Emphysema of the lung: symptoms and treatment
Emphysema of the lungs is a nonspecific pulmonary pathology, accompanied by destructive alveolar dilatation and changes in the alveolar walls themselves.Initially, against the background of such common diseases as severe pneumonia, oncology and tuberculosis of the respiratory system, emphysema was considered as a concomitant disease.In itself, it was rare.
However, in recent years the percentage of detection of emphysema, as an independent disease, has been steadily increasing.Moreover, the disease often leads to respiratory failure, disability and early disability, so the relevance of the problems of diagnosis, treatment and prevention of emphysema today is quite acute.Especially often the disease occurs in the elderly.Table of contents:
Causes of emphysema
The main causes leading to pulmonary emphysema include:
- various malformations of the respiratory system;Deformity of the chest of various etiologies
- circulatory disorders due to various diseases;
- violation of lymphatic drainage;
- toxic effect of air components( exhaust gases);
- toxic effect of tobacco smoke components;
- trauma and surgery on the chest;
- pathology of respiratory organs( chronic inflammatory pathologies of bronchi and lungs, bronchial asthma, pneumosclerosis);
- congenital pathology of enzyme systems - deficiency of antitrypsin, inadequate synthesis of elastane, impaired synthesis of surfactant;
- pathological professional processes - getting into the lungs of dust asbestos, silicon, manganese, the development of light glass blowers.
Structural changes in the lungs that occur with emphysema
Note: , against a background of various causes, increases the air pressure inside the terminal sections of the bronchi and alveoli.If, under normal conditions, this does not affect the lungs and they are quickly restored, then, in the presence of certain factors provoking a loss of elasticity of the lung tissue, excessive pressure leads to permanent changes.
In the inelastic alveoli, air remains.He does not participate in the act of breathing and contributes to an even greater hyperextension of the lung tissue.On the one hand, this limits the depth of inspiration, since in fact "the lungs have already inhaled the air".On the other hand, due to the accumulation of carbon dioxide, the lungs include compensatory protection - shortness of breath.And this leads to an even greater stretching of the lungs and aggravation of the severity of manifestations of the disease.In an effort to prevent overgrowth of the alveoli, the body begins to produce more connective tissue.This process, unfortunately, leads to a narrowing of the lumen of the bronchi and makes it difficult to inflow and outflow of air.At the stage of development of connective tissue, emphysema loses its connection with external causes, begins to progress independently.
Types and types of pulmonary emphysema
According to the current classification, the following types of disease are distinguished:
- Diffuse - air spaces of lung tissue are distributed throughout the tissue of both lungs.This form was originally considered idiopathic, proceeds with early disability and the most severe clinical manifestations.This form is most often associated with hereditary causes and deficiency of certain enzyme systems.
- Local - with its normal sections of lung tissue combined with emphysematous bloated, and the more tissues are present, overgrown with air, the more pronounced clinical manifestations of the disease.
- Bullous - there is a presence in the lung tissue of swollen areas larger than 10 mm.These areas are called bullae.
To all, experts distinguish the following types of emphysema:
- Primary diffuse emphysema of the lungs is considered an independent disease with a complex etiology.As provoking reasons, internal factors, such as enzyme deficiency-alpha-antitrypsin, and external ones: injuries, diseases, toxic effects of harmful substances in the air, smoking are considered.
- Concomitant emphysema - based on the name, the disease is not self-contained and accompanies a number of lung diseases.
Important! By the nature of the flow, emphysema refers to continuously flowing, progressive diseases.The severity of clinical manifestations and the degree of progression of emphysema depend not only on the form of the disease, but also on the therapeutic tactics for the patient.
Symptoms of emphysema
At the initial stages of development of emphysema, its clinical symptoms are masked by manifestations of the underlying disease.
At the stages when the emphysema clinic begins to prevail, the following symptoms of can be highlighted.
- Dyspnea, significantly worse with exercise.Initially, it appears with a high degree of physical activity, in the future - with normal activity, at the most remote stages, with extreme severity of the disease - and at rest.
- Cyanosis of the skin - as a local( nasolabial triangle, fingertips), and general.Usually it is expressed in terms of severity and depends on physical activity or psycho-emotional state.
- Forced position - for patients with pulmonary emphysema, the most convenient position that facilitates well-being is a sitting position with a forward torso bent and resting on the hands.This fixes the shoulder girdle and allows the musculature of the upper humeral girdle to be included in the act of breathing.In neglected cases, with extremely pronounced emphysematous manifestations, the patients even sleep in the sitting position.In some patients in the initial stages of the disease, relief is possible if you lie on your stomach and lower your head and shoulders.
- Characteristic type of breathing - for the disease characteristic is a short "grabbing", "fishy" breath and a considerably elongated, hard exhalation, which is often performed with closed teeth with swelling of the cheeks "puffing out".
- Barrel chest - due to the overall increase in lung volume, the chest looks like a human breast at the height of maximum inspiration.At the same time, the total volume of movements( excursion) of the chest on inspiration and outlet is significantly reduced.
- Expansion of intercostal spaces and supraclavicular areas - these symptoms are similar to each other in the mechanism of development, leading to a general increase in lung volume and increased pressure inside the sternum.Under the constantly increasing pressure from the inside, the elastic spaces, which are the mids / rib spaces and supraclavicular spaces, begin to swell and protrude outward.
The incidence of pathology among all diseases of the respiratory system is about 4%, at the initial stages it skillfully masquerades as many other lung diseases.Timely diagnosis of pulmonary emphysema will help to stop the development of destructive processes and reduce the risk of complications.
What can I tell you about the presence of emphysema
Important! If you are susceptible to chronic lung diseases such as bronchial asthma and chronic bronchitis, if you smoke or work in hazardous production, you are at risk.
It is possible to suspect the onset of development of emphysema if:
- Periods of worsening of major diseases have become more frequent.
- The exacerbations are more severe and prolonged.
- Previously effective treatment of bronchial and pulmonary diseases became insufficient.
- You started, according to the doctor's recommendations, more intensive therapy.
- During periods of remission of chronic lung diseases and especially - exacerbations, you have increased dyspnea.
- Exacerbations sharply limited physical activity.
Having noticed these symptoms, immediately consult a doctor - they can talk about the development of the initial stages of emphysema.
How should thephysician act?
The diagnosis of "emphysema of the lungs" can be set exclusively by a physician( therapist, pulmonologist) after a thorough thorough examination of the patient.
When examined by a physician in patients with emphysema, the following symptoms are revealed, in addition to the described clinical manifestations:
- boxed sound with percussion of the chest;
- decrease or disappearance of absolute dullness of the heart;
- displacement of the lower bounds of the liver downwards;
- reduced excursion of the lower edge of the lungs;
- wadded, muffled breath.
Laboratory and instrumental examination methods help identify :
- increase in red blood cell count( erythrocytosis);
- laboratory indicators of inflammation;
- pneumatization( airiness) of lung tissue on the X-ray and an increase in the total lung volume.
Involves in the diagnosis of pulmonary emphysema and accurate computer examination methods that help to establish the most accurate localization of foci of the disease.Usually they are used to prepare for surgery.
The patient also performs functional tests to determine the degree of decrease in lung function, decrease the volume of inspiration and expiration, decrease the working volume of the lungs, and other indicators that indicate emphysema.
Treatment of emphysema
Treatment of emphysema is difficult, because pathogenetically, morphologically and functionally, the disease is associated with other chronic diseases that mankind has not learned to fully cure.
The current successful treatment for emphysema involves:
- The most effective, complete and comprehensive therapy for chronic diseases of the bronchopulmonary system and other organs and tissues.At the same time, the correct tactics in relation to these diseases lead to a significant reduction in the occurring exacerbations and as much as possible hinders the development and progression of emphysema.
- Application of surgical method( classical or minimally invasive) in the presence of local and especially bullous form.
- Preventive measures in the form of quitting, transfer to work without contaminated air, sanatorium treatment.Respiratory gymnastics and restorative measures at an acceptable level.
- Oxygen therapy, the appointment of drugs that relieve spasm of smooth muscles of the bronchi, drugs that help improve the excretion of sputum and normalization of its production.All of them are appointed for admission on an ongoing basis.
Important! The main principle of the treatment of emphysema at the present stage of the development of medicine( mainly for diffuse emphysema) is the containment of the progression of the disease and the prevention of the development of complications.
Complications of emphysema
Complications of emphysema as a separate nosological unit are:
- Purulent diseases of the lung tissue are mainly characteristic of the bullous form, due to the presence of large cavities in which ventilation and outflow are difficultAnd bacterial infection occurs very easily.This is due to the fact that most often as a main agent is a stable, own, conditionally pathogenic flora, therefore, such pulmonary purulent diseases with pulmonary emphysema are difficult enough to be treated with antibiotics.
- Pneumothorax - most often accompanied by local and bullous form and is associated with overgrowth of individual sections of the lungs so that under certain unfavorable conditions, their rupture occurs.
- Heart failure - in the form of a symptom complex called "pulmonary heart" is a rather serious complication of emphysema of the lung, significantly reducing the comfort and life expectancy of patients.
- Respiratory failure - a complication that arises sharply, poses a serious threat to health and life.Insufficiency is a decompensation of the respiratory function in response to even minor physical exertion or at rest.
Remember! Do not self-medicate with emphysema.At the first symptoms of the disease, consult a doctor.
Совинская Елена Николаевн, therapeutist, cardiologist