Pulmonary emphysema: causes, symptoms, treatment. Signs and symptoms of pulmonary emphysema Localized pulmonary emphysema

is a chronic nonspecific lung disease, which is based on persistent, irreversible expansion of the air spaces and increased swelling of the lung tissue distal to the terminal bronchioles. Pulmonary emphysema is manifested by expiratory shortness of breath, cough with a small amount of mucous sputum, signs of respiratory failure, and recurrent spontaneous pneumothorax. Diagnosis of pathology is carried out taking into account data from auscultation, radiography and CT of the lungs, spirography, and blood gas analysis. Conservative treatment of pulmonary emphysema includes taking bronchodilators, glucocorticoids, oxygen therapy; in some cases, resection surgery is indicated.

ICD-10

J43 Emphysema

General information

Pulmonary emphysema (from the Greek emphysema - bloating) is a pathological change in the lung tissue, characterized by increased airiness due to expansion of the alveoli and destruction of the alveolar walls. Pulmonary emphysema is detected in 4% of patients, and it occurs 2 times more often in men than in women. The risk of developing emphysema is higher in patients with chronic obstructive pulmonary disease, especially after 60 years of age. The clinical and social significance of pulmonary emphysema in practical pulmonology is determined by the high percentage of development of cardiopulmonary complications, disability, disability of patients and increasing mortality.

Causes

Any causes leading to chronic inflammation of the alveoli stimulate the development of emphysematous changes. The likelihood of developing emphysema increases if the following factors are present:

• congenital α-1 antitrypsin deficiency, leading to destruction of alveolar lung tissue by proteolytic enzymes;
• inhalation of tobacco smoke, toxic substances and pollutants;
• microcirculation disorders in lung tissues;
• bronchial asthma and chronic obstructive pulmonary diseases;
• inflammatory processes in the respiratory bronchi and alveoli;
• features of professional activity associated with a constant increase in air pressure in the bronchi and alveolar tissue.

Pathogenesis

Under the influence of these factors, damage to the elastic tissue of the lungs occurs, reduction and loss of its ability to fill and collapse. Air-filled lungs lead to sticking of small bronchi during exhalation and obstructive pulmonary ventilation disorders. The formation of the valve mechanism in pulmonary emphysema causes swelling and overstretching of lung tissue and the formation of air cysts - bullae. Ruptures of bullae can cause episodes of recurrent spontaneous pneumothorax.

Emphysema is accompanied by a significant increase in lung size, which macroscopically becomes similar to a large-porous sponge. When examining emphysematous lung tissue under a microscope, destruction of the alveolar septa is observed.

Classification

Pulmonary emphysema is divided into primary or congenital, developing as an independent pathology, and secondary, occurring against the background of other lung diseases (usually bronchitis with obstructive syndrome). Based on the degree of prevalence in the lung tissue, localized and diffuse forms of pulmonary emphysema are distinguished.

Based on the degree of involvement of the acinus (the structural and functional unit of the lungs that ensures gas exchange and consists of the branching of the terminal bronchiole with the alveolar ducts, alveolar sacs and alveoli) in the pathological process, the following types of pulmonary emphysema are distinguished:

• panlobular(panacinar) - with damage to the entire acinus;
• centrilobular(centriacinar) – with damage to the respiratory alveoli in the central part of the acinus;
• perilobular(periacinar) – with damage to the distal part of the acinus;
• peri-scar(irregular or uneven);
• bullous(bullous lung disease in the presence of air cysts - bulls).

Particularly distinguished are congenital lobar (lobar) pulmonary emphysema and McLeod syndrome - emphysema of unknown etiology that affects one lung.

Symptoms of emphysema

The leading symptom of pulmonary emphysema is expiratory shortness of breath with difficulty exhaling air. Dyspnea is progressive, occurring first during exertion and then at rest, and depends on the degree of respiratory failure. Patients with pulmonary emphysema exhale through closed lips while puffing out their cheeks (as if “puffing”). Shortness of breath is accompanied by a cough with the production of scanty mucous sputum. A pronounced degree of respiratory failure is indicated by cyanosis, puffiness of the face, and swelling of the veins of the neck.

Patients with pulmonary emphysema lose significant weight and have a cachectic appearance. Loss of body weight in pulmonary emphysema is explained by high energy costs spent on intensive work of the respiratory muscles. In the bullous form of pulmonary emphysema, repeated episodes of spontaneous pneumothorax occur.

Complications

The progressive course of pulmonary emphysema leads to the development of irreversible pathophysiological changes in the cardiopulmonary system. The collapse of small bronchioles during exhalation leads to obstructive pulmonary ventilation disorders. Destruction of the alveoli causes a decrease in the functional pulmonary surface and the phenomenon of severe respiratory failure.

Reduction of the capillary network in the lungs entails the development of pulmonary hypertension and an increase in the load on the right side of the heart. With increasing right ventricular failure, edema of the lower extremities, ascites, and hepatomegaly occur. An emergency condition for pulmonary emphysema is the development of spontaneous pneumothorax, requiring drainage of the pleural cavity and aspiration of air.

Diagnostics

The history of patients with pulmonary emphysema includes a long history of smoking, occupational hazards, and chronic or hereditary lung diseases. When examining patients with pulmonary emphysema, attention is drawn to an enlarged, barrel-shaped (cylindrical) chest, widened intercostal spaces and epigastric angle (obtuse), protrusion of the supraclavicular fossa, shallow breathing with the participation of auxiliary respiratory muscles.

Percussion is determined by the displacement of the lower borders of the lungs by 1-2 ribs downwards, a box sound over the entire surface of the chest. On auscultation, with pulmonary emphysema, weakened vesicular (“cotton”) breathing and muffled heart sounds are heard. In the blood with severe respiratory failure, erythrocytosis and increased hemoglobin are detected.

Pulmonary emphysema is a type of disease in which the pulmonary system the alveoli are stretched, due to impaired exchange of oxygen and carbon dioxide.

The air ceases to participate in gas exchange, which is why the lungs expand and cannot perform their respiratory functions.

What it is?

With diffuse emphysema, due to the destruction of the alveoli, the entire lung tissue is damaged. Bullae and large cavities appear. Reaching enormous sizes, they begin to replace large parts of the lungs. Happening disruption of blood flow to organs and they deteriorate over time.

When you inhale, air enters the lungs and does not come out in full when you exhale. As a result, the pulmonary arteries are compressed. The heart begins to work harder to supply blood, disturbances occur in the organ, and as the disease progresses, the patient develops cor pulmonale.

The disease always leads to complications and in most cases there is a need for transplantation. Most often, this form of the disease is associated with heredity, but the disease can also be provoked by various external factors and a lack of the enzyme alpha-antitrypsin.

If the patient has a primary form of the disease, then its manifestations are associated with congenital pathologies of the organs. This form quite difficult to treat, and emphysema only progresses. In the secondary form, the disease develops due to problems with the lungs. As a result of changes in the smooth muscle framework in the pulmonary system, functional disorders occur.

The elasticity of tissues is lost, when exhaling, the airways collapse, and the patient cannot exhale fully. It often happens that at the initial stage, patients do not experience significant symptoms. Therefore, in most cases, patients come to the doctor when emphysema has become protracted. In this case, over time, the disease leads to loss of ability to work.

The secondary type often occurs due to complications after bronchitis, pneumosclerosis or bronchial obstruction.

Important! Diffuse emphysema is a continuous disease that only progresses over time.

Causes

Depending on the type of disease, the causes may vary. The primary form is characterized by the following factors that provoke the disease:

• deficiency of the enzyme alpha1-antitrypsin;
• hereditary predisposition;
• work with harmful substances: sulfur, nitrogen;
• injuries and operations on the pulmonary system;
• smoking;
• regularly inhaling dust or black smoke;
• the presence of infectious processes in the bronchi or lungs.

Secondary appears if:

• the patient has obstructive bronchitis;
• severe stretching of the alveoli;
• bronchial asthma;
• tuberculosis;
• frequent pneumonia.

Symptoms

The initial stage of the disease is characterized by hidden symptoms, which in most cases resemble infectious or colds of the respiratory system. Therefore, many patients consult a doctor when the disease takes a severe form currents. The most characteristic are:

1. Shortness of breath that occurs after minor physical exertion. As the disease progresses over time, it may be present in the patient even at rest.
2. Skin cyanosis is observed at the fingertips and in the area of ​​the nasolabial folds.
3. For a full exhalation, the patient begins to look for a comfortable position. He leans forward while leaning on his hands to make it easier to exhale. At an advanced stage of the disease, a person has to sleep even half-sitting in order to be able to breathe properly.
4. The muscles of the shoulders are involved in the act of breathing.
5. Inhalation becomes short, and exhalation becomes long and difficult. The patient exhales, puffing out his cheeks and pursing his lips into a tube.
6. Over time, deformation of the chest occurs due to large accumulations of air, which begins to resemble a barrel.
7. An expansion occurs between the ribs and they protrude outward.
8. A person suffers from a strong dry cough with a minimal amount of sputum.
9. Weight loss occurs.
10. Fatigue increases and the person becomes unable to work as the disease progresses.
11. A network of purple capillaries appears on the face.

Survival prognosis

As the disease progresses, pathological changes occur in the respiratory system. Not only the respiratory system is affected, but also the circulatory system. Pulmonary ventilation is disrupted, large bullae form, and small bronchioles begin to collapse during exhalation.

In the pulmonary walls of the alveoli begins destruction occurs and respiratory failure begins to develop. Due to thickening of the walls of the heart, pulmonary hypertension develops, the lower extremities swell, and ascites appears. A patient may suddenly develop pneumothorax. With such a prognosis, the patient becomes incapacitated and disabled. Death is also possible.

Important! Although the survival prognosis for a large percentage of patients is poor, appropriate treatment can improve quality of life.

Treatment

There is a comprehensive treatment that is selected by the doctor, taking into account all the features of the disease.

1. An important condition is to quit smoking. If a patient is prescribed drug treatment, but smokes, there will be no positive dynamics in the course of the disease.

2. To improve bronchial patency, bronchodilators are prescribed in tablet form or by inhalation.

3. It is mandatory to take glucocorticoids:

• prednisolone;
• hydrocortisone.

4. To improve sputum discharge, the patient needs to take the mucus thinner acetylcysteine, as well as expectorant medications:

• bromhexine;
• lazolvan;
• ambroxol.

5. If a bacterial infection is detected, it is advisable to take antibiotics.
6. The following medications will support heart function:

• nitroglycerine;
• strophanthin.

7. For the functioning of the urinary system, the following are prescribed:

• isoket;
• furosemide;
• korglykon.

8. Oxygen therapy has a positive effect on the disease, in which the patient breathes pure oxygen using special cylinders.

9. It is necessary to regularly carry out breathing exercises so that during attacks the patient can control breathing.

10. Aeroion therapy is also indicated, which helps eliminate respiratory failure.

It is impossible to cure diffuse pulmonary emphysema. But if you adhere to a healthy lifestyle and take medications throughout your life, you can improve your quality of life and avoid disability.

A lung disease such as emphysema is accompanied by cough with sputum, shortness of breath, pneumothorax and symptoms of respiratory failure.

The pathology is characterized by a high risk of developing complications from the lungs and heart, disability and a significant percentage of deaths.

Pulmonary emphysema - what is it and how to treat the disease?

Pulmonary emphysema is a disease in which the alveoli of the lungs expand and their walls undergo destruction, as a result of which the lung tissue changes pathologically. Together with asthmatic bronchitis, the pathology also refers to chronic obstructive pulmonary diseases ().

From Greek “emphysema” is translated as “swelling”. Among the male population, the disease is diagnosed twice as often; in old age, the risk of its development increases.

Emphysema is progressive and is a chronic disease. Due to prolonged inflammation and narrowing of the airways, the lung tissue becomes less elastic, and after exhalation, more air remains in the lungs than usual.

Connective tissue begins to grow (pneumosclerosis in emphysema), replacing air pockets, and these changes are irreversible.

Emphysema can be localized or diffuse. In the first case, not all of the lungs are damaged, but only certain parts of them. This type is often caused by congenital disorders.

What is dangerous about the accumulation of fluid in the pleural cavity, the causes and signs of hydrothorax and how to treat it:

With the diffuse type, the entire lung tissue is affected, which can be a complication of obstructive or allergic bronchitis.

There are also such forms of emphysema:

• Vesicular - the most common, in which the changes are irreversible, in most cases this is a complication of other pulmonary diseases;
• Vicarious - an increase in the volume of one area with simultaneous compression of others, the alveoli are not affected;
• Senile – age-related increase in tissue rigidity without destruction, deformation of areas of the lungs;
• McLeod syndrome is a unilateral lesion of blood vessels and lung tissue of unknown etiology;
• Interstitial - accumulation of air under the pleura, between the lobules and in other areas due to rupture of the bronchi or alveoli;
• Acute swelling of the lung tissue develops after the removal of one of the lungs or as a result of an asthma attack.

Causes of emphysema lungs are:

1. Impaired microcirculation in the lung tissue;
2. and other obstructive chronic pulmonary pathologies;
3. Inflammatory process in the alveoli or bronchi;
4. Smoking, including passive smoking, is considered one of the main factors of emphysema;
5. Constant exposure of toxic compounds to the lungs, for example, when working in industrial production;
6. Hereditary α-1 antitrypsin deficiency, which causes proteolytic enzymes to begin to destroy alveolar tissue.

Under the influence of these factors, the elastic tissue of the lungs is damaged, its ability to the normal process of filling with air and removing it is disrupted.

Small branches of the bronchi stick together, the lung tissue becomes swollen and overstretched, and air cysts or bullae form. Their rupture leads to. With emphysema, the lungs are enlarged and resemble a sponge with large pores.

Signs of diffuse emphysema:

• shortness of breath even with slight physical exertion;
• sudden weight loss;
• barrel-shaped chest;
• slouch;
• the spaces between the ribs are widened;
• protrusion of the supraclavicular fossa;
• weakened and sometimes absent breathing when listening with a phonendoscope.

What is pulmonary bronchoscopy, indications for the procedure and preparation for it:

With diffuse emphysema, x-rays show increased transparency of the lung zone and a low-lying diaphragm. The heart begins to take a more vertical position and respiratory failure increases.

Symptoms of localized emphysema develop due to the fact that the affected areas of the lungs put pressure on healthy areas, resulting in severe breathing difficulties, including attacks of suffocation.

There is a high risk of rupture of air subpleural cavities, in which air penetrates into the pleural cavity.

Treatment methods for pulmonary emphysema are aimed at eliminating respiratory failure and the cause of damage to the lung tissue, for example, a disease.

The first condition for successful therapy is complete cessation of smoking. This is helped not only by special preparations containing nicotine, but also by the patient’s motivation and psychological assistance.

For emphysema that has developed as a result of another pathology, drugs are used to treat the primary disease. These are drugs from the group of antibiotics and expectorants (mucolytics), selected by the doctor individually.

To make breathing easier, exercises are shown that allow you to use a larger volume of lungs in air exchange.

Segmental, acupressure or classic massage is performed for better removal of phlegm. To expand the lumen of the bronchi, the drugs Salbutamol, Berodual or Theophylline are prescribed.

Alternate supply of air with low and normal oxygen content to the lungs is used if respiratory failure is low. The course of such treatment for emphysema is designed for 2-3 weeks.

• In case of severe failure of the respiratory process, inhalations with small doses of pure oxygen or ionized air are carried out, and in extreme cases, ventilation of the lungs.

Bullous emphysema most often requires surgical intervention, the purpose of which is to remove air cysts (bullae). The operation is performed classically or minimally invasively (using an endoscope), and its timely implementation prevents the development of pneumothorax.

Emphysema - life prognosis and mortality

Without proper and timely treatment, the pathology steadily progresses, and heart and respiratory failure develops. This leads to the patient's disability and inability to work. In this case, with pulmonary emphysema, the life prognosis is unfavorable, and death may occur earlier than in 3-4 years.

But if therapy is carried out and inhalations are regularly used, then despite the irreversibility of lung damage, the quality of life can be improved.

Theoretically, a relatively favorable prognosis is considered to be a life expectancy of 4-5 years, but under good conditions a person can live with emphysema for 10-20 years or longer.

Complications

If the pathology progresses rapidly or treatment is not carried out, the following complications of pulmonary emphysema develop:

• failure of obstructive pulmonary ventilation;
• cardiac right ventricular failure and, as a consequence, ascites, swelling of the legs, hepatomegaly.

The most dangerous consequence is spontaneous pneumothorax, which requires drainage of the pleural cavity and aspiration of air.

Emphysema occurs when the alveoli of the lung tissue stretch beyond acceptable limits and lose the ability to contract back. This disrupts the normal flow of oxygen into the blood and the removal of carbon dioxide from the body, which leads to heart failure.

In accordance with the modern classification, diffuse and bullous pulmonary emphysema are distinguished. The first form involves complete tissue damage. Bullous emphysema is diagnosed when swollen (widened) areas are adjacent to normal lung tissue.

Causes of emphysema

The disease often manifests itself as a consequence of chronic bronchitis or bronchial asthma. The bullous form can also occur under the influence of hereditary factors and certain lung diseases, in particular tuberculosis. In addition, the development of the disease is influenced by factors such as smoking and excessive air pollution, which is especially typical for large cities.

Emphysema - symptoms

Severe shortness of breath up to suffocation, widening of the intercostal spaces, barrel-shaped chest, weakened breathing, decreased mobility of the diaphragm, increased transparency of the pulmonary fields during X-ray examination - these are the symptoms of pulmonary emphysema. Treatment of the disease depends on the severity of the symptoms and clinical picture.

The primary stage of development of pulmonary emphysema is characterized by: severe shortness of breath, rapid fatigue during any physical activity, the effect of the so-called “puffing”, disturbance of the blood gas composition and collapse of the small bronchi.

As the condition of the lung tissue deteriorates, the transparency of the lung fields increases, the diaphragm shifts and other changes interfere with normal gas exchange.

Emphysema - treatment and prognosis

In the treatment of pulmonary emphysema, the main measures are aimed at eliminating respiratory failure and treating the disease under the influence of which a person developed the disease. Treatment with folk remedies shows quite effective results, however, we under no circumstances recommend abandoning traditional medicinal methods.

Basic principles of treatment of emphysema:

• Quitting smoking is one of the most important steps on the road to recovery. Let us note that a sharp, immediate reduction in the number of cigarettes smoked has a much greater effect than a gradual cessation of tobacco;
• prescription of antibacterial drugs - the main drugs are anticholinergics (Berodual, Atrovent), beta-2 sympathomimetics (Berotec, Salbutamol) and theophyllines (Euphylline, Teopec). The choice of drug and the intensity of therapy depend on the severity of the symptoms that emphysema manifests itself. Treatment with antibacterial complexes is combined with the use of expectorants;
• breathing exercises to improve gas exchange. As a rule, patients are prescribed ambient air with a reduced oxygen content for 5 minutes. The patient breathes normal air for the next 5 minutes. The cyclic pattern is repeated 6-7 times during 1 session. The full course of treatment lasts about 3 weeks;
• Pulmonary emphysema, the symptoms of which are associated with severe respiratory failure, is treated with low-flow oxygen therapy. It can also be used at home, using compressed gas cylinders or special concentrators as oxygen sources;
• In recent years, doctors have been actively using aeroion therapy, which shows good results in eliminating respiratory failure. The course of treatment lasts 15-20 days;
• Special breathing exercises and training programs aimed at enabling a person to control his breathing are also effective;
• For better sputum removal, positional drainage is used - the patient takes a certain position in which the cough reflex and viscous sputum cause the least inconvenience. In this case, you can combine drainage treatment of emphysema with the use of expectorant herbs and infusions, for example, thermopsis, wild rosemary, plantain or coltsfoot.

Is there a permanent cure for emphysema? Forecasts are individual in each specific case and depend on how fully patients follow all the recommendations of the attending physician, and whether they are willing to make certain sacrifices for the sake of their health. Also, timely detection and adequate treatment of the disease that led to emphysema has a huge impact on the treatment process.

Emphysema - treatment with folk remedies

Home remedies:

• drink green potato tops juice with a daily increase in dose until the volume of juice reaches half a glass;
• inhalation of jacket potato vapors;
• applying pieces of pre-boiled potatoes to the chest.

Herbal infusions:

• Add three tablespoons of buckwheat flowers to 500 ml of boiling water. Infuse the mixture in a thermos for two hours. Take half a glass 3-4 times a day;
• Take one part each of juniper fruit and dandelion root, add two parts of birch leaf to them and pour boiling water over the resulting mixture. The broth is infused for three hours, after which it is filtered and poured into a suitable container. The infusion should be consumed 2-3 times a day. Standard dosage – 1/3 cup;
• a teaspoon of potatoes is poured into a glass of boiling water, left for one hour and filtered. Take half a glass of infusion 40 minutes before meals for one month.

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According to WHO, up to 4% of the population, mainly older men, suffer from emphysema (emphysao - “to swell”), a pathological increase in lung capacity. There are acute and chronic forms of pathology, as well as vicarious (focal, local) and diffuse emphysema. The disease occurs with disturbances in pulmonary ventilation and blood circulation in the respiratory organs. Let's take a closer look at why emphysema occurs, what it is and how to treat it.

What is pulmonary emphysema?

Pulmonary emphysema (from the Greek emphysema - bloating) is a pathological change in the lung tissue, characterized by increased airiness due to expansion of the alveoli and destruction of the alveolar walls.

Pulmonary emphysema is a pathological condition that often develops in a wide variety of bronchopulmonary processes and is of extremely great importance in pulmonology. The risk of developing the disease in some categories is higher than in other people:

• Congenital forms of pulmonary emphysema associated with whey protein deficiency are more often detected in residents of Northern Europe.
• Men get sick more often. Emphysema is detected at autopsy in 60% of men and 30% of women.
• People who smoke have a 15 times higher risk of developing emphysema. Passive smoking is also dangerous.

Without treatment, changes in the lungs due to emphysema can lead to loss of ability to work and disability.

Causes leading to the development of emphysema

The likelihood of developing emphysema increases if the following factors are present:

• congenital deficiency of α-1 antitrypsin, leading to destruction of alveolar lung tissue by proteolytic enzymes;
• inhalation of tobacco smoke, toxic substances and pollutants;
• microcirculation disorders in lung tissues;
• bronchial asthma and chronic obstructive pulmonary diseases;
• inflammatory processes in the respiratory bronchi and alveoli;
• features of professional activity associated with a constant increase in air pressure in the bronchi and alveolar tissue.

Under the influence of these factors, damage to the elastic tissue of the lungs occurs, reduction and loss of its ability to fill and collapse.

Emphysema can be considered as an occupationally caused pathology. It is often diagnosed in individuals who inhale various aerosols. The etiological factor may be pneumonectomy (removal of one lung) or trauma. In children, the cause may lie in frequent inflammatory diseases of the lung tissue (pneumonia).

The mechanism of lung damage in emphysema:

1. Stretching of bronchioles and alveoli - their size doubles.
2. Smooth muscles are stretched, and the walls of blood vessels become thinner. The capillaries become empty and the nutrition in the acinus is disrupted.
3. Elastic fibers degenerate. In this case, the walls between the alveoli are destroyed and cavities are formed.
4. The area in which gas exchange occurs between air and blood decreases. The body experiences oxygen deficiency.
5. The enlarged areas compress healthy lung tissue, further impairing the ventilation function of the lungs. Shortness of breath and other symptoms of emphysema appear.
6. To compensate and improve the respiratory function of the lungs, the respiratory muscles are actively involved.
7. The load on the pulmonary circulation increases - the vessels of the lungs become overfilled with blood. This causes disturbances in the functioning of the right side of the heart.

Types of disease

The following types of emphysema are distinguished:

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

According to the nature of the flow:

• Spicy. It can be caused by significant physical activity, an attack of bronchial asthma, or the entry of a foreign object into the bronchial network. There is swelling of the lung and overstretching of the alveoli. The condition of acute emphysema is reversible, but requires emergency treatment.
• Chronic emphysema. Changes in the lungs occur gradually; at an early stage, a complete cure can be achieved. Without treatment it leads to disability.

According to anatomical features, they are distinguished:

• Panacinar (vesicular, hypertrophic) form. Diagnosed in patients with severe emphysema. There is no inflammation, there is respiratory failure.
• Centrilobular form. Due to the expansion of the lumen of the bronchi and alveoli, an inflammatory process develops, and mucus is released in large quantities.
• Periacinar (parasepital, distal, perilobular) form. Develops with tuberculosis. It may result in a complication - rupture of the affected area of ​​the lung (pneumothorax).
• Peri-scar form. It is characterized by minor symptoms and appears near fibrotic foci and scars in the lungs.
• Interstitial (subcutaneous) form. Due to the rupture of the alveoli, air bubbles form under the skin.
• Bullous (bubble) form. Bullae (bubbles) with a diameter of 0.5-20 cm are formed near the pleura or throughout the parenchyma. They arise at the site of damaged alveoli. They can rupture, become infected, and put pressure on surrounding tissues. Bullous emphysema usually develops as a result of loss of tissue elasticity. Treatment of emphysema begins with eliminating the causes that provoke the disease.

Symptoms of emphysema

The symptoms of emphysema are numerous. Most of them are not specific and can be observed with other pathologies of the respiratory system. Subjective signs of emphysema include:

• nonproductive cough;
• expiratory shortness of breath;
• the appearance of dry wheezing;
• feeling of lack of air;
• weight loss
• a person experiences severe and sudden pain in one of the halves of the chest or behind the sternum;
• Tachycardia is observed when the rhythm of the heart muscle is disrupted due to lack of air.

Patients with pulmonary emphysema mainly complain of shortness of breath and cough. Shortness of breath, gradually increasing, reflects the degree of respiratory failure. At first it occurs only during physical stress, then it appears while walking, especially in cold, damp weather, and sharply intensifies after coughing attacks - the patient cannot “catch his breath.” Shortness of breath with emphysema is inconsistent, changeable (“it doesn’t happen from day to day”) - stronger today, weaker tomorrow.

A characteristic sign of pulmonary emphysema is loss of body weight. This is due to fatigue of the respiratory muscles, which work at full strength to facilitate exhalation. A marked decrease in body weight is an unfavorable sign of the development of the disease.

Noteworthy is the bluish color of the skin and mucous membranes, as well as the characteristic change in the fingers like drumsticks.

People with chronic long-term pulmonary emphysema develop external signs of the disease:

• short neck;
• anteroposteriorly expanded (barrel-shaped) chest;
• the supraclavicular fossae protrude;
• on inhalation, the intercostal spaces are retracted due to tension in the respiratory muscles;
• the abdomen is somewhat saggy as a result of the prolapse of the diaphragm.

Complications

A lack of oxygen in the blood and an unproductive increase in lung volume affect the entire body, but above all, the heart and nervous system.

1. The increased load on the heart is also a compensation reaction - the body’s desire to pump more blood due to tissue hypoxia.
2. Arrhythmias, acquired heart defects, and coronary artery disease may occur—a symptom complex known collectively as “cardiopulmonary failure.”
3. In the extreme stages of the disease, lack of oxygen causes damage to nerve cells in the brain, which is manifested by decreased intelligence, sleep disturbances, and mental pathologies.

Diagnosis of the disease

At the first symptoms or suspicion of pulmonary emphysema, the patient is examined by a pulmonologist or therapist. It is difficult to determine the presence of emphysema in the early stages. Often, patients consult a doctor when the process is already advanced.

Diagnostics includes:

• blood test to diagnose emphysema
• detailed patient interview;
• examination of the skin and chest;
• percussion and auscultation of the lungs;
• determination of the boundaries of the heart;
• spirometry;
• plain radiography;
• CT or MRI;
• assessment of blood gas composition.

X-ray examination of the chest organs is of great importance for the diagnosis of pulmonary emphysema. At the same time, dilated cavities are detected in various parts of the lungs. In addition, an increase in lung volume is determined, indirect evidence of which is the low location of the dome of the diaphragm and its flattening. Computed tomography also allows you to diagnose cavities in the lungs, as well as their increased airiness.

How to treat emphysema

There are no specific treatment programs for pulmonary emphysema, and those carried out do not differ significantly from those recommended in the group of patients with chronic obstructive respiratory diseases.

In the treatment program for patients with pulmonary emphysema, general measures that improve the quality of life of patients should come first.

Treatment of pulmonary emphysema has the following objectives:

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

To alleviate acute conditions, drug therapy is used:

1. Eufillin to relieve an attack of shortness of breath. The drug is administered intravenously and relieves shortness of breath within a few minutes.
2. Prednisolone as a strong anti-inflammatory agent.
3. For mild or moderate respiratory failure, oxygen inhalation is used. However, here it is necessary to carefully select the oxygen concentration, because this can be both beneficial and harmful.

For all patients with emphysema, physical programs are indicated, especially chest massage, breathing exercises and teaching the patient kinesitherapy.

Is hospitalization necessary to treat emphysema? In most cases, patients with emphysema are treated at home. It is enough to take medications according to the schedule, adhere to a diet and follow the doctor’s recommendations.

Indications for hospitalization:

• sharp increase in symptoms (shortness of breath at rest, severe weakness)
• the appearance of new signs of illness (cyanosis, hemoptysis)
• ineffectiveness of the prescribed treatment (symptoms do not decrease, peak flow measurements worsen)
• severe concomitant diseases
• newly developed arrhythmias; difficulties in establishing a diagnosis.

Emphysema has a favorable prognosis if the following conditions are met:

• Prevention of pulmonary infections;
• Quitting bad habits (smoking);
• Providing balanced nutrition;
• Living in a clean air environment;
• Sensitivity to medications from the group of bronchodilators.

Breathing exercises

When treating emphysema, it is recommended to regularly conduct various breathing exercises in order to improve the exchange of oxygen in the lung cavity. The patient should do this for 10-15 minutes. inhale the air deeply, then try to hold it as long as possible while exhaling with gradual exhalation. This procedure is recommended to be carried out daily, at least 3 - 4 times. per day, in small sessions.

Massage for emphysema

Massage helps remove mucus and dilate the bronchi. Classic, segmental and acupressure massage is used. It is believed that acupressure has the most pronounced bronchodilator effect. The purpose of massage:

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

Exercise therapy

With emphysema, the respiratory muscles are in constant tone, so they quickly get tired. To prevent muscle overstrain, physical therapy has a good effect.

Oxygen inhalations

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

Surgical treatment of emphysema

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 for surgery:

• Multiple bullae (more than a third of the chest area);
• Severe shortness of breath;
• Complications of the disease: oncological process, bloody sputum, infection.
• Frequent hospitalizations;
• Transition of the disease to a severe form.

Contraindications to surgery may be severe exhaustion, old age, chest deformation, asthma, pneumonia, in severe form.

Nutrition

Compliance with rational food intake in the treatment of emphysema plays a fairly important role. It is recommended to eat as many fresh fruits and vegetables as possible, which contain large amounts of vitamins and microelements beneficial to the body. Patients need to adhere to the consumption of low-calorie foods so as not to provoke a significant burden on the functioning of the respiratory system.

The daily calorie intake should not exceed more than 800 - 1000 kcal.

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

In any case, you cannot treat the disease yourself. If you suspect that you or your relative have emphysema, you should immediately contact a specialist for timely diagnosis and initiation of treatment.

Life prognosis with emphysema

A complete cure for emphysema is impossible. A feature of the disease is its constant progression, even during treatment. With timely seeking medical help and compliance with treatment measures, the disease can be somewhat slowed down, the quality of life can be improved, and disability can also be delayed. When emphysema develops against the background of a congenital defect of the enzyme system, the prognosis is usually unfavorable.

Even if the patient is given the most unfavorable prognosis due to the severity of the disease, he will still be able to live at least 12 months from the date of diagnosis.

The length of time a patient survives after diagnosis of the disease is largely influenced by the following factors:

1. General condition of the patient's body.
2. The appearance and development of systemic diseases such as bronchial asthma, chronic bronchitis, tuberculosis.
3. How the patient lives plays a big role. Does he lead an active lifestyle or does he have little mobility? Does he follow a balanced diet or eat food haphazardly?
4. The age of the patient plays an important role: young people live longer after diagnosis than older people with the same severity of the disease.
5. If the disease has genetic roots, then the prognosis of life expectancy with emphysema is determined by heredity.

Despite the fact that irreversible processes occur with pulmonary emphysema, the quality of life of patients can be improved by constantly using inhaled drugs.

Prevention

1. Anti-tobacco programs aimed at preventing children and adolescents from smoking, as well as stopping smoking in people of any age, are of great preventive importance.
2. It is also necessary to treat lung diseases in time so that they do not become chronic.
3. It is important to monitor patients with chronic respiratory diseases with a pulmonologist, administer vaccines to the population, etc.