1-2 ml 3 times a day. For inhalation in a nebulizer, the drug is mixed with saline. | |
| Theophyllines | Theophylline long acting | It has a bronchodilator effect, reducing systemic pulmonary hypertension. Increases diuresis. Reduces fatigue of the respiratory muscles. | Initial dose of 400 mg / day. Every 3 days it can be increased by 100 mg until the desired therapeutic effect appears. The maximum dose is 900 mg / day. |
| Glucocorticosteroids | Prednisolone | It has a strong anti-inflammatory effect on the lungs. Promotes the expansion of the bronchi. | Applied with the ineffectiveness of bronchodilator therapy. 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. This improves the energy supply of muscles, blood and lymph circulation. 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 inhalations. Inhalation is carried out for a long time for 18 hours a day. In this case, oxygen is supplied to the mask at a rate of 2-5 liters per minute. In severe respiratory failure, helium-oxygen mixtures are used for inhalation.
- Breathing exercises- training of the respiratory muscles, aimed at strengthening and coordinating the muscles during breathing. All exercises are repeated 4 times a day for 15 minutes.
- Exhale with resistance. Slowly exhale through a cocktail straw into a glass filled with water. Repeat 15-20 times.
- Diaphragmatic breathing. At the expense of 1-2-3 make a strong deep breath sucking in the stomach. At the expense of 4, exhale - inflating the stomach. Then tighten your abdominal muscles and cough deafly. This exercise helps to expel mucus.
- Lying down. Lying on your back, bend your legs and clasp your knees with your hands. As you inhale, take in full lungs of air. As you exhale, stick out your stomach (diaphragmatic exhalation). Straighten your legs. Tighten the press and cough.
When is surgery needed for emphysema?
Surgical treatment of emphysema is not often required. It is necessary in the case when the lesions are significant and drug treatment does not reduce the symptoms of the disease. Indications to 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 emphysema mild severe degree"
- inflammatory process - bronchitis, pneumonia
- asthma
- exhaustion
- severe deformity of the chest
- age over 70
Types of operations for emphysema
- lung transplant and its variants: transplantation of the lungs together with the heart transplantation of a lobe of the lung. Transplantation is carried out with a volumetric diffuse lesion or multiple large bullae. The goal is to replace the affected lung with a healthy donor organ. However, the waiting list for transplantation is usually too long and problems with organ rejection can occur. Therefore, such operations are resorted to only as a last resort.
- Decrease in lung volume. The surgeon removes the most damaged areas, approximately 20-25% of the lung. At the same time, the work of the remaining part of the lung and respiratory muscles improves. The lung is not compressed, its ventilation is restored. The operation is carried out in one of three ways.
- Minimally invasive technique (thoracoscopy) under video control. Between the ribs make 3 small incisions. A mini video camera is inserted into one, and surgical instruments into the others. The affected area is removed through these incisions.
- Bronchoscopy. 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 when the affected area is located close to the large bronchi.
Opening of the chest. The doctor removes the affected lobe and applies stitches to seal the lung. Then he puts a seam on the chest.
Is hospitalization required to treat emphysema?
In most cases, patients with emphysema are treated at home. It is enough to take medication according to the scheme, stick to a diet and follow the doctor's recommendations.Indications for hospitalization:
- a sharp increase in symptoms (shortness of breath at rest, great weakness)
- the appearance of new signs of the disease (cyanosis, hemoptysis)
- ineffectiveness of the prescribed treatment (symptoms do not decrease, peak flow measurements worsen)
- severe comorbidities
- newly developed arrhythmias
- difficulty in establishing a diagnosis;
Nutrition for emphysema (diet).
Therapeutic nutrition for pulmonary emphysema is aimed at combating intoxication, strengthening immunity and replenishing the patient's high energy costs. Recommended diet number 11 and number 15. Basic dietary guidelines for emphysema
- Increasing calories up to 3500 kcal. Meals 4-6 times a day in small portions.
- Proteins up to 120 g per day. More than half of them must be of animal origin: animal and poultry meat, liver, sausages, fish of all varieties and seafood, eggs, dairy products. Meat in any culinary treatment, excluding excessive frying. All complications of emphysema are life-threatening. Therefore, if any new symptoms appear, it is urgent to seek medical attention. medical care.
- Pneumothorax. Rupture of the pleura surrounding the lung. In this case, air enters the pleural cavity. The lung collapses and becomes unable to expand. around him in pleural cavity fluid accumulates and needs to be removed. There is severe pain in the chest, aggravated by inhalation, panic fear, palpitations, the patient takes a forced position. Treatment must begin immediately. If the lung does not heal in 4-5 days, surgery will be needed.
- infectious complications. decline local immunity increases the sensitivity of the lungs to bacterial infections. Severe bronchitis and pneumonia often develop, which become chronic. 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 are overstretched and worn 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 of 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.