Emphysema of the lungs – what is it, symptoms, schemetreatment, prognosis

According to who, from emphysema (emphysao – “inflate”) –
pathological increase in lung volume, up to 4%
population, mostly older men. Distinguish
acute and chronic pathology, as well as vicarious (focal,
local) and diffuse emphysema. The disease proceeds with violations
pulmonary ventilation and blood circulation in the respiratory system. Will consider
more about why emphysema appears, what it is and how
treat it.

What is pulmonary emphysema?

эмфизема лёгких

Emphysema of the lungs (from the Greek. Emphysema – bloating) – pathological
change in lung tissue, characterized by its increased
lightness, due to the expansion of the alveoli and destruction
alveolar walls.

Pulmonary emphysema is a pathological condition
often developing with a variety of bronchopulmonary processes and
extremely important in pulmonology. Development risk
diseases in some categories are higher than in other people:

  • Congenital forms of emphysema associated with deficiency
    whey protein, more commonly detected in residents of the North
    Of Europe.
  • Men get sick more often. Emphysema shows up at 60% in necropsy.
    men and 30% women.
  • In smokers, the risk of developing emphysema is 15 times higher. Passive
    smoking is also dangerous.

Without treatment, changes in the lungs with emphysema can lead to
disability and disability.

Causes leading to the development of emphysema

The likelihood of developing emphysema is increased by the presence of
following factors:

  • congenital α-1 antitrypsin deficiency leading to
    the destruction of proteolytic enzymes of the alveolar tissue
    lungs;
  • inhalation of tobacco smoke, toxic substances and pollutants;
  • нарушениях микроциркуляции в тканях lungs;
  • bronchial asthma and chronic obstructive diseases
    lungs;
  • inflammatory processes in the respiratory bronchi and
    alveoli;
  • features of professional activities related to
    constant increase in air pressure in the bronchi and alveolar
    tissue.

Under the influence of these factors damage occurs.
elastic tissue of the lung, reducing and losing its ability to
airflow and collapse.

Emphysema can be regarded as professionally determined
pathology. It is often diagnosed in persons breathing in various
aerosols. In the role of the etiological factor may be
pulmonectomy (removal of one lung) or injury. In children
the reason may lie in the frequent inflammatory diseases of the pulmonary
tissue (pneumonia).

The mechanism of lung damage in emphysema:

  1. Stretching the bronchioles and alveoli – their size increases
    twice.
  2. Smooth muscles stretch, and the walls of blood vessels thin.
    The capillaries become empty and the food in the acini is disturbed.
  3. Elastic fibers degenerate. At the same time walls collapse
    between the alveoli and cavities are formed.
  4. The area in which gas exchange occurs between
    air and blood. The body is deficient in oxygen.
  5. Extended areas squeeze healthy lung tissue, what else
    больше нарушает вентиляционную функцию lungs. Shortness of breath appears and
    other symptoms of emphysema.
  6. To compensate and improve the respiratory function of the lungs actively
    connects respiratory muscles.
  7. Increases the load on the pulmonary circulation – vessels
    lungs overflow with blood. This causes disruption to the work of the right.
    parts of the heart.

Types of disease

ХОБЛ и эмфизема

The following types of emphysema are distinguished:

  1. Alveolar – caused by an increase in the volume of the alveoli;
  2. Interstitial – developed by penetration
    air particles in the interstitial connective tissue –
    interstitium;
  3. Idiopathic or primary emphysema occurs without
    previous respiratory diseases;
  4. Obstructive or secondary emphysema is a complication.
    chronic obstructive bronchitis.

By the nature of the flow:

  • Spicy It can cause considerable physical exertion.
    bronchial asthma attack, foreign object
    bronchial network. Lung distention and overdistension occur.
    alveoli. The condition of acute emphysema is reversible, but requires urgent
    treatment.
  • Chronic emphysema. Changes in the lungs occur gradually,
    на ранней стадии можно добиться полного изtreatment. No treatment
    leads to disability.

By anatomical features, emit:

  • Panacinar (vesicular, hypertrophic) form.
    Diagnosed in patients with severe emphysema. Inflammation
    absent, there is respiratory failure.
  • Centrilobular form. Due to the expansion of the lumen of the bronchi
    and the alveoli develops an inflammatory process, in large numbers
    mucus is secreted.
  • Periacinar (parasepital, distal, perilobular)
    the form. Developed with tuberculosis. May end
    complication – rupture of the affected area of ​​the lung
    (pneumothorax).
  • Околорубцовая the form. Characterized by minor
    symptoms manifested near fibrous foci and scars in
    lungs.
  • Инстерциональная (подкожная) the form. Due to rupture of alveoli under
    skin bubbles are formed by air.
  • Bullous (пузырчатая) the form. Near the pleura or across
    parenchyma bullae (bubbles) with a diameter of 0.5-20 cm are formed. They
    возникают на месте поврежденных alveoli. May burst
    инфицироваться, подвергают сдавливанию окружающие tissue. Bullous
    emphysema usually develops as a result of loss of elasticity
    tissues. The treatment of emphysema begins with the elimination of the causes,
    provoking the disease.

Симптомы эмфиземы легких

Symptoms of emphysema are numerous. Most of them are not
are specific and can be observed in another pathology of the respiratory
system. The subjective signs of emphysema include:

  • unproductive cough;
  • expiratory dyspnea;
  • the appearance of dry rales;
  • feeling short of breath;
  • weight loss
  • у человека возникает сильный и внезапный болевой синдром в
    one of the halves of the chest or behind the sternum;
  • tachycardia is observed in violation of the cardiac rhythm
    muscles with a lack of air ..

Patients with emphysema mainly complain of shortness of breath and
cough. Dyspnea, gradually increasing, reflects the degree of respiratory
failure. Initially, it happens only with physical
tension, then appears while walking, especially during cold,
wet weather, and dramatically worse after coughing – sick
can not “catch my breath”. Dyspnea with emphysema of the lungs is not constant,
changeable (“day to day is not necessary”) – today is stronger, tomorrow
weaker.

A characteristic sign of emphysema is a decrease in mass.
body. This is due to the fatigue of the respiratory muscles that work in
full force to relieve exhalation. Выраженное weight loss
is an unfavorable sign of the development of the disease.

Noteworthy is the bluish color of the skin and mucous membranes.
shells, as well as the characteristic change of fingers type
drum sticks.

In people with chronic long-lasting emphysema
develop external signs of the disease:

  • short neck;
  • widened in anteroposterior size (barrel-shaped) chest
    cell;
  • supraclavicular fossa bulge;
  • during inhalation, intercostal spaces retracted due to stress
    respiratory muscles;
  • the stomach is slightly sagging as a result of the omission of the diaphragm.

Complications

Lack of oxygen in the blood and unproductive increase in volume
lungs affect the entire body, but above all – the heart and
nervous system.

  1. Increased heart load is also a reaction.
    compensation – the desire of the body to pump more blood due to
    гипоксии tissues.
  2. The occurrence of arrhythmias, acquired heart defects,
    ischemic disease – a symptom complex, known under the general
    name “cardiopulmonary failure.”
  3. In the extreme stages of the disease, lack of oxygen causes
    damage to nerve cells in the brain that manifests
    reduced intelligence, sleep disturbance, mental
    pathologies.

Diagnosis of the disease

At the first symptoms or suspicion of patient lung emphysema
examines pulmonologist or therapist. Determine the presence of emphysema
in the early stages is difficult. Patients often turn to
The doctor is already running.

Diagnosis includes:

  • blood test for the diagnosis of emphysema
  • a detailed survey of the patient;
  • examination of the skin and chest;
  • перкуссию и аускультацию lungs;
  • defining the boundaries of the heart;
  • spirometry;
  • general radiography;
  • CT scan or MRI;
  • assessment of blood gas composition.

X-ray examination of the chest has
большое значение для диагностики эмфиземы lungs. With this in
various parts of the lungs are revealed dilated cavity. Besides
того,  определяется увеличение объема легких, косвенным
evidence of this is the low location of the dome of the diaphragm and
its flattening. Computed tomography also allows
diagnose cavities in the lungs, as well as their increased
airiness.

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How to treat pulmonary emphysema

Как лечить эмфизему лёгких

No specific treatment for emphysema
carried out, and conducted are not significantly different from those that
recommended in the group of patients with chronic obstructive
respiratory diseases.

In the treatment program of patients with emphysema in the first place
there should be general activities that improve the quality of life
the sick.

Treatment of emphysema has the following objectives:

  • elimination of the main symptoms of the disease;
  • improving heart function;
  • improvement in bronchial patency;
  • ensuring normal blood saturation with oxygen.

To relieve acute conditions use medication.
therapy:

  1. Euphyllinum for relieving an attack of shortness of breath. Drug is injected
    intravenously and relieves shortness of breath for several minutes.
  2. Prednisone as a strong anti-inflammatory
    facilities.
  3. For mild to moderate respiratory failure
    oxygen inhalation. However, it is necessary to clearly select
    oxygen concentration because it can both benefit
    and harm.

All patients with emphysema are shown physical programs,
especially chest massage, breathing exercises and training
patient kinesitherapy.

Do you need hospitalization to treat emphysema? In most
cases of emphysema patients are treated at home. Enough
take medication according to the regimen and perform
doctor’s recommendations.

Indications for hospitalization:

  • sharp increase in symptoms (dyspnea at rest, severe
    weakness)
  • the emergence of new signs of the disease (cyanosis, hemoptysis)
  • the ineffectiveness of the prescribed treatment (the symptoms do not diminish,
    indicators peak flowmetry worsen)
  • severe concomitant diseases
  • first developed arrhythmias difficulty setting
    diagnosis.

Emphysema has a favorable prognosis, subject to
the following conditions:

  • Prevention of lung infections;
  • Refusal of bad habits (smoking);
  • Providing a balanced diet;
  • Living in a clean air environment;
  • Sensitivity to drugs from the group of bronchodilators
    drugs.

Breathing exercises

When treating emphysema, it is recommended to regularly conduct various
breathing exercises to improve the exchange of oxygen in the cavity
lungs. The patient should be for 10 – 15 minutes inhale deeply
air, then try to delay as long as possible
exhale it with a gradual exhalation. This procedure
recommended daily, at least 3 – 4 p. in a day,
in small sessions.

Massage with emphysema

Massage promotes sputum discharge and expansion of the bronchi.
Used classic, segmental and acupressure.
Acupressure is considered to be the most pronounced.
bronchodilator effect. The task of the massage:

  • prevent further development of the process;
  • normalize respiratory function;
  • reduce (eliminate) tissue hypoxia, cough;
  • improve local ventilation, metabolism and sleep
    the patient.

Exercise therapy

При  эмфиземе дыхательные мышцы находятся в постоянном
tonus, so quickly tired. To prevent overvoltage
muscles have a good effect physiotherapy.

Oxygen inhalation

A long procedure (up to 18 hours in a row) breathing through
oxygen mask. In severe cases, oxygen-helium is used.
mixes.

Surgical treatment of emphysema

Surgical treatment of emphysema is not often required. It
necessary in the case when the lesions are significant and
drug treatment does not reduce the symptoms of the disease. Indications
for surgery:

  • Multiple bulls (more than a third of the chest area);
  • Severe dyspnea;
  • Complications of the disease: pneumothorax, oncological process,
    bloody sputum, the accession of infection.
  • Frequent hospitalization;
  • Transition of the disease into a severe form.

Contraindication to the operation can be strong
exhaustion, old age, chest deformity, asthma,
pneumonia, severe bronchitis.

Nutrition

Compliance with the rational use of food in the treatment of emphysema
plays quite an important role. Eating is recommended as you can
more fresh fruits and vegetables that contain a large amount
beneficial for the body of vitamins and trace elements. To the sick
it is necessary to adhere to the use of low-calorie foods to
do not provoke a significant load on the functioning of organs
respiratory system.

Daily daily calories should not exceed more than 800 –
1000 kcal.

With the daily diet should be excluded fried and fatty
foods that negatively affect the functioning of internal organs and
systems. It is recommended to increase the amount of fluid consumed to
1-1.5 liters in a day.

In any case, you can not treat the disease yourself. If you
if you suspect emphysema in your relative or in your relative, then
should immediately consult a specialist for timely
diagnosis and initiation of treatment.

Life forecast for emphysema

Full cure for emphysema is impossible. Feature
the disease is its constant progression, even in the background
treatment. With timely treatment for medical care and
observance of therapeutic interventions disease succeeds several
slow down, improve the quality of life, and also delay
disability. With the development of emphysema on the background of a congenital defect
enzyme system prognosis is usually unfavorable.

Even if the patient is made the most unfavorable prognosis because
the severity of the disease, he will still be able to live at least 12 months from
момента постановки diagnosis.

For the duration of the patient after
The diagnosis of the disease is greatly influenced by the following
factors:

  1. Общее состояние организма the patient.
  2. The emergence and development of such systemic ailments as bronchial
    asthma, chronic bronchitis, tuberculosis.
  3. A big role is played by how the patient lives. He leads active
    mode of existence or he has low mobility. He abides
    nutritional system or eat food
    unsystematic.
  4. An important role is given to the patient’s age: young people live
    after a diagnosis is longer than older people with
    the same severity of the disease.
  5. If the disease has genetic roots, then the prognosis
    longevity with emphysema is determined by
    heredity.

In spite of the fact that irreversible
processes, patient’s quality of life can be improved constantly
using inhalation drugs.

Prevention

  1. Important preventive value have anti-tobacco programs
    aimed at preventing the smoking of children and adolescents, as well as
    to quit smoking for people of any age.
  2. It is also necessary to treat lung diseases in time so that they do not
    passed into a chronic form.
  3. Observation by the pulmonologist of patients with chronic
    diseases of the respiratory system, vaccines among the population and
    etc.

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