What is emphysema? Pulmonary emphysema, what it is, how to treat it.

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Diseases respiratory system are very common - many of them, with proper treatment, go away without a trace, but not all pathologies are harmless.

Thus, with pulmonary emphysema, tissue once damaged will never recover. The insidiousness of this disease is that, developing gradually, it can completely affect the entire lung.

Pulmonary emphysema - what is it?

What it is? Pulmonary emphysema is a pathological change in the organ associated with the expansion of the alveoli and an increase in the “airiness” of the lung tissue. The disease mainly affects men and, since the disease has a chronic course, it affects mainly older people.

Emphysema (lung disease) is often a complication of occupational pathologies (silicosis, anthracosis) in people who work with toxic gaseous products or inhale dust. Smokers, including passive smokers, are also susceptible to pathology.

In rare cases, emphysema can result from birth defects. For example, it develops with α-1 antitrypsin deficiency, which results in destruction of the alveoli. A change in the normal properties of surfactant, a lubricating substance that coats the alveoli to reduce friction between them, can also provoke pathology.

• Lung diseases often lead to emphysema - chronic obstructive bronchitis, tuberculosis.

Pathogenesis

There are two main mechanisms for the development of pathology. The first is associated with impaired elasticity of the lung tissue, and the second is determined by increased air pressure inside the alveoli.

The lungs are not able to change their volume on their own. Their compression and expansion is determined solely by the movement of the diaphragm, but it would be impossible if the tissue of this organ were not elastic.

Inhalation of dust age-related changes reduce the elasticity of the lungs. As a result, the air does not completely leave the organ when exhaling. The ends of the bronchioles expand, and the lungs increase in size.

Toxic gaseous substances, including nicotine from cigarettes, cause inflammation in the alveoli, ultimately leading to the destruction of their walls. In this case, large cavities are formed. As a result of the pathological process, the alveoli merge with each other, inner surface lung capacity decreases due to the destruction of the interalveolar walls and, as a result, gas exchange suffers.

The second mechanism for the development of emphysema, associated with an increase in pressure inside the structural elements of the lungs, is observed against the background of chronic obstructive diseases (asthma, bronchitis). The tissue of the organ stretches, it increases in volume and loses elasticity.

Against this background, spontaneous lung ruptures are possible.

Classification

Depending on the cause that provoked the disease, primary and secondary emphysema are distinguished. The first develops as an independent pathology, the second is a complication of other diseases.

According to the nature of the lesion, emphysema can be localized or diffuse. The latter implies changes in the entire lung tissue. In the localized form, only certain areas are affected.

However, not all types of emphysema are terrible. So, with the vicarious form, a compensatory increase in the area or the entire lung occurs, for example, after the removal of the second one. This condition is not considered a pathology, since damage to the alveoli does not occur.

Depending on how severely the structural element of the lung - the acinus - is affected, emphysema is classified into the following types:

• perilobular (end elements of the acinus are affected);
• panlobular (the entire acinus is completely affected);
• centrilobular (the central alveoli of the acinus are affected);
• irregular (different areas of different acini are affected).

In the lobar form, pathological changes cover entire lobes of the lung. With interstitial, due to thinning and rupture of the lung tissue, air from the alveoli enters pleural cavity, accumulating under the pleura.

• When bullae or air cysts form, they speak of bullous emphysema.

Bullous emphysema

Otherwise, this form of emphysema is referred to as “vanishing lung syndrome.” Bullae are air cavities with a diameter of 1 cm or more. Their walls are covered by the epithelium of the alveoli. Bullous emphysema is the most dangerous due to its complication – spontaneous pneumothorax.

In this case, through the rupture of the lung, air penetrates into the pleural cavity, occupying its volume and thereby compressing the damaged organ. Spontaneous pneumothorax often develops for no apparent reason.

Bullae in the lungs can be congenital or form during life. In the first case, the process of formation of air cysts is associated with dystrophic changes connective tissue or α-1 antitrypsin deficiency. Acquired bullae are formed due to pulmonary emphysema, against the background of pneumosclerosis.

Sclerotic tissue changes develop against the background of long-term infectious and degenerative-dystrophic processes that have a chronic course. With pneumosclerosis, normal lung tissue is replaced by connective tissue, which is unable to stretch and perform gas exchange.

• This is how a “valve system” is formed: air rushes into the healthy parts of the organ, stretching the alveoli, which ultimately ends in the formation of bullae.

Bullous emphysema mainly affects smokers. Often the disease is asymptomatic, since the functions of areas not involved in gas exchange are taken over by healthy acini. With multiple bullae, respiratory failure develops and, accordingly, the risk of spontaneous pneumothorax increases.

Symptoms of emphysema, cough and shortness of breath

The clinical picture of pulmonary emphysema is determined by the degree of organ damage. First, the patient experiences shortness of breath. It occurs, as a rule, sporadically, after an overload. Attacks of shortness of breath become more frequent in winter time.

As the disease progresses and more and more lung volumes are affected, other signs of pulmonary emphysema appear:

• barrel-shaped chest, reminiscent of the shape when exhaling;
• enlarged intercostal spaces;
• supraclavicular areas smoothed against the background of bulging of the apexes of the lungs;
• blue discoloration of nails, lips, mucous membranes due to hypoxia (lack of air);
• swelling of the veins in the neck;
• drumstick-shaped fingers with thickened terminal phalanges.

Despite the fact that the patient’s skin acquires a bluish tint due to oxygen starvation, during an attack of shortness of breath the person’s face turns pink. He strives to take a forced position - lean forward, while his cheeks are swollen and his lips are tightly compressed. This is a characteristic picture of emphysema.

The patient has difficulty exhaling air during an attack of shortness of breath. The respiratory muscles, as well as the muscles of the neck, are actively involved in this process. healthy people not involved in exhalation. Due to increased stress and debilitating attacks, patients with emphysema lose weight and look exhausted.

Cough with emphysema occurs after an attack and is accompanied by thin, clear sputum. In addition, pain appears in the chest.

At first, it is more comfortable for the patient to be in a lying position with his head down, but as the disease progresses, this position begins to cause discomfort. People with significant lung damage due to emphysema even sleep in a semi-sitting position. This is the easiest way for the diaphragm to “act” on the lungs.

Most often, patients fall into a stupor when they hear the diagnosis of “pulmonary emphysema” - what it is and how to treat the disease are the first questions the doctor hears. First of all, it should be noted that once lung tissue has died, it will not recover, so the main treatment tactics are aimed at preventing the progression of the pathology.

The influence should be excluded harmful factors, if necessary, change jobs. Smokers are strongly advised to quit the bad habit, as otherwise there will be no effect from the treatment.

If emphysema has developed against the background of any underlying disease, it must be treated immediately. For bronchitis and asthma, medications that dilate the bronchi (salbutamol, berodual), as well as mucolytics necessary for the removal of sputum (ambroxol preparations) are prescribed. Infectious pathologies are treated with antibiotic therapy.

In order to expand the bronchi and stimulate the removal of mucus, a special massage (acupressure or segmental) is indicated. Independently, without the help of doctors, the patient can perform special breathing exercises. It stimulates the work of the diaphragm and thereby improves the “contractility” of the lung, which has a positive effect on the function of gas exchange. Exercise therapy complexes are used for the same purpose.

In severe cases, in the treatment of pulmonary emphysema, a course of oxygen therapy can be used to eliminate attacks of hypoxia. First, the patient is given oxygen-depleted air, and then enriched or normal air. Therapy is carried out both in the hospital and at home. For this purpose, the patient may need an oxygen concentrator.

Pulmonary emphysema is a reason for constant monitoring by a pulmonologist, and the treatment of this pathology requires great consciousness from the patient: lifestyle adjustments, taking medications, at the initial stage you can use folk remedies to ease breathing and remove mucus, but if the pathology has acquired a more severe form, you will need surgical intervention.

Chronic emphysema, complicated by pneumothorax, formation of bullae, and pulmonary hemorrhages, is an indication for surgery.

In this case, the pathological area is removed, and the remaining healthy part of the lung is enlarged compensatory to maintain gas exchange function.

Prognosis and mortality

The prognosis for life, as a rule, is unfavorable with the development of secondary pulmonary emphysema against the background of congenital connective tissue pathologies and α-1 antitrypsin deficiency. When a patient suddenly loses weight, this is also a sign of high danger to life.

Usually, without treatment, progressive pulmonary emphysema can kill a person in less than 2 years. A good indicator for severe forms of pulmonary emphysema is the 5-year survival rate of patients. With severe disease, no more than 50% of patients are able to cross this threshold. However, if the pathology was detected on early stage, the patient adheres to all the recommendations of the attending physician, he can live 10 years or more.

Against the background of pulmonary emphysema, in addition to respiratory failure, the following complications develop:

• heart failure;
• pulmonary hypertension;
• infectious lesions (pneumonia, abscesses);
• pneumothorax;
• pulmonary hemorrhage.

Avoiding all these conditions will help you quit smoking, monitor your health, especially chronic diseases of the respiratory system, and follow safety rules when working in hazardous industries.

The causes of pulmonary emphysema are conventionally divided into two groups.

I. Pathological microcirculation, congenital deficiency of α-antitrypsin, changes in the properties of surfactant, harmful substances in the air (nitrogen oxides, cadmium compounds, dust, tobacco smoke, etc.). These factors contribute to the disruption of the strength and elasticity of the lung structure. Primary diffuse emphysema develops. Pathological restructuring of the entire respiratory part of the lung occurs. During exhalation, when intrathoracic pressure increases, the small bronchi passively collapse, bronchial resistance increases, and, consequently, pressure in the alveoli increases. This occurs as a consequence of weakening of the elastic properties of the lungs due to diffuse emphysema, because the small bronchi initially do not have a cartilaginous frame.

But bronchial patency in primary emphysema is still not impaired. All alveoli of the lung acini are affected evenly. Panacinar emphysema develops, atrophy of the interalveolar septa and reduction of the capillary bed occur. However, the bronchi and bronchioles are not subject to obstruction, because there are no inflammatory changes.

Gymnastics for emphysema

One of the mandatory components of palliative therapy for emphysema is therapeutic exercises. The purpose of its purpose is proper breathing with maximum involvement of the diaphragm and intercostal muscles in the process.

The set of exercises is selected in such a way as to increase the strength of the chest muscles, increase the mobility of the ribs, teach the patient to inhale, during which the diaphragm works maximally, and elongate the exhalation, which helps reduce the content of residual air in the lungs.

Therapeutic walking is recommended for short distances (from 200 to 800 meters, depending on the condition) at a slow or moderate pace with an extended exhalation, and after the condition improves, climbing stairs no higher than the third floor with breathing control.

Straining, sudden movements, inhaling large volumes of air, holding your breath, fast-paced or intense exercises should be avoided. At the initial stages, gymnastics is carried out in a lying and sitting position; with the expansion of the regime, standing exercises are introduced.

A properly selected set of exercises has an effect by improving blood circulation and active work of the remaining alveoli.

Bullous emphysema

Bullous pulmonary emphysema (e. pulmonum bullosum) is considered by many doctors and researchers as a process of dysplastic tissue development, as well as a manifestation of genetic and hereditary abnormalities. The etiology and pathogenesis of bullous emphysema has not yet been fully elucidated.

For bullous emphysema, the formation of so-called bullae is typical - air bubbles of different sizes, concentrated mainly in the marginal parts of the lungs. Bullae can be multiple or single, local or widespread, their size varies from 1 to 10 cm.

Bullous emphysema is characterized by the early development of respiratory failure, which develops not only as a result of the emphysema itself, but due to compression of the surrounding healthy tissue by the bullae. The functionality of the area with the bullae and those located next to them (with morphologically unchanged tissue) is sharply impaired.

IN Lately for the treatment of bullous emphysema (especially with giant or widespread bullae), the technique began to be used surgical intervention, in which bullous tissue is removed. This allows you to improve the condition and functionality of healthy tissues and reduce the severity of the process. This method, of course, does not lead to a complete cure, and little experience in its use, lack of assessment of long-term consequences and fragmented data on mortality prevent the widespread implementation of this operation.

Diffuse emphysema

Primary diffuse pulmonary emphysema (e. pulmonum secundarium diffusum) is considered as an independent nosological unit, which includes various variants of the course of the disease. To this day, the causes of diffuse emphysema have not been fully elucidated, but the connection between chronic obstructive bronchial diseases and the subsequent development of emphysema has been firmly established. Secondary diffuse emphysema is often a consequence of bronchitis, chronic bronchial obstruction, and pneumosclerosis.

Pathogenetically, diffuse emphysema is manifested by functional and mechanical disorders of the lung tissue, which lead to the development of secondary bronchial obstruction, chronic increase in intrathoracic pressure, collapse of the bronchial lumen, pneumosclerosis. These disorders are diffuse in nature, although in some cases the affected area may be small.

It is against the background of changes in emphysema that its symptoms develop: an increase in chest volume, a decrease in the frequency and depth of breathing; bulging of the intercostal spaces and horizontal arrangement of the ribs; panting as a way to compensate for low pressure in the bronchi; percussion boxed sound due to increased air content of the lungs and decreased tissue elasticity.

Complications

The variety of forms of pulmonary emphysema contributes to a large number possible complications. Most of them are typical for all forms of emphysema, but there is a difference in the speed and intensity of their manifestations.

For the same reason, it is impossible to definitely predict the timing of the onset of disability and death: the intensity of the processes, the degree of their prevalence, and the individual characteristics of the patient’s body can influence (and in different directions).

The most frequent complications emphysema are:

• respiratory failure;
• heart failure;
• a complex of symptoms accompanying right ventricular failure;
• spontaneous pneumothorax;
• the addition of an infection, its transition to chronic forms that are difficult to treat.

Treatment with traditional methods

Like allopathic medicine, traditional treatments for emphysema offer supportive care. This is the use of herbs that have a bronchodilator effect, promote better mucus discharge, improve the trophism of the lung tissue, and relieve the appearance of inflammation. As aid folk and herbal remedies are also used to support the activity of the immune system and help prevent infections.

Potato tops, buckwheat, lemon balm and mint, elecampane roots, thyme, and sage are used. Among expectorants, traditional medicine recommends the use of eucalyptus leaves, licorice roots, anise, marshmallow root, and horsetail herb. Herbs can be used individually or in the form of collections, by preparing decoctions and infusions from them.

It should be remembered that treatment traditional methods is auxiliary and requires consistency and careful adherence to recommendations.

Photos of emphysema

In medical histories you can find interesting x-rays, clearly demonstrating the pathological picture of pulmonary emphysema. Bullae are clearly visible in the bullous form - in the form of light round cavities. Depletion of the vascular pattern, flattening of the diaphragm, transparent lung fields are typical for diffuse forms of emphysema.

Pulmonary emphysema (translated as “bloating” from the Greek “emphysema”) is a pathology belonging to chronic obstructive pulmonary disease (COPD), provoking the expansion of the alveoli - the air sacs located in the bronchioles, the destruction of their walls and irreversible changes lung tissue. The lungs increase in volume, and the chest takes on the shape of a barrel. It's deadly dangerous disease when every hour is important to take urgent measures to provide medical care.

Emphysema affects men twice as often, especially those who have reached old age.

The disease has a high risk of disability, disability, and the development of complications in the heart and lungs for males at a younger age.

The pathology is characterized by progressive and chronic courses.

The mechanism of the disease is:

• the predominance of the volume of incoming air over the volume of outgoing air, while the alveoli double in size when stretched;
• accumulation of excess air - carbon dioxide and other impurities - disrupting the blood supply to the lungs and destroying tissue;
• an increase in intrapulmonary pressure, at which the arteries and lung tissue are compressed, shortness of breath and other signs of illness appear;
• thinning of vascular walls, stretched smooth muscles, impaired nutrition in the acinus (structural unit of the lungs);
• the occurrence of oxygen deficiency.

In this mechanism of lung damage, the heart muscle ( Right side) experiences serious stress, resulting in a pathology called chronic cor pulmonale.

It is important to know! Emphysema is a dangerous disease that affects the respiratory and heart systems, causing a lack of oxygen in the lung tissue. Symptoms of shortness of breath as a result of untimely medical care rapidly intensify, which leads to negative consequences and even death.

Emphysema classification system

Character of the current:

• Acute form (caused by increased muscle load, asthmatic attacks, the presence of a foreign body in the bronchi. The lung swells, the alveoli stretch. It is necessary to start treatment urgently).
• Chronic form (transformation in the lung occurs gradually, without medical intervention disability is possible, otherwise, you can be completely cured with initial stage diseases).

Origin:

• Primary emphysema. It is considered as an independent disease diagnosed in infants and sometimes in newborns. A rapidly progressing pathology that develops against the background of congenital characteristics of the body is practically not subject to treatment.
• Emphysema secondary. The disease is associated with obstructive pulmonary pathologies in a chronic course. The problem that has arisen may not be noticed; due to increased symptoms, the ability to work is lost.

Prevalence:

• Diffuse. With this form, the entire lung tissue is affected, the alveoli are destroyed. It is possible to transplant a donor lung after suffering a serious illness.
• Focal. Parenchymal transformations are studied at sites of bronchial blockage, scars and in the area of ​​tuberculosis foci. The symptoms of emphysema are not clearly expressed.

Anatomical features that distinguish the following forms of emphysema:

• Hypertrophic (or panacinar/vesicular). It is registered as a severe form. With respiratory dysfunction, inflammation is not observed, as is the absence of healthy tissue among the damaged and swollen acini.
• Centrilobular. The center of the acinus is affected by destructive processes. Enlarged lumens of the alveoli and bronchi provoke the occurrence of inflammatory process. Mucus is separated into large quantities, the walls of the acini undergo fibrous degeneration. The pulmonary parenchyma, located among the areas that have undergone destructive changes, is not damaged.
• Periacinar (distal/perilobular). Its development is promoted by tuberculosis. The disease often ends in pneumothorax, a rupture of the affected part of the lung.
• Okolorubtsovaya. The manifestation of pathology occurs near fibrous foci and scars in the lung. Symptomatic picture has no obvious signs.
• Bullous or vesicular. The entire parenchyma is affected by bullae of varying sizes (from a few millimeters to 21 centimeters) that arise in places of damaged alveoli. Tissues under the influence of bubbles are compressed, destroyed, and infected.
• Interstitial. Bursted alveoli form air bubbles under the skin. They migrate through the lymph and tissue lumens into the subcutaneous space of the neck and head. Bubbles localized in the lungs contribute to the occurrence of pneumothorex.

Cause:

• Senile type. Appears due to the presence of a modified vascular system, destruction of the elasticity of the alveolar walls due to old age.
• Lobar type. It is registered in newborn children; the disease is promoted by obstruction of any bronchial tube.

It is important to know! Chronic emphysema is typical for adults; children hardly suffer from this disease. Childhood is characterized by a disease of the so-called obstructive type, affecting either one or two lungs. One-sided pathology in a child is most often due to a foreign body entering the bronchi.

Factors influencing the development of emphysema

The occurrence of pathology can be facilitated by causes of external and internal origin associated with:

• bronchitis chronic course obstructive in nature;
• bronchial diseases;
• bronchiolitis of a chronic course of an autoimmune nature;
• interstitial pneumonia;
• tuberculosis;
• congenital features of the respiratory system;
• bad environmental situation, polluted air with harmful impurities;
• active and passive smoking;
• harmful conditions of professional activity;
• unfavorable heredity;
• imbalance of hormones in the body;
• age-related changes;
• respiratory tract infections;
• blocking the lumen of the bronchi with a foreign body.

A specific cause contributing to the onset and progression of emphysema has not been established to date. In scientific circles, it is believed that pathology manifests itself from the combined influence of several factors.

Symptomatic picture of pulmonary emphysema

Painting developing illness dynamic and fast.

The main signs of emphysema are the following:

• strong and sharp pain occurring in the retrosternal region or in one of the halves of the chest;
• rapid decline blood pressure, shortness of breath and difficulty breathing appear;
• wheezing in the lungs;
• the appearance of tachycardia, expansion of the heart to the right side;
• breathing is carried out with the inclusion abdominals and other muscles;
• enlarged neck veins;
• cough with hemoptysis;
• expansion of the sternum, protrusion of the supraclavicular fossa and intercostal segments;
• severe headaches, decreased breathing, sometimes loss of consciousness;
• disturbances in speech, coordination of movement, shortness of breath with any physical effort;
• rapid weight loss;
• prolapse of an enlarged liver;
• manifestation of paresis, paralysis;
• deformation of the nail plates due to insufficient breathing;
• abdominal pain, bloating, liquid stool mixed with blood;
• the skin of the extremities is pale, there is pain in them;
• signs of cyanosis (blueness) on the face;
• numbness of the affected area, which feels more low temperature than other zones;
• the appearance of gangrene on the extremities, manifested by black spots, blisters filled with dark-colored liquid.

These and other signs appear in different cases depending on the type of pathology. The severity of their course is influenced by the duration of the developing disease.

It is important to know! With emphysema, the air subpleural cavities may rupture, resulting in the penetration of air into the pleural cavity. The risk of such a complication is very high.

Diagnostic measures

At the first symptoms of emphysema or suspected pathology, the patient is referred to a pulmonologist or therapist who takes an anamnesis. Using leading questions, the doctor elicits information from the patient that is important for making a diagnosis. Through auscultation - listening to the chest with a phonendoscope, percussion - tapping with fingers - the specialist determines and evaluates possible signs illness.

The doctor prescribes a number of instrumental methods for diagnosing pathology, consisting of:

1. X-rays.
2. MRI of the lungs.
3. Computed tomography of the lungs.
4. Scintigraphy (a gamma camera takes photographs of the lungs after radioactive isotopes are injected into them).
5. Spirometry (using a spirometer that records the volume of air during exhalation and inhalation).
6. Peak flowmetry (measurement maximum indicator exit air velocity to determine bronchial obstruction).
7. Taking blood from a vein to assess the ratio of gas components - oxygen and carbon dioxide.
8. Clinical blood test.

Treatment of emphysema

Treatment for emphysema should have A complex approach and be aimed, first of all, at combating the main causes of the development of the disease. Forms of the disease that do not have a complicated course can be treated at home, regularly consulting with a doctor. Advanced and severe stages require hospital treatment to avoid complicated processes.

Treatment of emphysema is carried out with medication (in order to reduce the progressive processes of cardiac and respiratory failure), in special cases– by surgical intervention, as well as by means alternative medicine, improving respiratory function. The duration of therapy courses is directly dependent on existing complications.

For a significant and rapid expansion of the lumen of the alveoli and bronchi, preference in treatment is given to:

• bronchodilators “Neophylline”, “Berodual”, “Salbutamol”, “Theophylline”;
• antitussive drugs with expectorant action “Ambroxol”, “Bromhexine”, “Libexin”, “Flavamed”, “Gerbion”;
• antibiotics “Ofloxacin”, “Sumamed”, “Amoxiclav”, “Amoxil”, etc., prescribed in the event of the development of complicated disease conditions;
• glucocorticosteroids “Prednisolone”, “Dexamethasone”, which help reduce the inflammatory process in the lungs;
• analgesics "Pentalgin", "Analgin", "Ketalong", "Sedalgin" - in cases of strong pain in the sternal region;
• vitamins “Undevita”, “Dekamevit”, multivitamin complexes in order to strengthen the immune system.

It is important to know! All medications are taken only as prescribed by a doctor and under his supervision to avoid complicating processes.

Smoking and drinking alcohol with emphysema is strictly prohibited, as this aggravates the development of the disease.

Application of the surgical method

Surgery is resorted to in cases of unsuccessful drug treatment, a large area of ​​​​pulmonary damage, and also taking into account the absence of contraindications to intracavitary surgery.

A patient cannot undergo surgery if he:

• severely exhausted;
• has a chest deformity;
• suffers from severe bronchitis, asthma, pneumonia;
• in old age.

Surgical assistance is indicated in situations:

• formation of multiple bullae in an area occupying a third of the chest;
• presence of severe shortness of breath;
• pneumothorax, infectious/oncological processes, sputum mixed with blood;
• regular hospitalizations;
• transformation of pathology into severe forms.

Surgical intervention is divided into several types, including:

• transplantation of a donor lung (in case of formation of multiple bullae, a large area of ​​affected lungs);
• elimination of affected areas with a reduction in lung volume to 1/4 by opening the sternum;
• thoracoscopy (resection of affected areas of the lungs using a minimally invasive method);
• bronchoscopy (carried out through the mouth if the damaged area is located near large bronchi).

Surgical treatment restores lung ventilation, no longer compressed by the affected parts of the organ. Improvement in condition is recorded after three months from the date of surgery. But shortness of breath may return seven years after surgery.

How to eat with emphysema

For this pathology, diets No. 11 and No. 15 are used, which can have a strengthening effect on protective functions body, replenish energy reserves and remove toxins.

Dietary nutrition consists of the following principles:

• daily calorie content should be at least 3600 Kk with six meals a day in small portions;
• daily fat content (as a result of consuming vegetable oils, butter, fatty dairy products) – up to 100 g;
• daily protein intake is 110-115 g (they contain eggs, meat of all types, fish, seafood, liver, etc.);
• carbohydrates must complement daily ration in a volume of up to 0.4 kg (cereals, bread, honey, pasta, etc.);
• consumption of fruits, vegetables, bran to provide the body with vitamins and fiber;
• drinking juices, kumis, rosehip compote;
• limiting salt to 5 g to prevent swelling and cardiac dysfunction.

It is important to know! Patients with emphysema exclude from the diet alcoholic beverages, cooking fats, sweets, baked goods, cakes, pastries and other products containing a high percentage of fat.

The use of traditional medicine methods in the treatment of emphysema

As mentioned above, in uncomplicated forms of pathology it is possible to be treated at home, using folk remedies in addition to medications. They have proven themselves in practice and are easy to use.

• freshly squeezed potato juice(drink up to three times a day), which effectively affects the organs of the respiratory tract;
• natural honey (a large spoon three times a day), which has an anti-inflammatory effect;
• lemon balm (for 30 g, 0.5 liters of boiling water, infuse throughout the day, consume 30 ml twice a day);
• walnuts (eat up to 2 g every day);
• plantain (for 20 g of dry leaves, 500 ml of boiling water, leave for three days, strain, drink 15 ml twice a day for a month);
• steam inhalation over potatoes (for an anti-inflammatory effect).

In fact, traditional medicine offers a huge selection of recipes herbal decoctions and infusions for pulmonary emphysema, but each patient, after consultation with a doctor, settles on what is acceptable to him in order to avoid various complications, for example, allergic ones.

The patient is also recommended to perform breathing exercises to improve oxygen exchange and restore impaired functions of the bronchi and alveoli. During the day, you should do the following exercise four times for 15 minutes: deep breath, holding your breath with periodic “fractional” exhalation.

Application of coursework (up to 20 days) therapeutic warming massage The chest helps improve breathing by expanding the bronchi, coughing, and expectoration of sputum. After the course you need to take a break for 14 days.

Prevention of emphysema

Among the most important preventive measures There are simple rules regarding:

• quitting smoking, drinking alcohol, and using drugs;
• immediate treatment of diseases of the bronchi and other organs involved in the breathing process;
• physical education classes medical direction, as well as sports on an ongoing basis;
• compliance with personal hygiene standards;
• using personal respiratory protection equipment, avoiding inhalation of dust, exhaust gases, chemical, toxic, carcinogenic substances, etc.;
• daily walks in the fresh air in the forest, park areas;
• strengthening the immune system using both pharmaceutical and folk remedies.

Forecast

It should be remembered that this disease is dangerous and is related to bronchopulmonary pathologies. Consequently, the altered lung tissue is not restored. Treatment consists of slowing down the progressive process and reducing signs of respiratory dysfunction by ensuring bronchial patency.

The prognosis of the disease is based on the timeliness and adequacy of treatment for the underlying pathology, the duration of the disease, and adherence to the rules of “behavior” by the patient. It is impossible to completely get rid of emphysema, but medicine can influence the developing process. If you follow the recommendations of specialists, a person can lead his usual lifestyle. This prognosis against the background of a stable course with maintenance of a minimal level of emphysema can be considered favorable.

With severe pathology, the prognosis may not be favorable. Patients must use expensive medications throughout their lives to maintain the necessary respiratory parameters. Such people cannot hope for an improvement in their condition.

Life extension is directly dependent on the patient’s age, the body’s ability to recover and compensate to the required extent for the pathological process.

Emphysema implies chronic pathology lungs, the alveoli are affected, they lose their natural ability to contract. The disease in 90% of cases is accompanied by respiratory failure. Frequent warning signs of emphysema are long-term illnesses organs of the respiratory system, such as bronchitis, pneumonia. Pathology in the medical environment is considered insidious, since it has no obvious manifestations and can develop over a fairly long period of time without causing severe discomfort to the patient.

Emphysema comes from the word “to bloat” and represents the process of disruption of gas exchange in the lungs and respiratory function. The alveoli, which are located at the endings, have a responsible function - they help in the breathing process. When a person inhales air, they fill and swell like a small ball; when exhaling, they become the same due to natural contractions.

Emphysema is a disorder this process when the result various diseases respiratory organs, the alveoli begin to perform increased work, the air pressure in them increases, which leads to their stretching. This is where the derivative of the definition comes from – “to inflate”.

When the alveoli lose their ability to participate in the breathing process as before, the lungs begin to suffer. Impaired gas exchange leads to the fact that in the lungs there is increased amount air, this helps malfunction organ. If the pathology is not noticed and treated in time, it can spread to the heart and lead to complications. Often, every third patient has a history of cardiac or respiratory failure.

Emphysema in medicine has a specific classification. On its basis, the disease is divided according to the nature of its manifestations, its prevalence, anatomical features and origin. It is possible to consider the classification of emphysema in more detail using the table presented.

The classification helps specialists understand what to focus on during therapy and which treatment methods to use.

Symptoms and first complaints

Emphysema is a pathology that is difficult to recognize immediately, since at the initial stage the symptoms are minor. It can be confused with signs viral infection or inflammatory process in the bronchi, trachea. Without medical examination It is extremely difficult to recognize the disease, so even when it appears minor symptoms cough and accompanying symptoms respiratory infection, you need to contact a specialist.

Signs of pulmonary emphysema include the following manifestations.

1. Cyanosis. This strange definition speaks of the pathology that often accompanies emphysema. It is expressed in a bluish tint to the earlobes, tip of the nose and nails. The manifestation is associated with oxygen starvation body, resulting in pallor skin and a bluish tint. The capillaries cannot fully fill with blood.
2. Shortness of breath, which manifests itself slightly at the initial stage and only during physical activity. Over time, the patient begins to notice strangeness in breathing; during inhalation, it seems that there is not enough air, and the process of exhalation becomes difficult and lengthy. The symptoms are associated with the accumulation of mucus in the lung cavity.
3. “Pink puffer” - this strange definition also refers to the symptoms of the disease. With emphysema, the patient is plagued by coughing attacks. At the same time, the skin of the face becomes pink. This distinguishing feature from COPD, since with the latter illness, during the coughing process, the person’s face takes on a bluish tint.
4. Swelling of the veins in the neck, associated with increased pressure inside the sternum, which is reflected in a coughing attack. During it, the neck veins swell, the same phenomenon can be observed when exhaling.
5. Losing weight. Due to the intense work of the respiratory muscles, a person begins to lose weight over time, which becomes noticeable to others.
6. Intensive functioning of the respiratory muscles is associated with increased work diaphragm, intercostal muscles and abdominals. They help the lungs stretch when inhaling, since the organ loses this function with emphysema.
7. Changes in the location and size of the liver. These symptoms can only be detected through diagnosis. It is one of the components in making a diagnosis. When examining the patient, a specific position of the diaphragm may be detected; it should be elevated. As a result, the localization of the liver changes under its influence. The decrease in size of the organ is associated with stagnation of blood in its vessels.

Experienced specialists can already appearance make a diagnosis of pulmonary emphysema. They focus on external manifestations that occur in patients with chronic form illness. This is a shortening of the neck, protrusion of the supraclavicular fossa, the patient’s chest looks voluminous. In addition, the specialist may ask the patient to breathe and then note the specific location of the diaphragm and abdomen, which becomes saggy under its pressure. When inhaling, there is a protrusion of the intercostal muscles; they seem to stretch under the pressure of air.

Causes leading to illness

According to statistics, about 60% of patients affected by emphysema had a history of other pathologies of the respiratory system. Pneumonia, Chronical bronchitis, bronchial asthma, tuberculosis - can cause the development of the disease.

There are other reasons that are worth paying attention to, because many of them are related to a person’s daily lifestyle. For example, the state environment, in the area where the patient works or lives. If a person is exposed to coal dust, smog, toxic substances, nitrogen and sulfur released during the operation of enterprises, then his lungs may eventually fail. In a polluted atmosphere, they operate with increased efficiency and at the same time are penetrated harmful substances, which affects the condition.

Separately, it is worth mentioning about smokers, since inhaling tobacco smoke vapors can lead to diseases of the bronchi and lungs. Nicotine lovers may eventually develop bronchial asthma, followed by emphysema, if the person does not stop smoking. Constant cough should make you think about immediately eliminating the dangerous habit.

The disease can also occur in newborns. This is due to several factors:

• congenital defects in the structure of lung tissue;
• congenital deficiency of α-1 antitrypsin, when the walls of the alveoli are destroyed independently;
• heredity, expressed in insufficient functioning of the respiratory organs, while over time the elasticity and strength of lung tissue is impaired.

In adults, the cause of the disease can be hormonal in nature, when the ratio between estrogens and androgens is disrupted. Hormones are involved in the process of contraction of bronchioles. Therefore, if the balance is disturbed, they can stretch over time, but do not affect the functioning of the alveoli. Age-related changes should also be taken into account. In old age, the lungs do not have the same density, strength, and elasticity as at a young age.

Doctors identify causes that relate to increased pressure in the lungs. As a rule, it is because of this process that emphysema develops. Negative pressure can form in the lungs when the bronchial lumen is blocked, or when harmful work, which implies an increase in air pressure in the lungs, for example, in trumpet musicians.

Modern experts will never take into account one factor that could influence the development of pathology, since they believe that only a combination of several reasons can contribute to emphysema.

Features of the disease in children

According to statistics among children, infants are more often susceptible to pathology, boys have greater risk than girls in the development of the disease. Several factors are considered to be the cause of pulmonary emphysema in newborns. One of them is associated with congenital characteristics, that is, the process abnormal development organ and respiration occurs in the perinatal period. The second one talks about, but modern experts believe that this factor is no longer relevant.

Numerous observations and studies have proven that a common cause of emphysema in children is insufficient development of tissues, the organ itself or a separate bronchus. Lung stretching is caused by a pathological process when, during breathing, the bronchi narrow and the alveoli slow down the flow of oxygen that is in the lungs.

Congenital emphysema has symptoms that any parent will undoubtedly notice:

• tachycardia;
• shortness of breath, which manifests itself quite clearly in childhood;
• there is a blue tint of the skin in the area of ​​the nose and lips;
• during an attack, the child may lose consciousness due to lack of air;
• breathing is accompanied by a distinct whistle.

In childhood, there are several forms of the disease: decompensated, subcompensated, compensated. The first appears in the first days of a baby’s life and is observed in premature babies. It is easy to recognize this form of the disease; the symptoms manifest themselves clearly. The second one is not talking about congenital pathology, but acquired.

Symptoms may appear several years after birth; they will be subtle at the initial stage.

The compensated form is considered the most dangerous, since it does not imply the presence of severe symptoms. Signs of the disease may be completely absent, which complicates the diagnostic process.

Surgery for pulmonary emphysema is indicated for children. In case of decompensated form, it should be carried out urgently. Subcompensated and compensated imply elective surgery.

How to treat - drugs for emphysema

Therapy is usually prescribed not only by the therapist, but by the treating pulmonologist. Without his consultation, it is impossible to obtain an adequate treatment plan. All activities are subject to patient compliance special diet, giving up bad habits, oxygen therapy is prescribed, therapeutic physical training and massage are prescribed. The treatment complex also includes taking special medications that help eliminate the manifestations of the disease.

1. Inhibitors are prescribed, for example, Prolastin. It helps reduce the level of enzymes through protein content that destroy the connective fibers of organ tissue.
2. Antioxidants are prescribed to improve tissue nutrition and metabolism. They help slow down and eliminate the pathological process occurring in the alveoli. The representative is Vitamin E.
3. A prerequisite is the use of mucolytic drugs, such as Lazolvan or ACC. They thin out mucus, help faster, and reduce the production of free radicals.
4. Teopek is a bronchodilator inhibitor, often used for pulmonary emphysema. It leads to relaxation of the smooth muscles of the bronchi, reduces mucous swelling and helps to expand the lumen in the organ.
5. Prednidazole is a glucocorticosteroid. Prescribed only if bronchodilator therapy is ineffective. It has a strong anti-inflammatory effect on the lungs and helps expand the lumen of the bronchi.
6. Atrovent is used in the form of inhalations. The drug is used together with saline solution in a nebulizer. Prevents bronchospasm, improves the breathing process.
7. Theophyllines are prescribed; these are long-acting medications that help eliminate pulmonary hypertension. They help the respiratory system not to get tired by influencing its muscles.

In addition to a set of medications, massage, oxygen therapy, therapeutic exercises and diet, specialists can prescribe breathing exercises. It helps strengthen the respiratory muscles and restore the process of natural inhalation and exhalation, which was disrupted by emphysema.

Folk remedies

In combination with drug treatment, you can use the advice of traditional medicine. Before using a specific recipe, you should consult with a therapist and pulmonologist; each plant has its own contraindications for use, and individual individual in relation to the reaction to herbal medicine.

Among the numerous traditional medicine treatments for emphysema, the following 3 recipes are popular.

1. An infusion of coltsfoot can help with complex therapy emphysema. It is necessary to collect the leaves of the plant and dry it; only ground components are used. They are taken per 1 tbsp. spoon of leaves 2 cups of boiling water. The duration of exposure to boiling water should be at least an hour. After the infusion, use 1 tbsp. spoon 6 times a day.
2. You can use a collection of herbs: sage, eucalyptus, raspberry leaves, thyme and elecampane root. The components are used in equal proportions, usually a measure of 1 tbsp is used. spoon, pour a glass of boiling water and infuse for 60 minutes. The decoction is great for coping with shortness of breath. Apply after straining ¼ cup per day, 4 times.
3. There is a simple recipe that does not cost money. Potato flowers are used. 1 teaspoon of the plant is poured into a glass of boiling water and infused for 2 hours. Use the decoction for shortness of breath, strain and drink 1/2 cup half an hour before meals, 3 times a day.

Life forecast - how long do people live with emphysema?

For the patient's life expectancy after therapeutic effects many factors may influence. There are no specific statistics that could indicate favorable or unfavorable development of emphysema after surgery or conservative treatment. The further development of the pathology and life of the patient depends on individual characteristics the body and the patient himself, to what extent he adheres to the specialist’s recommendations.

Separately, there is a forecast for morbidity among patients who have a genetic form of pathology, because life expectancy in this case depends on heredity.

After therapy it is advisable to undergo special examination, which helps determine breathing capacity sick. It is carried out through a test that determines the volume of air exhaled by a person over a certain period of time, indexes the patient’s body weight, and diagnoses the presence of shortness of breath. Based on the results of the study, a professional can draw a picture of the further development of the disease and whether relapses are possible.

Much depends on the patient’s life and lifestyle. If the patient refuses to eliminate bad habits or change working conditions, this can adjust the doctors’ prognosis in a negative direction.

Patients in whom it was possible to detect the pathology in time and carry out treatment can count on a favorable outcome. adequate treatment. People who follow all the doctor’s recommendations during the postoperative or therapeutic period can also count on a positive outcome.

In children, the life prognosis depends on the form of the pathology and how early neonatologists or pediatricians were able to detect the disease and proceed to its treatment. If a child experiences frequent relapses of inflammatory processes in the respiratory system, for example, tracheitis, bronchitis, pneumonia, it is necessary to urgently consult a pulmonologist to examine the lungs in order to exclude the possibility of the formation of emphysema.

It is easier to prevent any illness than to treat it; every person needs to monitor their lifestyle. Availability negative factors, bad habits, heredity can cause the development of pathology. By eliminating the causes that influence the predisposition to the development of emphysema, the occurrence of pathology can be prevented.

– serious chronic illness respiratory system, leads to disability in many cases. Occurs as a result of a violation of the breathing process. With the proper functioning of the human respiratory system, which performs the gas exchange function, inhaled oxygen from the lungs enters the blood and spreads throughout the body. After the oxidation process, oxygen turns into carbon dioxide and goes back out through the lungs.

With pulmonary emphysema, the gas exchange process is disrupted; some of the oxygen is not distributed throughout the body, but accumulates in the lungs. The lungs increase in size, breathing becomes difficult: some of the air is already in the lungs and there is no room left for a new portion of oxygen. This defect occurs as a result of a violation of elasticity (microbubbles in the lungs through which gas exchange occurs) and their increased volume. Overstretched bubbles (sacs) cannot fully contract, and therefore air remains in them.

The process can involve both part of the lung and the entire volume. Depending on the prevalence of the process, the forms of the disease are distinguished:

• diffuse
• local
• bullous

Air sacs of different sizes, formed in the lungs in large quantities and scattered throughout the entire volume of the lung, give diffuse form diseases. If swollen areas alternate with normal lung tissue, then the local form of the disease is determined. Bullous emphysema is a form of the disease in which the size of the cavity of the stretched sac exceeds 1 cm.

Women are more susceptible to the disease. Age category, located under increased risk- people over 60 years old.

Causes

In most cases, emphysema is a consequence of other chronic pulmonary diseases. First of all . The inflammatory process moves from the bronchi to the adjacent alveoli and occurs suitable conditions for the process of stretching and disruption of the elasticity of the alveoli (the pressure in them increases). This type of emphysema is secondary.

There is also a primary form of the disease. The causes of pulmonary emphysema in this form are associated with a deficiency in the human body of a protein called alpha-1-antitrypsin, the deficiency of which leads to damage to lung tissue (impaired elasticity, decreased strength). The disease occurs without previous pulmonary disease. Protein deficiency is associated with the human genetic apparatus, to which the defect is inherited, or its deficiency arises as a result of exposure to aggressive factors on the lungs:

• tobacco smoke when smoking;
• sulfur and nitrogen dioxide - exhaust gases from transport and thermal power plants;
• increased concentrations of ozone in the air;
• other toxic substances, inhalation of which is associated with professional activity miners, builders and others.

Symptoms

On initial stages disease, signs of pulmonary emphysema are practically not noticeable and may appear to a small extent with physical activity in the form of shortness of breath. Shortness of breath, which initially occurs in winter and with significant effort, gradually becomes permanent and occurs at rest. The characteristic breathing in the form of a shallow, rapid inhalation and a long, labored exhalation is similar to “puffing” with puffed out cheeks, while the skin acquires a characteristic pink color.

Over time, the disease progresses, and the symptoms of emphysema become more pronounced. In addition to severe shortness of breath, other signs of oxygen starvation are added:

• cyanosis (blueness of the tongue, lips, nails);
• the chest takes on a barrel-shaped appearance (due to increased volume);
• expansion and/or bulging of intercostal spaces and supraclavicular areas;
• the fingers take on the appearance of drumsticks (the last phalanx is expanded).

There is a decrease in the patient's body weight, associated with fatigue of the respiratory muscles, which are heavily loaded to facilitate exhalation. Severe weight loss indicates an aggressive course of the disease.

Diagnostics

If pulmonary emphysema is suspected, a doctor (pulmonologist or therapist) will initial examination which includes an external examination, listening to the lungs with a stethoscope, tapping chest.

Further diagnosis of emphysema includes pulmonary function testing. Using certain instruments, the tidal volume of the lungs, the degree of respiratory failure, and the degree of narrowing of the bronchi are determined. Respiratory parameters are measured at normal respiratory rhythm and after several deep inhalations/exhalations. Can also be carried out breath tests after using bronchodilators. These methods reveal the differences between emphysema and bronchial asthma and bronchitis.

Necessary X-ray examination chest organs. In the image, the doctor determines the presence of defects in the form of enlarged cavities, weakening of the vascular pulmonary pattern, and assesses the volume of the lungs. If it is expanded as a result of illness, then the image shows a downward shift of the diaphragm. A CT scan reveals cavities in the lungs and their exact location.

Treatment

The treatment plan for the disease is determined by a therapist or pulmonologist. Treatment of emphysema is carried out at home and is aimed at alleviating the signs of respiratory failure and reducing its further development, since a complete recovery is impossible.

If the patient smokes, quitting smoking is very important in treating the disease. It is also necessary to limit respiratory contact with harmful substances. Non-drug treatment methods are widely used:

• diet. The diet should have enough vitamins and microelements. Raw fruits, vegetables, juices are required. Low calorie content. The daily norm is 800 kcal, in case of severe respiratory failure - 600 kcal;
• oxygen therapy (inhalation of oxygen). The course of treatment is prescribed by the doctor. Duration is usually 2-3 weeks;
• massage. Helps dilate the bronchi and remove mucus. Various massage techniques are used, including acupressure;
• physiotherapy. It is used to reduce tension in the respiratory muscles, which get tired very quickly with emphysema. The doctor will tell you about all the exercises;

Exacerbation of the inflammatory process requires the prescription of drug treatment, which includes taking antibacterial, bronchodilator drugs and agents that facilitate the removal of sputum.

In the case of bullous emphysema, it may be indicated surgical removal bullae (stretched abdominal sacs). Removal methods depend on the location and size: endoscopic (through small punctures using special instruments) or traditional surgical with an incision in the chest.

Possible complications

The severity of the disease and its negative impact on the respiratory system increases in the case of complications of pulmonary emphysema. Possible complications are associated with:

• development, formation;
• respiratory failure resulting from impaired gas exchange in the lungs;
• pneumothorax. There is a dangerous accumulation of air in the chest as a result of rupture of the stretched cavity;
• heart failure;
• pulmonary hemorrhage. When the wall between the alveoli is destroyed, bleeding may occur.

To prevent complications of the disease, you must carefully follow all the instructions of your doctor. This will improve the quality of life with this incurable disease and delay the onset of disability.