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In recent years, in connection with the use of new methods of X-ray studies, X-ray diagnostics of pulmonary emphysema plays a very important role and in many cases allows one to judge the degree of functional disorders. When selecting patients for surgical treatment, it is especially important to accurately interpret the X-ray data.
X-ray changes in pulmonary emphysema were described in detail by Yu. N. Sokolov, EV Neshel, W. Frich a. ass., W. Fray, G. Simon, et al. In case of widespread emphysema, changes in the chest skeleton can be found, but they are not of great diagnostic value.
The most characteristic sign of diffuse emphysema is an increase in pulmonary fields, mainly due to their vertical size (omission of the diaphragm, widening of the intercostal space) 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 can be clearly seen even on exhalation.
The diaphragm with emphysema is omitted. Its right dome is located at the neck of 10-11 ribs (normally on the ninth). The height of the dome of the diaphragm is usually 2-3 cm (normal according to W. Frick - at least 4 cm). The flattening of the diaphragm leads to an increase in the size of the lateral and costodiaphragmatic sinuses. Lateral sinus greater than 45 ° indicates emphysema. With severe emphysema, the diaphragm takes on the shape of a tent, its "scalloped", "stepped" appearance appears, which may be associated with adhesions or exposure of the places of attachment of the diaphragm to the ribs during its flattening.
Yu.N. Sokolov found this symptom in healthy individuals with well-pronounced diaphragmatic breathing, but in patients with emphysema of the lungs, the diaphragm is not mobile: with a pronounced form of the disease, the dome moves to less than the height of one intercostal space, and in very severe cases the fluctuations 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.
Diplogram (or bigram) allows you to judge the degree of expansion of the chest. One of the pictures is taken on inhalation, the other on exhalation (it is possible on the same film) and, combining them, the coefficient of expansion is determined. According to W. Fray, the ratio of the area of inhalation - exhalation normally does not exceed 72 (according to E. V. Neshel - 65-75). With the initial emphysema of the lungs, it is equal to 70-80, with emphysema of the II degree - 80-90, with emphysema of the III degree - more than 90. By the bigram it is possible to determine the SAM. S. Mutina), which clearly reveals a slowdown in exhalation (the exhalation knee is lengthened and deformed) with emphysema.
The change in the transparency of the pulmonary fields in different phases of respiration reflects the ventilation function of the lungs. The methods of this test were developed by Yu. N. Sokolov, EV Neshel, AI Sadofiev and others. In severe emphysema, the transparency of the pulmonary fields in different phases of respiration almost does not change. The increased transparency of the lungs alone does not indicate emphysema, because it may be due to decreased blood circulation in the pulmonary vessels or atrophy of the chest wall during exhaustion. Against the background of increased transparency of the pulmonary fields, an increase in the pulmonary pattern in the root area and its depletion at the periphery, which is characteristic of emphysema, appears, which reflects a decrease in the blood supply to the peripheral parts of the lungs and an increase in resistance to blood flow in the small circle.
Tomography and angiopulmonography play an important role in judging the state of the pulmonary circulation. The latter, in most cases, allows one to judge the localization, prevalence and degree of the disease. This method requires special equipment and is not yet widespread in clinical practice. IA Shekhter, MI Perelman, FA Astrakhaitsev, MZ Upinger discovered vasoconstriction in the area of emphysematous fields. They are spread apart, have few vascular branches, which do not depart 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. Huramovich on angiograms of patients with emphysema found dilatation of the hilar and lobar arteries, reflecting an increase in vascular resistance, vasoconstriction from the center to the periphery with a very poor vascular network in the areas of emphysema. K. Semish revealed, in addition, a slowdown in capillary current and arterio-venous anastomoses. MA Kuznetsova (1963) found similar changes in blood vessels on X-ray tomograms, and V. Lopez-Majano a. ass. - on scannograms.
The change in the vascular bed increases as the disease progresses. According to L. Read, on angiograms, the process seems to be more common than it is revealed on autopsy, which reflects the presence of vasospasm, which, like bronchospasm, plays an essential role in the progression of the disease.
Bubble areas may not be detected on a conventional radiograph, especially with peripheral subpleural localization of bullae. Sometimes they are recognized as finely delineated annular shadows or an avascular zone with a cellular pattern and a deviation of the shadows of the vascular and bronchial branches. They are better seen on tomograms.
Bronchography with diffuse emphysema has not become widespread - it is hardly tolerated by this group of severe patients, and the contrast, due to the ineffectiveness of the cough, is retained for a long time in the airways.
Lung function in patients with widespread emphysema is markedly impaired. According to our observations, ventilation changes first. In the initial period, violations are small and are manifested by a moderate restriction of VC, MMV and breathing reserves, an increase in residual air and VVR. The tidal volume in the first period of the disease may even increase.
An increase in the minute volume of respiration at the onset of the disease ensures sufficient saturation of the blood with oxygen and the elimination of carbon dioxide; in some patients, hypocapnia is found. During exercise, especially if it is accompanied by a bronchospastic reaction, ventilation disturbances are more pronounced, may be accompanied by a reduced saturation of arterial blood with oxygen and equalize not in 2-3 minutes, as in healthy people, but much later.
Ventilation disorders increase with the progression of emphysema, which is most often associated with an exacerbation of the infection - an outbreak of bronchitis or pneumonia. At the same time, shortness of breath and coughing increase, body temperature may rise, weakness, sweating, and severe fatigue may appear. Sputum often acquires a purulent character and, along with various infectious agents, a large number of neutrophils are found in it.
An exacerbation of infection always worsens bronchial patency due to the accumulation of secretions, edema of the bronchi and bronchioles, bronchospasm leads to complete or partial destruction of the alveoli and to an increase in the area of emphysema.
The deterioration of bronchial patency is reflected in ventilation indicators: the AVL decreases, especially the one-second volume (B.E. Votchal and TI Bibikova propose to determine the forced VC in 2 seconds), the power of the air stream and the ratio of MMOD to VC are sharply reduced. This indicates an increased resistance to air flow in the respiratory tract. An increase in the anatomical and especially functional dead space, uneven ventilation (not all areas are affected equally and the disturbance of the air flow occurs at different times) leads to alveolar hypoventilation.
The work of the respiratory muscles increases accordingly. Additional muscles that enhance inhalation are located mainly in the upper chest (sternocleidomastoid, scalene, trapezius), muscles that enhance exhalation are located in the lower. Discoordination of respiratory movements or pathological upper thoracic type of breathing develops. This additionally loads the respiratory muscles, makes them less efficient and increases the energy consumption for breathing. Therefore, although the minute volume of respiration is increased, most of the energy is spent on ensuring the work of the respiratory muscles.
External respiration no longer provides sufficient oxygen saturation of the blood and the removal of carbon dioxide. However, there is no complete correspondence between the severity of the disease and the degree of impairment of ventilation indicators. But an approximate conclusion about the degree of gas exchange disturbances can also be made on the basis of studying the indicators of external respiration (residual air, MOF, FVC, MMOD, ventilation reserves and expiratory power). J. Hamm in 155 patients with emphysema and bronchial asthma determined the severity of the disease by spirometric parameters and obtained the results corresponding to the clinic.
Changes in blood gases are indicative. Gas exchange disorders are caused by ventilation disorders, increased work of breathing and desolation of a part of the capillary bed. Diffusion of gases through the alveolar-capillary membrane in emphysema without concomitant pneumosclerosis changes little (mainly due to swelling of the alveoli during exacerbation of brochorespiratory infection). The difference in oxygen tension in the alveoli and in arterial blood in emphysema can be increased by 8-10 mm of mercury against the norm. Most often this is due to uneven ventilation (N. Marx, P. Rossier and others).
Gas exchange disturbances are usually detected if the volume of residual air is more than 45% and the MMOD is less than 50 l / min. Our observations confirm the data of other authors (V.G. Uspenskaya, N.N.Savitsky, N. Marx, and others) 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 only in 1/3 of our patients with hypoxemia. According to V.G. Uspenskaya, in the early stages of the disease, the oxygen capacity decreased, but in general its changes were small.
The presence of hypercapnia always indicates a poor prognosis and a very severe phase of the disease. If in a patient with emphysema, hypercapnia is caused by a hypoventilation crisis against the background of an abdominal operation or an exacerbation of a bronchorespiratory infection, then after the crisis is eliminated, the carbon dioxide content in the blood may again become normal. But chronic hypercapnia always accompanies a sharp and persistent depression of ventilation.
Functional studies after exercise make it possible to more accurately judge the extent of disease spread, reserves and prognosis. Tolerance to exercise in patients with pulmonary emphysema is significantly less than in heart disease. With moderately severe emphysema, a small load can initially lead to an increase in blood oxygen saturation, as the minute volume of respiration increases. In healthy people, the MOU rises to 100-130 liters per minute, a further increase in ventilation is useless, everything is spent on the work of breathing. In patients with emphysema, the MOD, in which a further increase in ventilation is useless, is achieved much earlier (especially in those patients in whom the MOD at rest is significantly increased). Similar conditions are created, apparently, at a respiration rate of 45 per minute.
Exercise studies are risky in critically ill patients. N. Marx considers load tests contraindicated in case of circulatory decompensation, prolonged and severe bronchospasm, exacerbation of bronchorespiratory infection, if MMOD is less than 30 l / min, VC is less than 2 liters, 1 "volume is less than 50% VC, 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 the use of bronchodilator drugs.
We observed mainly 2 types of the course of the disease:
1.
Slowly progressive, when the increase in the clinical picture occurs over many years, often unnoticed by the patient, the symptoms are limited for a long time to ventilation disorders and moderate hypoxemia, exacerbations of broncho-respiratory infection flow sluggishly, at normal body temperature. Patients usually seek medical help 1-2 times a year, they are more often treated with various antibiotics and bronchodilators themselves and can remain limited for a long time.
2.
A rapidly progressive type of course, which is usually observed in younger people and is characterized by frequent, rapidly current periods of exacerbation of broncho-respiratory infection. Hypoxemia develops rapidly, in the next 2-3 years hypercapnia also joins, that is, a global insufficiency according to P. Rossier is formed, from which it is not possible to completely remove patients. In such patients, as a rule, more pronounced disturbances in the blood supply to the lungs are noted on the section and more often there is a blistering form of emphysema.
Emphysema of the lungs is a common disease that predominantly affects middle-aged and elderly men, occurring with significant impairment of pulmonary ventilation and blood circulation, in contrast to the conditions listed in the differential diagnosis, which have only an external resemblance to true emphysema.
Frequency... The prevalence in the population is over 4%.
Emphysema is an increase in the volume of the airways located distal to the bronchioles. Centrilobular emphysema is characterized by the expansion of predominantly alveolar ducts and respiratory bronchioles. In contrast, with panlobular emphysema, the terminal alveoli expand. They say about a "flabby" lung if only the elastic traction decreases. Pathological changes can affect only a limited area (local emphysema) or the entire lung (diffuse emphysema). Emphysema is one of the most common causes of human death.
Causes of emphysema of the lungs
Emphysema of the lungs, as shown by observations of cases of rapid development of the disease in young people following an injury to the chest, may be the result of severe damage to the bronchi and interstitial tissue of the lungs. Apparently, a violation of bronchial patency, especially of the final branching of the bronchi, due to blockage of mucus and spasm, along with a decrease in alveolar nutrition when their blood circulation is disturbed (or vascular damage), can lead to stretching of the alveoli with persistent changes in the structure of the walls and their atrophy.
With incomplete closure of the bronchi, the mechanism described in the section devoted to the description of violations of bronchial patency comes into play, when air enters the alveoli during inhalation, but does not find an outlet during exhalation, and intra-alveolar pressure rises sharply.
Experimentally, it was possible to obtain emphysema by tracheal stenosis after a few weeks. A similar mechanism is believed to underlie true emphysema, which develops in old age without obvious preliminary inflammatory diseases or bronchial obstruction. Apparently, this is also about chronic, sluggish bronchitis and interstitial inflammatory processes, possibly with vascular lesions, accompanied by functional spasm, which is why the name obstructive emphysema is now considered rational for true emphysema.
Emphysema of the lungs often accompanies both bronchial asthma, peribronchitis, and various types of pneumosclerosis, with which it, therefore, has a close pathogenetic and clinical affinity. Peri-bronchitis and inflammatory-degenerative lesions of the pulmonary parenchyma, according to a number of authors, are a necessary condition for the development of pulmonary emphysema with loss of elastic properties (Rubel).
Previously, in the origin of pulmonary emphysema, predominant importance was attached to individual constitutional weakness, premature wear of the elastic tissue of the lungs and even changes in the skeleton, ossification of the cartilage of the chest, which seemed to stretch the lungs in the inhalation position; emphysema was brought closer to atherosclerosis and metabolic disorders. They also attached great importance to purely mechanical inflation of the lungs (glass blowers, musicians on wind instruments, etc.). However, as clinical experience shows, without disturbing the patency of the bronchi and bronchioles and affecting the lungs, these moments are not enough for the development of emphysema.
Undoubtedly, in the origin of pulmonary emphysema, as well as bronchial asthma and bronchiectasis, a violation of the nervous regulation of the entire activity of the bronchopulmonary system, which occurs both by a reflex path from adjacent organs and from the receptor fields of the respiratory tract, and due to a violation of the activity of the central nervous system, as evidenced by, for example, the development of acute emphysema ate brain contusion.
Pulmonary ventilation, gas exchange and lungs are impaired in emphysema due to the worse ventilation of the alveoli. In fact, although the minute volume of air, due to the increased frequency and tension of respiratory movements, can even be increased, but the air exchanges mainly in the large airways, fresh air penetrates less into the depths of the bronchioles, mixes worse and changes in the alveoli, the unventilated "dead" space. The amount of residual air in emphysema can increase to 3/4 of the total total lung capacity (instead of 1/4 in the norm). The increase in residual air, as well as the decrease in additional air, is explained by the stretching of the lungs due to the loss of elasticity of the lung tissue. Due to these mechanisms, oxygen uptake during high ventilation can be abnormally low (wasteful use). The force of the stream of incoming and especially outgoing air, due to small expiratory movements of the chest, is insignificant: a patient with emphysema is not able to blow out the candles. The respiratory muscles of the chest, like the diaphragm, this most important respiratory muscle, due to constant tension as a result of the excitation of the respiratory center by the altered composition of the blood, hypertrophies, and subsequently degenerates, which contributes to respiratory decompensation.
At the same time, blood circulation in the small circle suffers, which further reduces external respiration. Increased intraalveolar pressure exsanguinates the pulmonary capillaries embedded in the thin-walled interalveolar septa, capillaries disappear with progressive atrophy of these septa. “In addition, the inflammatory process often affects the vessels of the bronchial and pulmonary systems embedded in the interstitial tissue of the lungs, which carry blood for nutrition and respiratory function of the lungs.
This decrease in the blood capillary bed of the small circle causes a corresponding increase in the work of the right ventricle, which compensates for blood circulation at a higher hemodynamic level; the pressure in the pulmonary artery system and its branches increases several times, there is, as they say, pulmonary hypertension, which provides the pressure in the pulmonary artery system, which is necessary to transfer the entire amount of blood entering the right ventricle to the left ventricle; the blood flow velocity in the small circle with powerful contractions of the sharply hypertrophied right ventricle does not change.
The experiment shows that when ligating one main branch of the pulmonary artery in an animal, the pressure in the artery trunk almost doubles.
Due to the greater pressure in the small circle, the arterio-venous anastomoses of the lungs open to a greater extent, transferring non-arterialized blood to the bronchial veins of the large circle. The resulting bronchial plethora contributes to the chronic course of bronchitis. Of course, all the altered conditions of gas exchange and blood circulation in the lungs lead to hypoxemia and hypercapnia characteristic of emphysema. Already in the aorta or in the radial artery, which is more accessible for research, the blood in emphysema is undersaturated with oxygen (central or arterial pulmonary cyanosis). The retention of carbon dioxide in the blood comes with great difficulty due to its easier return to the lungs (greater diffusion capacity).
In this period of emphysema, despite a violation of the pulmonary function of gas exchange or external respiration, we can talk about cardiac-retired pulmonary emphysema (similar to the idea of compensated heart defects and cardiac compensation of hypertension).
However, the very long-term overstrain of the myocardium, along with a low oxygen content in the arterial blood supplying the heart muscle (and other organs), creates the prerequisites for decompensation of the heart, which is facilitated by concomitant infections, bronchitis, pneumonia, often simultaneously present atherosclerosis of the coronary arteries of the heart, etc. .; this cardiac decompensation in pulmonary emphysema is discussed in the section of cor pulmonale.
It should be added that the very increase in intrathoracic and intrapleural pressure in patients with emphysema, lower suction force and functional shutdown of the diaphragm cause an adaptive increase in venous pressure in the vena cava, which provides an approximately normal pressure drop during the transition of blood into the chest; therefore, only a moderate increase in venous pressure does not speak definitely for myocardial weakness. Due to a decrease in the capillary bed of the small circle, even with a failure of the left heart, the lungs do not give a pronounced picture of stagnation, in particular, a sharp veil of the pulmonary fields.
Centrilobular emphysema develops mainly against the background of obstructive pulmonary disease: in the case of a "flabby" lung, the mass of connective tissue is reduced, and in diffuse emphysema, there is also a rupture of the interalveolar septa. With age, the ratio between the volume and area of the alveoli usually increases. In some cases (approximately 2% of patients), there is a deficiency of an inhibitor of α 1 -proteinase (α 1 -antitrypsin), which usually inhibits the activity of proteinases (eg, leukocyte elastase, serine proteinase-3, cathepsin and matrix metalloproteinase). Insufficient inhibition of proteinases leads to an increased breakdown of proteins and, as a result, to a loss of elasticity of the lung tissue. Disruption of secretion and accumulation of defective proteins can cause liver damage. And finally, as a result of a lack of proteinase inhibitors, the development of pathology of other tissues, for example, kidney glomeruli and pancreatic cells, is possible. Smoking causes oxidation and therefore inhibition of agantitrypsin, which accelerates the development of emphysema even in the absence of a genetic predisposition.
In addition to the lack of inhibitors, the cause of the development of emphysema may be increased production of elastase (for example, the formation of serine elastase by granulocytes, metalloproteinases by alveolar macrophages and various proteinases by pathogenic microorganisms). Excessive content of elastases in chronic inflammation leads, in particular, to the destruction of the elastic fibers of the lungs.
Considering the changes that occur with pulmonary emphysema, it becomes obvious how significant the decrease in the elastic traction of the lung tissue is. For exhalation, elastic traction of the lungs creates positive pressure in the alveoli relative to the external environment. External compression (as a result of contraction of the respiratory muscles) causes positive pressure not only in the alveoli, but also in the bronchioles, which creates additional resistance to air flow. Therefore, the maximum expiratory flow rate (V max) depends on the relationship between elastic traction (T) and resistance (R L). Thus, as a result of a decrease in elastic traction, changes occur similar to those in obstructive pulmonary disease. Elastic traction increases with the volume of inhaled air, which ultimately leads to a displacement of the resting point towards inspiration (barrel chest). If the volume of inhaled air remains constant, the FRU and the residual volume (and sometimes dead space) increase. However, due to a decrease in expiratory volume, VC decreases. A shift in the resting point leads to a flattening of the diaphragm and, according to Laplace's law, requires increased muscle tension. With the destruction of the interalveolar septa, the diffusion area decreases; a decrease in the number of pulmonary capillaries leads to an increase in the functionally dead space and an increase in pressure in the pulmonary arteries and vascular resistance with the eventual development of cor pulmonale. Different resistance to air flow in individual bronchioles with centrilobular (non-widespread) emphysema causes disturbances in its distribution. The abnormal distribution results in hypoxemia, and diffuse cyanosis develops in patients with centrilobular emphysema associated with obstructive pulmonary disease. In contrast, with widespread emphysema, the skin acquires a pink tint, which is explained by the need for deeper breathing due to an increase in functional dead space. However, diffusion disturbances lead to hypoxemia only in the case of a significant decrease in diffusion capacity or an increase in the demand for O 2.
Pathological anatomical the lungs are pale, swollen, inelastic, retaining depressions from the ribs. The wall of the right ventricle of the heart, as well as the trabecular muscles, are sharply thickened, even without a pronounced increase in the cavity. The wall of the left ventricle is often thickened from concomitant hypertension.
Classification... According to the pathogenesis, primary (congenital, hereditary) and secondary emphysema of the lungs arising against the background of chronic lung diseases (more often chronic obstructive pulmonary disease) are distinguished; by prevalence - diffuse and localized emphysema of the lungs; by morphological features - proximal acinar, panacinar, distal, irregular (irregular, uneven) and bullous.
Symptoms and signs of pulmonary emphysema
The clinical picture is characterized by shortness of breath, cyanosis, cough, chest changes.
Shortness of breath - the most constant complaint of those suffering from emphysema - at first appears only during physical work, which becomes possible in smaller and smaller sizes, as well as with exacerbations of bronchitis and concomitant pneumonia, with asthmatic spasms of the bronchi. Later, shortness of breath does not leave the patient and in a position of complete rest, intensifying even after eating, with excitement, conversation. Since hypoxemia is already present in a resting state, it is clear that physical work worsens the blood composition even more and, pumping blood from the skeletal muscles into the vena cava, into the right heart, further increases the pressure in the pulmonary circulation, which also reflexively increases shortness of breath.
Cyanosis is a constant sign of pulmonary emphysema. In accordance with persistent hypoxemia at normal blood flow velocity and unchanged peripheral circulation, in emphysema, in contrast to the state of cardiac decompensation, cyanosis is not accompanied by a cold snap in distant parts of the body (hands remain warm).
The cough is of a peculiar character due to the weakness of the chest excursions, the weakness of the expiratory air stream, and therefore it is often especially painful and persistent. The causes of cough are varied: inflammatory bronchitis, asthmatic spasms of the bronchi, high pressure in the vessels of the small circle, which also causes cough in a neuroreflex way.
Often, patients have a characteristic appearance: a purple-cyanotic face with a pattern of dilated cutaneous veins, a shortened neck due to the expansion of the chest, as when inhaling, swollen cervical veins, especially during coughing fits, when the cyanosis of the face sharply increases. Characterized by interrupted speech due to lack of air, muscle tension during exhalation, and often a barrel-shaped chest with an increased anteroposterior size.
The most important clinical sign of emphysema is the almost complete absence of respiratory mobility of the chest, which often solves the diagnosis of pulmonary emphysema in the absence of a proper barrel chest. On the chest, the corolla of dilated small veins is visible along the line of attachment of the diaphragm and along the edge of the heart in front. Patients even with severe cyanosis usually maintain a low position of the upper body in bed (no orthopnea is observed), possibly due to the absence of any significant enlargement of the heart. The apical impulse is not defined, but under the xiphoid process on the left, it is possible to feel the enhanced impulse of the right ventricle. Percussion of the lung gives, instead of the normal one, of very varying intensity, the typical loud boxy, or cushion, sound caused by an excess of air in the alveoli, especially in the lower part of the lungs along the axillary line. Swollen lungs push the liver downward and cover the heart, making it impossible to determine its size by percussion (the lungs also push the apex of the heart away from the chest wall).
An excursion of the lower edge of the lungs along the anterior axillary line and an increase in the circumference of the chest during breathing, which are normally 6-8 cm, fall to 2-1 cm.Weakened, usually harsh breathing with prolonged exhalation, dry wheezing, wheezing and buzzing, often signs focal pneumonia with a greater sonority of moist rales and increased bronchophonia.
Heart sounds are muffled due to the crowding out of the heart by the lungs, which weakens the emphasis of the second pulmonary tone.
X-ray examination reveals horizontally running ribs with wide intercostal spaces, often ossification of costal cartilage, a flattened, slightly mobile diaphragm. The normal pulmonary pattern is poorly expressed due to the lack of blood vessels in the lungs. Often also find severity, an increase in bronchial lymph nodes. It should be emphasized that the lungs are anemic; expansion of the hilar shadow is possible due to an increase in lymph nodes (wheezing in the lungs of inflammatory origin).
The heart itself is often not dilated, possibly also due to the obstructed flow of blood to the left and right heart due to an increase in intrathoracic pressure, which limits the suction of blood in the heart; rather, a small heart is characteristic of patients with emphysema with bulging of the pulmonary artery as a result of increased pressure in the system of this artery.
The pressure in the pulmonary artery cannot be measured directly, although an attempt has recently been made by catheterizing the chambers of the right heart through the jugular or ulnar vein. The arterial pressure in the large circle is rather lowered, possibly due to the transfer of blood through the anastomoses and a decrease in blood flow to the left heart. The liver is usually omitted.
On the part of the blood: erythrocytosis up to 5,000,000-6,000,000 - a consequence of irritation of the bone marrow with hypoxemic blood composition; sometimes eosinophilia (usually in sputum).
The course, forms and complications of pulmonary emphysema
As a rule, the onset of pulmonary emphysema is gradual, chronic, usually long-term. During emphysema, three periods can be schematically distinguished.
The first period is the so-called bronchitis, when prolonged or repeated bronchitis, as well as focal bronchopneumonia, creates conditions for the development of emphysema. There may be signs of asthmatic bronchitis. The state of health of patients fluctuates sharply, significantly improving in summer, in a dry, warm climate.
The second period is severe emphysema with constant pulmonary insufficiency, cyanosis, shortness of breath, even worse with inflammatory complications; lasts for many years, up to 10 or more, which is rarely observed in other diseases with the same sharp cyanosis.
The third, relatively short period is cardiac, or, more precisely, pulmonary heart failure, when a patient with emphysema develops congestion - in a large circle, painful swelling of the liver, edema, stagnant urine, simultaneously with expansion of the heart, tachycardia, slowing blood flow, etc. d. (the so-called chronic cor pulmonale).
In terms of forms, in addition to the classic senile or presenile emphysema, which affects mainly men 45-60 years old, who do not have obvious broncho-pulmonary diseases in the anamnesis, emphysema of a young age should be isolated. With this form of emphysema, often of a more acute course, it occurs on the basis of obvious diseases of the bronchi and lungs, such as gas poisoning, gunshot wounds of the chest (with pneumothorax and hemoaspiration), kyphoscoliosis, bronchial asthma, etc., when during the course of the disease an important role is played, in addition to emphysema as such, and the underlying lung disease with its immediate consequences. In essence, and in the classical form, there are similar changes in the lungs in the form of peribronchitis and pneumosclerosis, but a slower, less clinically pronounced course.
Complications of emphysema include rarely observed pneumothorax and interstitial emphysema.
Diagnosis and differential diagnosis of pulmonary emphysema
Although a common and well-defined disease, pulmonary emphysema nevertheless often leads to misdiagnosis. It is not recognized where it is indisputably present and is found only at the autopsy; along with this, sometimes a diagnosis of emphysema is made, which is not justified by the entire clinical and anatomical picture. It is important not only to correctly recognize emphysema in general, but to correctly indicate the period of the disease, possible complications and concomitant (or primary) diseases, as this determines the prognosis, ability to work and methods of treatment.
Very often in a patient, in addition to pulmonary emphysema, heart decompensation or myocardial dystrophy is mistakenly recognized on the basis of shortness of breath, cyanosis, dull heart sounds, an emphasis on the pulmonary artery, sharp epigastric pulsation, wheezing in the lungs, protrusion of the liver from under the ribs in the presence of sensitivity in areas of the liver. Meanwhile, these false-hearted signs are characteristic of emphysema as such without heart failure. In these cases, wheezing in the lungs is bronchitic rather than stagnant, the liver is lowered rather than enlarged, and the tenderness is related to the abdominal muscles. The absence of orthopnea is also characteristic. A patient with emphysema is essentially a pulmonary patient, and so he remains for many years, heart failure (pulmonary heart failure) is only the end of the disease, accompanied by quite undeniable cardiac symptoms.
In the presence of enlargement of the heart, systolic murmur at the apex, enlargement of the liver, edema, etc., the diagnosis of decompensated mitral defect or decompensated atherosclerotic cardiosclerosis, etc., is often mistakenly made without taking into account the whole picture of the development of the disease, the presence of sharp cyanosis, erythrocytosis, non-increased arterial pressure, absence of arrhythmias, etc.
With emphysema with cyanosis in an elderly patient, atherosclerotic coronary sclerosis is recognized on the basis of pain in the heart region, although these pains can be pleural, muscular, and in rare cases, true angina pectoris is caused by hypoxemic blood composition (the so-called blue angina pectoris).
Due to a sharp change in percussion sound and a weakened, almost absent breathing in the lungs, pneumothorax is mistakenly recognized, although with emphysema, the lesion is bilateral and uniform.
The box sound in the sloping parts of the lungs does not always indicate pulmonary emphysema as a certain pathological condition.
Such changes can cause:
- The so-called functional emphysema of the lungs with left ventricular failure of the heart, when, due to hyperextension of stagnant blood of the vessels of the small circle, the chest becomes almost immobile during breathing, and the lungs are definitely expanded. Persistent organic changes - atrophy of the septa in the alveoli - are not detected, a decrease in blood mass during bloodletting, under the influence of mercusel, with an increase in the contractile force of the myocardium, stops this state. The presence of a gallop rhythm, angina pectoris, pallor of the face, relief under the influence of nitroglycerin also speaks against emphysema. This explains why, with acute nephritis or coronary sclerosis occurring with cardiac asthma, the doctor is often inclined to diagnose pulmonary emphysema (or bronchial asthma).
- The so-called senile emphysema, depending on age-related atrophy of the elastic tissue of the lungs in the absence of impaired bronchial patency and increased intraalveolar pressure, therefore, not accompanied by the most significant impairments of pulmonary ventilation and pulmonary circulation; besides, a slight decrease in external respiration may correspond to a decreased tissue metabolism, a decreased "internal" respiration in old age. Therefore, although percussion and the box sound of the sloping parts of the lungs is established and on the X-ray there is a large airiness of the corresponding pulmonary fields, there is no shortness of breath, cyanosis, wheezing, and in essence this condition does not deserve the name of a lung disease. In these forms, due to the relative atrophy of the lung tissue, overstretching of the lungs may occur, since the chest remains of normal volume or even enlarged due to calcification of the ribs. A similar state of atrophy of the lung tissue, in a certain sense of an adaptive nature, is found regardless of the age of patients and with other dystrophies - alimentary, wound, cancer, which also occur with a decrease in tissue metabolism.
- The so-called compensatory emphysema, limited to a part of the lung in the vicinity of the affected area or one lung if the other is affected.
Basically, the disease is explained by a change in the normal ratio of intrathoracic elastic forces, as discussed in the section on atelectasis, effusion pleurisy, and therefore only partially deserves the name "compensatory" emphysema.
- Interstitial, or interstitial, emphysema of the lungs is mentioned by us only for the sake of completeness and systematic presentation. It occurs after a lung injury as a result of rupture of the alveoli inside the lung with the release of air injected into the lungs into the intermediate tissue of the lungs, the mediastinum, into the subcutaneous tissue of the neck and chest. Interstitial emphysema is easily recognizable by a crispy swelling of the neck tissue and other characteristic features.
Forecast and working capacity. Emphysema of the lungs lasts for many years: infectious factors, working and living conditions are important for progression. In the first period, the patient can engage in habitual, even physical work, in the second period emphysema leads to significant, sometimes complete, and in the third period, always to complete disability.
Most often, patients die from severe heart failure or from acute pulmonary diseases, croupous or focal pneumonia, from general acute infectious diseases, in the postoperative period, etc.
Prevention and treatment of pulmonary emphysema
Prevention of true pulmonary emphysema consists in the prevention of inflammatory, traumatic lesions of the bronchial tree and interstitial vascular tissue of the lungs, in the fight against asthma, etc.
Treatment of advanced pulmonary emphysema is not very successful. In the early stages, various foci of irritation should be eliminated that disrupt the coordinated activity of the bronchopulmonary system by reflex, and measures should be taken to regulate the activity of the central nervous system. Based on these general provisions, it is necessary to persistently treat bronchitis and focal pneumonia; with inflammatory exacerbations, chemotherapeutic agents and antibiotics are indicated; with a spastic component, which is almost constantly present, - antispastic: ephedrine, belladonna. Climatic treatment is indicated, especially in the autumn and early spring months, as in bronchiectasis, in dry warm climatic stations.
Previously, they tried to enhance exhalation by compressing the chest with apparatus or to ensure exhalation into a rarefied space, but it is more expedient to strive to improve the patency of the bronchi (with antispasmodics, in extreme cases, by suction of viscous mucus through a bronchoscope) and treat interstitial pneumonia.
Attempts at surgical treatment were abandoned.
In advanced cases, rest, oxygen treatment; morphine is prohibited.
Emphysema of the lungs is a disease that occurs with the development of increased airiness of the lung tissue. Emphysema of the lungs is characterized by a long course and very often leads to disability. Women get sick half as often as men. In age groups over 60, pulmonary emphysema is more common than in young people.
Causes of pulmonary emphysema
All factors under the influence of which emphysema of the lungs can form can be divided into two large groups. The first group includes factors that violate the elasticity and strength of the lung tissue. These are, first of all, congenital defects of the body's enzyme system (changes in the properties of the surfactant, deficiency of a1-antitripsin). Also, a large role is played by gaseous toxic substances (compounds of cadmium, nitrogen, dust particles), which enter the lungs when breathing. Repeated viral infections of the respiratory tract reduce the protective properties of the lung cells and lead to their damage.
It is impossible not to mention smoking, which is one of the main causes of the development of emphysema. Tobacco smoke promotes the buildup of inflammatory cells in the lung tissue, which in turn release substances that destroy the septum between the lung cells. In smokers, emphysema of the lungs occurs much more often and is more severe than in non-smokers. The words of Elizabeth Gips, a famous writer and radio presenter, who died of respiratory failure on the background of long-term smoking, are impressive. She said: "If someone from those who still smokes could live in my body for a couple of minutes, he would never take a cigarette in his mouth."
Elizabeth Gips, writer and radio host who has studied alternative ancient cultures; died of respiratory failure due to long-term smoking
The second group includes factors that increase the pressure in the pulmonary alveoli. These are, first of all, previous lung diseases such as chronic obstructive bronchitis, bronchial asthma.
Emphysema, formed under the influence of the first group of factors, is called primary, the second group - secondary.
Symptoms of pulmonary emphysema
To understand the mechanism of development of emphysema and its symptoms, it is necessary to discuss the main structural features of the lung tissue. The main structural unit of the lung tissue is the acinus.
The acinus consists of alveoli - lung cells, the wall of which is closely adjacent to the blood capillaries. This is where the exchange of oxygen and carbon dioxide takes place. Between adjacent alveoli there is a surfactant - a special fatty film that prevents friction. Normally, the alveoli are elastic, expanding and collapsing in accordance with the phases of respiration. Under the influence of pathological factors in primary emphysema, the elasticity of the alveoli decreases, and in secondary emphysema, the pressure in the alveoli increases and the accumulation of excess air occurs. The wall between adjacent alveoli collapses, a single cavity is formed.
Diagram of the structure of the alveoli in pulmonary emphysema. The upper figure shows the alveoli in emphysema. Below are the normal alveoli.
Some authors describe cavities that are more than 10 cm in size. When cavities are formed, the lung tissue becomes more airy. Due to a decrease in the number of alveoli, the exchange of oxygen and carbon dioxide suffers, and respiratory failure occurs. The process of cavity formation is continuous, and ultimately affects all parts of the lungs.
The disease develops imperceptibly for the patient. All symptoms appear with significant damage to the lung tissue, so early diagnosis of emphysema is difficult. As a rule, shortness of breath begins to bother the patient after 50-60 years. At first, it appears during physical exertion, then it begins to bother and at rest. The appearance of the patient at the time of an attack of shortness of breath is characteristic. The skin of the face turns pink. The patient, as a rule, sits, leaning forward, often holding on to the back of the chair in front of him. Exhalation with emphysema is long, noisy, the patient folds his lips with a tube, trying to make breathing easier. When inhaling, patients do not experience difficulty, exhalation is very difficult. Because of the characteristic appearance during an attack of shortness of breath, patients with pulmonary emphysema are sometimes called "pink puffers."
"Pink puffer" - a typical appearance of the patient with an attack of shortness of breath.
Cough usually occurs some time after the onset of shortness of breath, which distinguishes pulmonary emphysema from bronchitis. The cough is not prolonged, the sputum is scanty, mucous, transparent.
Weight loss is a characteristic feature of pulmonary emphysema. This is due to fatigue of the respiratory muscles, which work at full strength to facilitate exhalation. A pronounced decrease in body weight is an unfavorable sign of the development of the disease.
In patients with emphysema, attention is drawn to the expanded, cylindrical shape, as if frozen on inspiration, the chest. Often it is figuratively called barrel-shaped.
The tops of the lungs bulge out in the supraclavicular areas, there is an expansion and retraction of the intercostal spaces.
Attention is drawn to the bluish color of the skin and mucous membranes, as well as the characteristic change in the fingers of the hands like drumsticks.
These external signs indicate prolonged oxygen starvation.
Diagnosis of pulmonary emphysema
In the diagnosis of pulmonary emphysema, the study of respiratory function has an important role. To assess the degree of narrowing of the bronchi, peak flowmetry is used. In a calm state, after a couple of breaths, an exhalation is made into a special recording device - peakfluometer.
The data obtained by peak fluometry allow the differentiation of pulmonary emphysema from bronchial asthma and bronchitis. Spirometry helps to determine the change in the respiratory volume of the lungs and to identify the degree of respiratory failure. The data is recorded at the moment of calm breathing, then the doctor asks to perform several forced inhalation and exhalation. Tests using bronchodilator drugs can also distinguish between different lung diseases and evaluate the effectiveness of treatment.
X-ray examination of the chest organs is of great importance for the diagnosis of pulmonary emphysema. At the same time, dilated cavities are revealed in various parts of the lungs. In addition, an increase in lung volume is determined, indirect evidence of which is the low position of the dome of the diaphragm and its flattening. Computed tomography can also diagnose cavities in the lungs, as well as their increased airiness.
Pulmonary emphysema treatment
All therapeutic measures for emphysema should be aimed at alleviating the manifestations and reducing the progression of respiratory failure, as well as treating the lung disease that led to the development of emphysema. Treatment is usually carried out on an outpatient basis, under the guidance of a pulmonologist or therapist. Hospitalization in a hospital is indicated when an infection is attached, a severe form of respiratory failure, as well as when surgical complications occur (pulmonary hemorrhage with a ruptured cavity, pneumothorax).
Diet and lifestyle correction for pulmonary emphysema
Patients with pulmonary emphysema are recommended a balanced diet with a sufficient content of vitamins and microelements. The diet should constantly contain raw fruits and vegetables, as well as juices and purees from them. In severe respiratory distress, consuming a lot of carbohydrates can lead to an even greater lack of oxygen. Therefore, in this case, a low-calorie diet with a calorie content of 600 kcal per day is recommended, and then, with positive dynamics, the calorie content of food expands to 800 kcal per day.
Quitting smoking, active and passive, is essential. One-time smoking cessation has the best effect compared to gradual cessation. At the present time, there is a large arsenal of medical products (chewing gums, plasters) that can help a patient in this difficult matter.
Medication for pulmonary emphysema
With an exacerbation of the inflammatory process, antibacterial drugs are prescribed. In case of bronchial asthma or bronchitis with attacks of difficulty in breathing, drugs that dilate the bronchi (theophylline, berodual, salbutamol) are recommended. To facilitate the excretion of sputum, mucolytics (ambrobene) are indicated.
Oxygen therapy for pulmonary emphysema
To improve gas exchange at the initial stage of the disease, oxygen therapy is successfully used. This method of treatment consists in inhaling air with a reduced amount of oxygen for 5 minutes, then the patient breathes air with a normal oxygen content for the same time. The session includes six such cycles. Treatment course: 1 session a day for 15-20 days. If it is impossible to apply the above technique, inhalation of humidified oxygen through a nasal catheter will help to alleviate the patient's condition.
Massage for pulmonary emphysema
The massage promotes the discharge of phlegm and the expansion of the bronchi. Classic, segmental and acupressure massage is used. It is believed that acupressure has the most pronounced bronchodilatory effect.
Physiotherapy exercises for pulmonary emphysema
With emphysema, the respiratory muscles are in constant tone, so they quickly get tired. To prevent muscle overstrain, exercise therapy has a good effect.
The following exercises apply:
Exercises with artificial creation of positive pressure on the exhale. The patient is asked to carry out a deep, long exhalation through a tube, one end of which is in a jar of water. The water barrier creates a lot of pressure when you exhale.
exercises for training diaphragmatic breathing. Starting position: standing, feet shoulder-width apart. The patient needs to take a deep breath and, while exhaling, stretch out his arms in front of him and lean forward. During exhalation, it is necessary to draw in the stomach. Starting position: lying on your back, hands on your stomach. On exhalation, hands press on the anterior abdominal wall.
exercises for training the rhythm of breathing.
1. After a deep breath, hold your breath for a short time, then exhale the air in small jerks through the lips folded into a tube. In this case, the cheeks should not puff up.
2. After a deep breath we hold our breath, then exhale with one sharp push through our open mouth. At the end of exhalation, the lips must be folded into a tube.
3. Take a deep breath, hold your breath. Stretch your arms forward, then clench your fingers into a fist. Bring your arms to your shoulders, slowly spread to the sides, and again return to your shoulders. Repeat this cycle 2-3 times, then exhale with force.
4. We count in the mind. Inhale for 12 seconds, hold the breath for 48 seconds, exhale for 24 seconds. Repeat this cycle 2-3 times.
Possible complications of pulmonary emphysema
Infectious complication. Development of pneumonia, lung abscesses is possible.
Respiratory failure. It is associated with a violation of the exchange of oxygen and carbon dioxide in the changed lungs.
Heart failure . In severe emphysema, the pressure in the pulmonary artery rises. The right ventricle and the right atrium are enlarged compensatory. Over time, changes affect all parts of the heart. The pumping function of the heart suffers sharply.
Surgical complications. When a cavity is ruptured next to a large bronchus, a large volume of air can enter this cavity. Formed pneumatorox. Damage to the wall between the two alveoli can lead to pulmonary hemorrhage.
Prognosis for pulmonary emphysema
A complete cure for pulmonary emphysema is impossible. A feature of the disease is its constant progression, even during treatment. With timely access to medical help and adherence to medical measures, the disease can be somewhat slowed down, the quality of life improved, and disability can be delayed. With the development of emphysema against the background of a congenital defect of the enzyme system, the prognosis is usually poor.
Prevention of pulmonary emphysema
As a preventive measure, it is recommended:
to give up smoking;
observance of the rules of personal hygiene when working with harmful gaseous substances.
timely treatment of lung diseases (bronchitis, bronchial asthma), which can lead to the development of emphysema.
Physician therapist E.V. Sirotkina
Emphysema of the lung- chronic lung disease, characterized by the expansion of small bronchioles (end branches of the bronchi) and destruction of the septa 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 pulmonary emphysema- shortness of breath, shortness of breath, cough with a small release of mucous sputum, signs of respiratory failure. Over time, the ribcage expands and takes on a characteristic barrel-shaped shape.
Reasons for the development of emphysema of the lung divided into two groups:
- Factors that disrupt the elasticity and strength of 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.
The risk of developing the disease some categories have higher than other people:
- Congenital forms of pulmonary emphysema associated with whey protein deficiency are more common in northern Europeans.
- 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. Secondhand smoke is also dangerous.
Lung anatomy
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-layer pleura. One of its layers grows together with the lung, and the other with the chest. There is a space between the sheets of the pleura - the pleural cavity, in which there is a certain amount of pleural fluid. This structure helps to stretch the lungs during inhalation.
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 lung has two. The lobes are divided into segments, and those, in turn, into secondary lobules. The latter consist of 10-15 acini.
The lung gate is located on the inner surface. This is the place where the bronchi, artery, veins enter the lung. Together they make up the root of the lung.
Lung functions:
- provide blood oxygen saturation 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 a hormone - angiotensin, which causes vasoconstriction
- bronchi, through which air enters the lungs;
- alveoli, in which gas exchange occurs;
- the 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 makes up the bronchial tree there. The right and left are bronchi of the 1st order, in the place of their branching 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 provide air conduction from the trachea to the alveoli and back.
The structure of the bronchi.
- Cartilaginous basis of the bronchi
- large bronchi outside the lung are composed of cartilaginous rings
- large bronchi inside the lung - cartilaginous connections appear between the cartilaginous half rings. Thus, the lattice structure of the bronchi is provided.
- 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.
- The muscular layer of the bronchi- smooth muscles are located circularly. They provide narrowing and expansion of the bronchial lumen. 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 by coughing.
- Lung glands
- unicellular mucus-secreting glands
- small lymph nodes associated with larger lymph nodes in the mediastinum and trachea.
- Cartilaginous basis of the bronchi
- Alveola - vesicle, in the lungs, braided by a network of blood capillaries. The lungs contain more than 700 million alveoli. This structure makes it possible to increase the surface in which gas exchange takes place. Atmospheric air enters the bubble through the bronchi. Oxygen is absorbed into the blood through the thinnest wall, and carbon dioxide is absorbed into the alveoli, which is excreted during exhalation.
The area around the bronchiole is called the acinus. It resembles a bunch of grapes and consists of the branches of the bronchiole, 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 gives off carbon dioxide. After that, it collects into the veins and enters the left atrium.
Causes of emphysema of the lungs
The causes of emphysema are usually divided into two groups.
- Violation of the elasticity and strength of lung tissue:
- Congenital α-1 antitrypsin deficiency... In people with this anomaly, proteolytic enzymes (whose function is to kill bacteria) destroy the walls of the alveoli. Whereas normally α-1 antitrypsin detoxifies these enzymes in a few tenths of a second after their release.
- Congenital defects in the structure of lung tissue... Due to the structural features, the bronchioles collapse, and the pressure in the alveoli rises.
- Inhalation of contaminated air: smog, tobacco smoke, coal dust, toxic substances. The most dangerous in this respect are cadmium, nitrogen and sulfur oxides emitted by thermal power plants and transport. Their smallest particles penetrate into the bronchioles and are deposited on their walls. They damage the ciliated epithelium and blood vessels that feed the alveoli and also activate the special cells of the alveolar macrophages.
They increase 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. Immunity 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 pass air into the alveoli, but do not release it in the opposite direction.
This leads to overfilling and overstretching of the alveolar sacs.
- Age changes associated with impaired blood circulation. In addition, older people are more sensitive to toxic substances in the air. With bronchitis and pneumonia, the lung tissue is less well restored.
- Increased pressure in the lungs.
- Chronic obstructive bronchitis. The patency of 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.
- Occupational hazards. Glassblowers, musicians-brass. A feature of these professions is an increase in air pressure in the lungs. Smooth muscles in the bronchi are gradually weakened, and blood circulation in their walls is impaired. 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 come out. An acute form of emphysema develops.
The mechanism of lung damage in emphysema- Stretching of the bronchioles and alveoli - their size doubles.
- Smooth muscles are stretched, and the walls of blood vessels become thinner. 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 takes place decreases. The body is deficient in oxygen.
- The enlarged areas compress 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 connected.
- 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 lung emphysema.By the nature of the flow:
- Sharp... It develops with an attack of bronchial asthma, a foreign object entering the bronchi, and severe physical exertion. It is accompanied by overstretching of the alveoli and swelling of the lung. It is a reversible condition but requires urgent medical attention.
- Chronic... It develops gradually. At an early stage, the changes are reversible. But without treatment, the disease progresses and can lead to disability.
Origin:- Primary emphysema... An independent disease that develops in connection with congenital characteristics of the body. It can even be diagnosed in babies. 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, and symptoms worsen 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 evenly affected. The alveoli are destroyed throughout the lung tissue. In severe cases, lung transplantation may be required.
- Focal form. Changes occur around tuberculous foci, scars, in places to which a blocked 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. There is no healthy tissue between them. The connective tissue in the lung does not grow. 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 parts of the acinus near the pleura. This form develops in tuberculosis and can lead to pneumothorax - rupture of the affected area of the lung.
- Okolubtsovaya- develops around scars and foci of fibrosis in the lungs. The symptoms of the disease are usually mild.
- Bullous(bubble) form. At the site 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. The bubbles can 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 the vacant space. The enlarged alveoli are surrounded by healthy capillaries, and there is no inflammation in the bronchi. 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 in boys. Its appearance is associated with obstruction of one of the bronchi.
Symptoms of lung emphysema
Diagnostics of the lung emphysema
Examination by a doctor
When symptoms of pulmonary emphysema appear, they turn to a therapist or pulmonologist.
Instrumental methods for the diagnosis of pulmonary emphysema
- X-ray- examination of the state of the lungs using X-rays, as a result of which an image of internal organs is obtained on a film (paper). A general view of the chest is done in a direct projection. This means that the patient faces the device during the exposure. A survey image allows you to identify pathological changes in the respiratory organs and the degree of their distribution. If the picture shows signs of the disease, 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
- suspected emphysema, chronic bronchitis, pneumonia, pulmonary tuberculosis
- breastfeeding period
- the lungs are enlarged, they compress the mediastinum and are on top of each other
- the affected areas of the lung appear overly transparent
- expansion of intercostal spaces with active muscle work
- the lower edge of the lungs is omitted
- low aperture
- decrease in the number of vessels
- bullae and foci of tissue airing
- Magnetic resonance imaging (MRI) of the lungs- 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 gives information about the state of the large bronchi of the vessels, lymphoid tissue, the presence of fluid and focal formations in the lungs. Allows you to obtain sections with a thickness of 10 mm and view 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.
Disadvantage - air interferes with 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 takes 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 changes cannot be detected on the X-ray
- tumors, cysts
- suspicion of tuberculosis, sarcoidosis, in which small focal changes are formed
- enlargement of intrathoracic lymph nodes
- anomalies in the development of the bronchi, lungs and their vessels
- the presence of a pacemaker
- metal implants, staples, splinters
- mental illness that does not allow you to lie still for a long time
- patient weight over 150 kg
- damage to alveolar capillaries at the site of destruction of lung tissue
- poor circulation in small pulmonary vessels
- signs of compression of healthy tissue by enlarged areas of the lung
- increased pleural fluid volume
- an increase in the size of the affected lungs
- cavities-bullae of different sizes
- low aperture
- Computed tomography (CT) of the lungs allow you to get a layer-by-layer image of the structure of the lungs. At the heart of CT is the absorption and reflection of X-rays by tissues. Based on the data obtained, the computer compiles a layer-by-layer image with a thickness of 1mm-1cm. The study is informative in the early stages of the disease. 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 the patient lying motionless. 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 layer-by-layer image.
Flaw- significant radiation exposure.
Indications:
- in the presence of symptoms, the changes are not detected on an X-ray picture 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
- resolving the issue of the operation
- contrast agent allergy
- extremely serious condition of the patient
- severe diabetes mellitus
- renal failure
- pregnancy
- patient weight that exceeds 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 that enter the lung
- enlarged cells are visible - areas of fusion of the alveoli
- reveals the size and location of the bulls
Lung scintigraphy - 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 sensor rotates.
Indications:
- early diagnosis of vascular changes in emphysema
- monitoring the effectiveness of treatment
- assessment of the condition of the lungs before surgery
- suspected lung cancer
- pregnancy
- compression of lung tissue
- violation of 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 blocks nasal breathing. The specialist tells you which breath tests need to be performed. And the electronic device converts the 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 lung capacity
- decrease in maximum ventilation
- increased airway resistance on exhalation
- decrease in speed indicators
- decreased distensibility of lung tissue
Peak flow measurement - measurement of the maximum expiratory flow rate to determine the obstruction of the bronchi.Determined using a device - peak flow meter. The patient needs to tightly grasp the mouthpiece with his lips and make the fastest and strongest exhalation through the mouth. The procedure is repeated 3 times with an interval of 1-2 minutes.
It is advisable to perform peak flow measurements in the morning and in the evening at the same time before taking the medication.
Disadvantage - the study cannot confirm the diagnosis of pulmonary emphysema. The expiratory rate decreases not only with emphysema, but also with bronchial asthma, pre-asthma, chronic obstructive pulmonary disease.
Indications:
- any diseases accompanied by bronchial obstruction
- evaluation of treatment results
Symptoms of emphysema:
- decrease in expiratory flow rate by 20%
- Determination of blood gas composition - a study of arterial blood, during which the blood pressure of oxygen and carbon dioxide and their percentage, acid-base balance of blood are determined. The results show how efficiently the blood in the lungs is cleared of carbon dioxide and oxygenated. 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
- breathing disorders in asthma, chronic obstructive pulmonary disease, emphysema
- the 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 the arterial blood over 50 mm Hg. st
- General blood analysis - a study that includes counting blood cells and studying their characteristics. For analysis, take blood from a finger or from a vein.
Indications- any diseases.
Contraindications does not exist.
Deviations with emphysema:
- increased number of red blood cells over 5 10 12 / l
- increased hemoglobin level over 175 g / l
- increased hematocrit over 47%
- reduced erythrocyte sedimentation rate 0 mm / hour
- increased blood viscosity: in men over 5 cps in women over 5.5 cps
Emphysema treatment
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 smoking cessation
- exercise to improve ventilation
- taking medications that 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 | The mechanism of therapeutic action | Mode of application |
| A1-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 body weight. Once a 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. | It is taken orally 200-300 mg 2 times a day. |
| Lazolvan | Thinns mucus. Improves its excretion from the bronchi. Reduces cough | Used internally or by inhalation. Inside during meals, 30 mg 2-3 times a day. In the form of inhalations with 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. It is taken in courses of 2-4 weeks. |
| Bronchodilator (bronchodilator) drugs 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. In the future, the dose is increased - 1 tablet (0.3 g) 2 times a day after 12 hours. It is taken after meals. The course is 2-3 months. |
| Atrovent | Blocks acetylcholine receptors in the muscles of the bronchi and prevents their spasm. Improves indicators of 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. | |
| Theophylline | Sustained-release theophylline | It has a bronchodilator effect, a decrease in systemic pulmonary hypertension. Strengthens 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 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. |
Treatments for emphysema
- Transcutaneous electrical stimulation diaphragm and intercostal muscles. Electrical stimulation with impulse 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. Thus, it is possible to avoid fatigue of the respiratory muscles, followed by respiratory failure. 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 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. Exhale slowly through the cocktail straw into a glass filled with water. Repeat 15-20 times.
- Diaphragmatic breathing. At the expense of 1-2-3, take a strong deep breath, drawing in your stomach. At the count of 4, exhale - inflating the stomach. Then tighten the abdominal muscles and cough dullly. This exercise promotes the discharge of phlegm.
- Lying push-up. Lying on your back, bend your legs and clasp your knees with your hands. On inhalation, draw full lungs of air. As you exhale, stick out your stomach (diaphragmatic exhalation). Straighten your legs. Strain your abs and cough.
When is emphysema surgery needed?
Surgical treatment for 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 to surgery for emphysema:
- disabling shortness of breath
- bullae occupying more than 1/3 of the chest
- complications of emphysema - hemoptysis, cancer, infection, pneumothorax
- multiple bulls
- permanent hospitalizations
- diagnosis of "severe mild emphysema"
- inflammatory process - bronchitis, pneumonia
- asthma
- emaciation
- severe chest deformity
- age over 70
Types of operations for lung emphysema
- Lung transplant and its variants: transplantation of lungs together with heart transplantation of a lung lobe. Transplantation is performed with diffuse volumetric 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 there may be problems with organ rejection. Therefore, such operations are resorted to only as a last resort.
- Decreased lung volume. The surgeon removes the most damaged areas, approximately 20-25% of the lung. At the same time, the robot improves the rest of the lung and respiratory muscles. 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 cuts are made between the ribs. A mini-video camera is inserted into one, and surgical instruments are introduced 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 when the affected area is located near the large bronchi.
Opening the chest. The doctor removes the affected lobe and stitches it to seal the lung. Then he puts a suture on the chest.
Do I need hospitalization for the treatment of emphysema?
In most cases, people with emphysema are treated at home. It is enough to take medications according to the scheme, adhere to a diet and follow the doctor's recommendations.Indications for hospitalization:
- a sharp increase in symptoms (shortness of breath at rest, severe weakness)
- the appearance of new signs of the disease (cyanosis, hemoptysis)
- ineffectiveness of the prescribed treatment (symptoms do not decrease, peak flowmetry indicators worsen)
- severe concomitant diseases
- newly developed arrhythmias
- difficulties in establishing a diagnosis;
Nutrition for emphysema (diet).
Nutritional therapy for lung emphysema is aimed at combating intoxication, strengthening immunity and replenishing the patient's large energy costs. Diet # 11 and # 15 is recommended. Basic principles of the emphysema diet
- Increase in calories up to 3500 kcal. Meals 4-6 times a day in small portions.
- Protein 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 sorts and seafood, eggs, dairy products. Meat in any culinary treatment, excluding excessive frying. All complications of lung emphysema are life-threatening. Therefore, if any new symptoms appear, urgent medical attention should be sought.
- Pneumothorax... Rupture of the pleura surrounding the lung. In this case, the air enters the pleural cavity. The lung collapses and becomes unable to expand. Around him in the pleural cavity accumulates fluid that needs to be removed. Severe chest pain appears, aggravated by 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 makes the lungs more susceptible 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 is overstretched and worn out. Heart failure is the leading cause of death in people with emphysema. Therefore, at the first signs of its development (swelling of the neck veins, pain in the heart and liver, edema), it is necessary to call an ambulance.
The prognosis of lung emphysema is favorable under a number of conditions:- complete smoking cessation
- prevention of frequent infections
- clean air, no smog
- good nutrition
- good sensitivity to drug treatment with bronchodilators.
Doctors call 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 violation of the gas exchange process and the development of respiratory failure.
To date, the incidence of this disease has increased significantly, and if earlier it was found mainly among people of retirement age, today people over the age of 30 suffer from it (men get emphysema twice as often). Moreover, the disease (in combination with BA and) belongs to the group of chronic lung diseases that have a progressive course, often cause temporary disability of patients or lead to their early disability. At the same time, such a disease as pulmonary emphysema is characterized by the fact that it can be accompanied by a lethal outcome, so everyone should know its symptoms and the basic principles of treatment.
Etiology, pathogenesis and types of the 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 a final pathological process that occurs against the background of severe morphological lesions of the bronchopulmonary system, which appear after such diseases as:
- silicosis;
- obstructive bronchitis;
- bronchiectasis;
- anthracosis.
In addition, pulmonary emphysema can be contracted as a result of long-term smoking or inhalation of certain toxic compounds of cadmium, nitrogen or dust particles that are in the air (for this reason, this disease is often found in construction workers).
The mechanism of development of the disease
Under normal conditions, gas exchange in the human body takes place in the alveoli - these are small “sacs” permeated with a large number of blood vessels, located at the end of the bronchi. During inhalation, the alveoli are filled with oxygen and inflate, and when exhaled, they contract. However, with emphysema of the lungs, certain disorders 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 disruption of their functioning. Over time, pulmonary emphysema progresses, which is manifested by the development of respiratory failure, so you need to start treating it as early as possible.
Disease classification
Depending on the reasons that lead to the development of a 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 a loss of elasticity of the lung tissue, morphological changes in the respiratory part of the lungs and an increase in 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 the absence) of another, as a result of which a healthy lung increases in volume, but only in order to ensure normal gas exchange in the human body (vicar emphysema of the lungs occurs only in within one lung and is not considered a pathological process, the prognosis is favorable).
There is also bullous emphysema of the lungs, which differs in that it proceeds imperceptibly, is often detected already at the stage of pneumothorax (accumulation of air in the pleural cavity) and requires immediate surgical intervention, the prognosis is poor (often leads to the death of the patient).
The clinical picture of the disease
Speaking about the main symptoms of pulmonary emphysema, doctors first of all mention:
- shortness of breath;
- visual increase (expansion) of the chest against the background of a decrease in its excursion during breathing (emphysema can be determined from the photo, which shows that the chest is, as it were, in the phase of deep inspiration);
- cyanosis (blue tint) of the tongue, nails and lips, occurs against the background of oxygen starvation of tissues;
- expansion of the intercostal spaces;
- smoothing of the supraclavicular areas.
At the very beginning, pulmonary emphysema is manifested by shortness of breath, which initially occurs during sports (mainly in winter) and is characterized by inconstancy, and then disturbs a person with the slightest physical effort. The characteristic signs of the disease include the fact that patients take short breaths with closed lips and puffed out cheeks, and you should also pay attention to the fact that the muscles of the neck are involved during inhalation (this should not be the case in a normal state). Also, emphysema of the lungs is accompanied by cough, chest pain and weight loss (the latter is explained by the fact that patients spend too much energy on maintaining the normal functioning of the respiratory muscles).
Patients often take a forced position of the body on the stomach (head down), because this position brings them relief, but this is in the early stages of the disease. As emphysema of the lungs develops, changes in the chest wall make it difficult for patients to be in a horizontal position, as a result of which they even sleep 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 necessarily be dealt with exclusively by a pulmonologist, who makes the initial diagnosis based on the data of the patient's examination and auscultation of pulmonary respiration using a phonendoscope. These are the main diagnostic methods, but they do not allow compiling a complete clinical picture of the disease, therefore, as additional research methods, the following is carried out:
- x-ray of the lungs (shows the density of the lung tissue);
- computed tomography (considered one of the most accurate methods for diagnosing pulmonary emphysema);
- spirometry (examination of respiratory function, in order to identify the degree of impairment of the lungs).
How to treat?
The main methods of treating pulmonary emphysema include:
- quitting smoking (this is a very important issue that doctors pay increased attention to, because if the patient does not quit smoking, then it will be impossible to cure pulmonary emphysema even with the most effective drugs);
- oxygen therapy (designed to saturate the patient's body with oxygen, since the lungs cannot cope with this function);
- gymnastics (breathing exercises "strengthens" the work of the diaphragm and helps to get rid of shortness of breath, which is the main symptom of pulmonary emphysema);
- conservative treatment of concomitant diseases (bronchial asthma, bronchitis, and so on) that cause emphysema, the symptoms of which are determined by the doctor; when an infection is added to the main treatment of pulmonary emphysema, antibiotic therapy is added.
Surgical treatment of pulmonary emphysema is indicated only if the disease proceeds in a bullous form, and it boils down to the removal of bullae - thin-walled blisters filled with air that can be localized in any part of the lung (it is almost impossible to see them in the photo). The operation is performed using the classical and endoscopic method. The first method involves surgical opening of 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 in pulmonary emphysema is more expensive, but such an operation has a shorter rehabilitation period.
The main number of conservative methods of treating this disease is characterized by low efficiency, because, unlike bronchitis, pulmonary emphysema causes irreversible structural changes in the lung tissue. The prognosis depends on the timeliness of the treatment started, adherence to the doctor's recommendations and the correctly selected method of drug therapy for both the main and concomitant diseases.
In any case, the treatment of emphysema of the lungs should be dealt with exclusively by a doctor. The disease is considered chronic and the patient has to take medications throughout his life that support the basic functions of the respiratory system. The life expectancy of people with pulmonary emphysema depends on the degree of damage to the lung tissue, the patient's age and the individual characteristics of his body.
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Diseases with similar symptoms:
Pulmonary insufficiency is a condition characterized by the inability of the pulmonary system to maintain a normal blood gas composition, or it is stabilized due to a strong 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 is constantly increasing. All this becomes the cause of oxygen starvation of organs.
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