Pulmonary emphysema: what it is, treatment, symptoms, causes, signs. Pulmonary emphysema: what is it, symptoms, treatment

Emphysema– a chronic lung disease characterized by the expansion of small bronchioles (the terminal branches of the bronchi) and the destruction of the partitions between the alveoli. The name of the disease comes from the Greek emphysao - to swell. Air-filled voids form in the lung tissue, and the organ itself swells and increases significantly in volume.

Manifestations of emphysema– shortness of breath, difficulty breathing, cough with a small amount of mucous sputum, signs of respiratory failure. Over time, the chest expands and takes on a characteristic barrel shape.

Reasons for development emphysema divided into two groups:

• Factors that impair the elasticity and strength of lung tissue are inhalation of polluted air, smoking, congenital deficiency of alpha-1-antitrypsin (a substance that stops the destruction of the walls of the alveoli).
• Factors that increase air pressure in the bronchi and alveoli are chronic obstructive bronchitis, blockage of the bronchus by a foreign body.

Risk of developing the disease some categories are higher than 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.

Anatomy of the lungs

Each lung is surrounded by a two-layer membrane, the pleura. One of its layers fuses with the lung, and the other with the chest. Between the sheets of pleura there remains a space - the pleural cavity, in which there is a certain amount of pleural fluid. This structure helps the lungs stretch during inhalation.

Due to anatomical features, the right lung is 10% larger than the left. The right lung consists of three lobes, and the left lung has two. The lobes are divided into segments, which in turn are divided into secondary lobules. The latter consist of 10-15 acini.
The gates of the lung are located on inner surface. This is the place where the bronchi, arteries, and veins enter the lung. Together they form the root of the lung.

Lung functions:

• ensure blood saturation with oxygen and removal of carbon dioxide
• participate in heat exchange due to liquid evaporation
• secrete immunoglobulin A and other substances to protect against infections
• participate in the transformation of the hormone angiotensin, which causes vasoconstriction

1. bronchi, through which air enters the lungs;
2. alveoli, where gas exchange occurs;
3. blood vessels that carry blood from the heart to the lungs and back to the heart;

1. Trachea and bronchi- called the respiratory tract.

   The trachea at the level of 4-5 vertebrae is divided into 2 bronchi - right and left. Each of the bronchi enters the lung and forms a bronchial tree there. The right and left are the bronchi of the 1st order; at the place of their branching, the bronchi of the 2nd order are formed. The smallest are bronchi of the 15th order.

   Small bronchi branch, forming 16-18 thin respiratory bronchioles. Alveolar ducts depart from each of them, ending in thin-walled vesicles - alveoli.

   Bronchial function– ensure the passage of air from the trachea to the alveoli and back.

   Structure of the bronchi.

   1. Cartilaginous base of the bronchi
      • large bronchi outside the lung consist of cartilaginous rings
      • large bronchi inside the lung - cartilaginous connections appear between the cartilaginous half-rings. Thus, the lattice structure of the bronchi is ensured.
      • small bronchi - cartilage looks like plates, the smaller the bronchus, the thinner the plates
      • the terminal small bronchi do not have cartilage. Their walls contain only elastic fibers and smooth muscles
   2. Muscle layer bronchi– smooth muscles are arranged circularly. They provide narrowing and expansion of the lumen of the bronchi. At the site of the branching of the bronchi there are special bundles of muscles that can completely block the entrance to the bronchus and cause its obstruction.
   3. ciliated epithelium, lining the lumen of the bronchi, performs a protective function - protects against airborne infections by drip. Small villi remove bacteria and small dust particles from distant bronchi into larger bronchi. From there they are removed when coughing.
   4. Lung glands
      • single-celled glands that secrete mucus
      • small lymph nodes connected to larger lymph nodes in the mediastinum and trachea.
2. Alveolus – a bubble in the lungs, entwined with a network of blood capillaries. The lungs contain more than 700 million alveoli. This structure allows you to increase the surface area in which gas exchange occurs. It enters the vesicle through the bronchi atmospheric air. Oxygen is absorbed into the blood through the thinnest wall, and carbon dioxide is released into the alveoli during exhalation.

   The area around the bronchiole is called the acinus. It resembles a bunch of grapes and consists of branches of the bronchioles, alveolar ducts and the alveoli themselves

3. Blood vessels. Blood enters the lungs from the right ventricle. It contains little oxygen and a lot of carbon dioxide. In the capillaries of the alveoli, the blood is enriched with oxygen and releases carbon dioxide. After this, it collects in the veins and enters the left atrium.

Causes of emphysema

1. Impaired elasticity and strength of lung tissue:
   • Congenital α-1 antitrypsin deficiency. In people with this abnormality, proteolytic enzymes (whose function is to destroy bacteria) destroy the walls of the alveoli. While normally α-1 antitrypsin neutralizes these enzymes within a few tenths of a second after their release.
   • Congenital defects in the structure of lung tissue. Due to their structural features, the bronchioles collapse and the pressure in the alveoli increases.
   • Inhalation of polluted air: smog, tobacco smoke, coal dust, toxic substances. The most dangerous in this regard are cadmium, nitrogen and sulfur oxides emitted by thermal power plants and transport. Their tiny particles penetrate the bronchioles and are deposited on their walls. They damage the ciliated epithelium and vessels feeding the alveoli and also activate special cells, alveolar macrophages.

     They help increase the level of neutrophil elastase, a proteolytic enzyme that destroys the walls of the alveoli.

   • Hormonal imbalance. An imbalance between androgens and estrogens impairs the ability of bronchiole smooth muscles to contract. This leads to stretching of the bronchioles and the formation of cavities without destruction of the alveoli.
   • Respiratory tract infections: chronic bronchitis, pneumonia. Immune cells, macrophages and lymphocytes, exhibit proteolytic activity: they produce enzymes that dissolve bacteria and the protein that makes up the walls of the alveoli.

     In addition, clots of sputum in the bronchi allow air into the alveoli, but do not release it in the opposite direction.

     This leads to overfilling and overstretching of the alveolar sacs.

   • Age-related changes associated with poor circulation. In addition, older people are more sensitive to toxic substances in the air. With bronchitis and pneumonia, lung tissue recovers worse.
2. Increased pressure in the lungs.
   • Chronic obstructive bronchitis. The patency of the small bronchi is impaired. When you exhale, air remains in them. With a new breath, a new portion of air enters, which leads to overstretching of the bronchioles and alveoli. Over time, disturbances occur in their walls, leading to the formation of cavities.
   • Occupational hazards. Glassblowers, wind players. A feature of these professions is an increase in air pressure in the lungs. The smooth muscles in the bronchi gradually weaken, and blood circulation in their walls is disrupted. When you exhale, all the air is not expelled; a new portion is added to it. A vicious circle develops, leading to the appearance of cavities.
   • Blockage of the lumen of the bronchus a foreign body leads to the fact that the air remaining in the segment of the lung cannot escape out. An acute form of emphysema develops.
   Scientists were unable to establish exact reason development of pulmonary emphysema. They believe that the appearance of the disease is associated with a combination of several factors that simultaneously affect the body.

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 emphysema

According to the nature of the flow:

• Acute. It develops during an attack of bronchial asthma, a foreign object entering the bronchi, or sudden physical exertion. Accompanied by overstretching of the alveoli and swelling of the lung. This condition is reversible but requires urgent medical attention.
• Chronic. Develops gradually. At an early stage, the changes are reversible. But without treatment, the disease progresses and can lead to disability.

• Primary emphysema. An independent disease that develops in connection with the congenital characteristics of the body. It can even be diagnosed in infants. It progresses quickly and is more difficult to treat.
• Secondary emphysema. The disease occurs against the background of chronic obstructive pulmonary diseases. The onset often goes unnoticed; symptoms intensify gradually, leading to decreased ability to work. Without treatment, large cavities appear that can occupy an entire lobe of the lung.

• Diffuse form. The lung tissue is uniformly affected. Alveoli are destroyed throughout the lung tissue. At severe forms A lung transplant may be required.
• Focal form. Changes occur around tuberculosis foci, scars, in places where a blocked bronchus approaches. Manifestations of the disease are less pronounced.

• Panacinar emphysema(vesicular, hypertrophic). All acini in the lung lobe or the whole lung are damaged and swollen. There is no healthy tissue between them. The connective tissue in the lung does not grow. In most cases there are no signs of inflammation, but there are manifestations of respiratory failure. Formed in patients with severe emphysema.
• Centrilobular emphysema. Damage to individual alveoli in the central part of the acinus. The lumen of the bronchioles and alveoli expands, this is accompanied by inflammation and mucus secretion. Fibrous tissue develops on the walls of damaged acini. Between the changed areas, the parenchyma (tissue) of the lungs remains intact and performs its function.
• Periacinar(distal, perilobular, paraseptal) - damage to the extreme parts of the acinus near the pleura. This form develops with tuberculosis and can lead to pneumothorax - rupture of the affected area of ​​the lung.
• Okolorubtsovaya– develops around scars and areas of fibrosis in the lungs. Symptoms of the disease are usually mild.
• Bullous(bubble) shape. In place of the destroyed alveoli, bubbles form, ranging in size from 0.5 to 20 cm or more. They can be located near the pleura or throughout lung tissue, mainly in upper lobes. Bullae can become infected, compress surrounding tissue, or rupture.
• Interstitial(subcutaneous) - characterized by the appearance of air bubbles under the skin. The alveoli rupture, and air bubbles rise through the lymphatic and tissue gaps under the skin of the neck and head. Bubbles may remain in the lungs, and when they rupture, spontaneous pneumothorax occurs.

• Compensatory– develops after removal of one lobe of the lung. When healthy areas swell, trying to take up the vacant space. Enlarged alveoli are surrounded by healthy capillaries, and there is no inflammation in the bronchi. The respiratory function of the lungs does not improve.
• Senile– caused by age-related changes in the vessels of the lungs and the destruction of elastic fibers in the wall of the alveoli.
• Lobarnaya– occurs in newborns, more often boys. Its appearance is associated with obstruction of one of the bronchi.

Symptoms of emphysema

Diagnosis of emphysema

Examination by a doctor

Instrumental methods for diagnosing pulmonary emphysema

1. Radiography– examination of the lung condition using x-rays, as a result of which an image of internal organs is obtained on film (paper). A general X-ray of the chest is taken in a direct projection. This means that the patient faces the device during the shooting. An overview image allows you to identify pathological changes in the respiratory organs and the extent of their spread. If the image shows signs of disease, then additional tests are prescribed: MRI, CT, spirometry, peak flowmetry.

   Indications:

   • Once a year as part of a preventive examination
   • prolonged cough
   • dyspnea
   • wheezing, pleural friction noise
   • decreased breathing
   • pneumothorax
   • suspected emphysema, chronic bronchitis, pneumonia, pulmonary tuberculosis
   Contraindications:
   • breastfeeding period
   Symptoms of pulmonary emphysema:
   • the lungs are enlarged, they compress the mediastinum and overlap each other
   • affected areas of the lung appear excessively transparent
   • expansion of intercostal spaces during active muscle work
   • the lower edge of the lungs is drooping
   • low aperture
   • reduction in the number of blood vessels
   • bullae and areas of tissue airing
2. Magnetic resonance imaging (MRI) of the lungs- a study of the lungs based on the resonant absorption of radio waves by hydrogen atoms in cells, and sensitive equipment records these changes. MRI of the lungs provides information about the condition of large bronchi, vessels, lymphoid tissue, the presence of fluid and focal formations in the lungs. Allows you to obtain sections 10 mm thick and view them from different positions. To study the upper parts of the lungs and areas around the spine, a contrast agent called gadolinium is injected intravenously.

   Disadvantage: air prevents accurate visualization of small bronchi and alveoli, especially at the periphery of the lungs. Therefore, the cellular structure of the alveoli and the degree of destruction of the walls are not clearly visible.

   The procedure lasts 30-40 minutes. During this time, the patient must lie motionless in the magnetic tomograph tunnel. MRI does not involve radiation, so the study is permitted for pregnant and breastfeeding women.

   Indications:

   • there are symptoms of the disease, but no changes can be detected on an x-ray
   • tumors, cysts
   • suspicion of tuberculosis, sarcoidosis, in which small focal changes are formed
   • enlarged intrathoracic lymph nodes
   • abnormal development of the bronchi, lungs and their vessels
   Contraindications:
   • presence of a pacemaker
   • metal implants, staples, fragments
   • mental illness that do not allow lying for a long time without moving
   • patient weight over 150 kg
   Symptoms of emphysema:
   • damage to the alveolar capillaries at the site of destruction of lung tissue
   • circulatory disorders in small pulmonary vessels
   • signs of compression of healthy tissue by expanded areas of the lung
   • increase in pleural fluid volume
   • increase in the size of the affected lungs
   • cavities-bullae different sizes
   • low aperture
3. Computed tomography (CT) of the lungs allow you to obtain a layer-by-layer image of the structure of the lungs. CT is based on the absorption and reflection of X-rays by tissues. Based on the data obtained, the computer creates a layer-by-layer image with a thickness of 1mm-1cm. The study is informative on early stages diseases. When a contrast agent is administered, CT provides more complete information about the state of the pulmonary vessels.

   During a CT scan of the lungs, the X-ray emitter rotates around the patient lying motionless. The scan lasts about 30 seconds. The doctor will ask you to hold your breath several times. The whole procedure takes no more than 20 minutes. Using computer processing, X-ray images taken from different points are summarized into a layer-by-layer image.

   Flaw– significant radiation exposure.

   Indications:

   • if symptoms are present, no changes are detected on the x-ray or they need to be clarified
   • diseases with the formation of foci or diffuse damage to the lung parenchyma
   • chronic bronchitis, emphysema
   • before bronchoscopy and lung biopsy
   • decision on the operation
   Contraindications:
   • allergy to contrast agent
   • extremely serious patient condition
   • severe diabetes mellitus
   • renal failure
   • pregnancy
   • patient weight exceeding the capabilities of the device
   Symptoms of emphysema:
   • an increase in the optical density of the lung to -860-940 HU – these are airy areas of the lung
   • expansion of the roots of the lungs - large vessels entering the lung
   • dilated cells are noticeable - areas of alveolar fusion
   • reveals the size and location of bullae
4. Lung scintigraphy – injection of labeled radioactive isotopes into the lungs, followed by a series of images taken with a rotating gamma camera. Preparations of technetium - 99 M are administered intravenously or in the form of an aerosol.

   The patient is placed on a table around which the sensor rotates.

   Indications:

   • early diagnosis of vascular changes in emphysema
   • monitoring the effectiveness of treatment
   • assessment of lung condition before surgery
   • suspicion of oncological diseases lungs
   Contraindications:
   • pregnancy
   Symptoms of emphysema:
   • compression of lung tissue
   • disturbance of blood flow in small capillaries


5. Spirometry – functional examination of the lungs, volume study external respiration. The procedure is carried out using a spirometer device, which records the amount of air inhaled and exhaled.

   The patient puts into his mouth a mouthpiece connected to a breathing tube with a sensor. A clip is placed on the nose that blocks nasal breathing. The specialist tells you what breathing tests need to be performed. And an electronic device converts the sensor readings into digital data.

   Indications:

   • breathing disorder
   • chronic cough
   • occupational hazards (coal dust, paint, asbestos)
   • smoking experience over 25 years
   • lung diseases (bronchial asthma, pneumosclerosis, chronic obstructive pulmonary disease)
   Contraindications:
   • tuberculosis
   • pneumothorax
   • hemoptysis
   • recent heart attack, stroke, abdominal or chest surgery
   Symptoms of emphysema:
   • increase in total lung capacity
   • increase in residual volume
   • decreased vital capacity of the lungs
   • reduction in maximum ventilation
   • increased resistance in the airways during exhalation
   • reduction in speed indicators
   • decreased compliance of lung tissue
   With pulmonary emphysema, these indicators are reduced by 20-30%
6. Peak flowmetry - measurement of maximum expiratory flow to determine bronchial obstruction.

   Determined using a device - a peak flow meter. The patient needs to tightly clasp the mouthpiece with his lips and exhale as quickly and forcefully as possible through his mouth. The procedure is repeated 3 times with an interval of 1-2 minutes.

   It is advisable to carry out peak flowmetry in the morning and evening at the same time before taking medications.

   Disadvantage: the study cannot confirm the diagnosis of pulmonary emphysema. The exhalation rate decreases not only with emphysema, but also with bronchial asthma, pre-asthma, and chronic obstructive pulmonary disease.

   Indications:

   • any diseases accompanied by bronchial obstruction
   • evaluation of treatment results
   Contraindications does not exist.

   Symptoms of emphysema:

   • reduction in expiratory flow by 20%
7. Determination of blood gas composition – an arterial blood test that determines the pressure of oxygen and carbon dioxide in the blood and their percentage, acid-base balance of blood. The results show how effectively the blood in the lungs is cleared of carbon dioxide and enriched with oxygen. For research, a puncture of the ulnar artery is usually done. A blood sample is taken from a heparin syringe, placed on ice, and sent to the laboratory.

   Indications:

   • cyanosis and other signs of oxygen starvation
   • breathing disorders due to asthma, chronic obstructive pulmonary disease, emphysema
   Symptoms:
   • oxygen tension in arterial blood is below 60-80 mmHg. st
   • blood oxygen percentage less than 15%
   • increase in carbon dioxide tension in arterial blood over 50 mmHg. st
8. General blood analysis - a study that includes counting blood cells and studying their characteristics. For analysis, blood is taken from a finger or from a vein.

   Indications- any diseases.

   Contraindications does not exist.

   Deviations for emphysema:

   • increased amount red blood cells over 5 10 12 /l
   • increased hemoglobin level over 175 g/l
   • increase in hematocrit over 47%
   • decreased erythrocyte sedimentation rate 0 mm/hour
   • increased blood viscosity: in men over 5 cP, in women over 5.5 cP

Treatment of emphysema

• improving the quality of life of patients - eliminating shortness of breath and weakness
• prevention of the development of heart and respiratory failure
• slowing the progression of the disease

• complete cessation of smoking
• exercise to improve ventilation
• taking medications to improve the condition of the respiratory tract
• treatment of the pathology that caused the development of emphysema

Treatment of emphysema with medications

Therapeutic measures for emphysema

1. Transcutaneous electrical stimulation diaphragm and intercostal muscles. Electrical stimulation with pulsed currents with a frequency of 5 to 150 Hz is aimed at facilitating exhalation. At the same time, the energy supply to the muscles, blood and lymph circulation improves. In this way, fatigue of the respiratory muscles, followed by respiratory failure, is avoided. During the procedure, painless muscle contractions occur. The current strength is dosed individually. The number of procedures is 10-15 per course.
2. Oxygen inhalation. Inhalation is carried out for a long time, 18 hours a day. In this case, oxygen is supplied to the mask at a rate of 2–5 liters per minute. In case of severe respiratory failure, helium-oxygen mixtures are used for inhalation.
3. Breathing exercises- training of the respiratory muscles, aimed at strengthening and coordinating muscles during breathing. All exercises are repeated 4 times a day for 15 minutes.
   • Exhale with resistance. Exhale slowly through a cocktail straw into a glass filled with water. Repeat 15-20 times.
   • Diaphragmatic breathing. On the count of 1-2-3 make it strong deep breath, sucking in his stomach. On the count of 4, exhale - inflating your stomach. Then tense your abdominal muscles and cough loudly. This exercise helps to expel mucus.
   • Lying push-up. Lying on your back, bend your legs and clasp your knees with your hands. As you inhale, draw in lungs full of air. As you exhale, stick your stomach out (diaphragmatic exhalation). Straighten your legs. Tighten your abs and cough.

When is surgery needed for emphysema?

Indications for surgery for emphysema:

• shortness of breath leading to disability
• bullae occupying more than 1/3 of the chest
• complications of emphysema - hemoptysis, cancer, infection, pneumothorax
• multiple bullae
• permanent hospitalizations
• diagnosis of emphysema mild severe degrees"

• inflammatory process – bronchitis, pneumonia
• asthma
• exhaustion
• severe deformation of the chest
• age over 70 years

Types of operations for emphysema

1. Lung transplant and its variants: lung transplantation together with a heart; transplantation of a lung lobe. Transplantation is performed in case of large diffuse lesions or multiple large bullae. The goal is to replace the damaged lung healthy donor organ. However, the waiting list for transplantation is usually too long and problems with organ rejection may arise. Therefore, such operations are resorted to only as a last resort.


2. Reduced lung volume. The surgeon removes the most damaged areas, approximately 20-25% of the lung. At the same time, the function of the remaining part of the lung and respiratory muscles improves. The lung is not compressed, its ventilation is restored. The operation is performed in one of three ways.

Opening the chest. The doctor removes the affected lobe and places stitches to seal the lung. Then a suture is placed on the chest.

3. Minimally invasive technique (thoracoscopy) under the control of video equipment. 3 small incisions are made between the ribs. A mini-video camera is inserted into one, and surgical instruments are inserted into the others. The affected area is removed through these incisions.
4. Bronchoscopic surgery. A bronchoscope with surgical equipment is inserted through the mouth. The damaged area is removed through the lumen of the bronchus. Such an operation is possible only if the affected area is located near large bronchi.

Is hospitalization necessary to treat emphysema?

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;

Nutrition for emphysema (diet).

Basic principles of diet for emphysema

1. Increasing calorie content to 3500 kcal. Meals 4-6 times a day in small portions.
2. Proteins up to 120 g per day. More than half of them must be of animal origin: animal and poultry meat, liver, sausages, fish of any kind and seafood, eggs, dairy products. Meat in any culinary preparation, excluding excessive frying.
All complications of pulmonary emphysema are life-threatening. Therefore, if any new symptoms appear, you should urgently seek help. medical care.

• Pneumothorax. Rupture of the pleura surrounding the lung. In this case, air escapes into the pleural cavity. The lung collapses and becomes unable to expand. Fluid accumulates around it in the pleural cavity, which needs to be removed. Appears strong pain in the chest, worsening with inhalation, panic, rapid heartbeat, the patient takes a forced position. Treatment must be started immediately. If the lung does not expand within 4-5 days, surgery will be required.
• Infectious complications. Decreased local immunity increases the sensitivity of the lungs to bacterial infections. Severe bronchitis and pneumonia often develop, which become chronic. Symptoms: cough with purulent sputum, fever, weakness.
• Right ventricular heart failure. The disappearance of small capillaries leads to an increase in blood pressure in the vessels of the lungs - pulmonary hypertension. The load on the right parts of the heart increases, which become overstretched and wear out. Heart failure is the leading cause of death in patients with emphysema. Therefore, at the first signs of its development (swelling of the neck veins, pain in the heart and liver, swelling), it is necessary to call an ambulance.

• complete cessation of smoking
• prevention frequent infections
• clean air, no smog
• good nutrition
• good sensitivity to drug treatment bronchodilators.

Pulmonary emphysema is serious illness respiratory apparatus, characterized by the accumulation of air in the lungs and disruption of their functions. The pathological process leads to oxygen starvation of the entire body, and at the time of exacerbation it is important to seek medical help as soon as possible. A characteristic symptom of emphysema is shortness of breath, which makes it difficult to take each subsequent breath.

Description of the disease

Emphysema is a pathology characterized by a chronic course, the name of which comes from Greek word emphysao. Translated, it means “inflating.” As the disease develops, the chest expands due to an increase in the size of the lungs due to air accumulated inside. As a result, gas exchange in the respiratory system is disrupted. The process is accompanied by destruction of the alveolar septum. In addition to the lungs, the bronchial branches expand and stretch. With emphysema, the entire body suffers, in particular the respiratory, circulatory and muscular system: thinning vascular walls, smooth muscles are stretched, capillaries are empty, and tissues do not receive enough nutrition.

The air that accumulates in the alveolar lumen does not contain oxygen, but gas masses with a high concentration of carbon dioxide. At the same time, patients feel a sharp lack of oxygen. The resulting expansions put pressure on healthy areas of tissue, as a result of which ventilation of the lungs is impaired, which is accompanied by shortness of breath and other signs of emphysema.

Increased pressure inside the lungs causes compression of the organ's arteries. The right part of the heart muscle is subjected to severe stress, which leads to its restructuring and the development of chronicity pulmonary heart.

Develops against the background of pulmonary emphysema oxygen starvation and respiratory failure.

The course of the disease is characterized by a violation of the exit of air from the alveoli and the entry of air into them with a predominance of failure of the first function. The air accumulated in the lungs cannot come out in full. At an advanced stage, the lungs become greatly inflated, since inside their cavities there are air masses with a large percentage of carbon dioxide. The functions of the organs are disrupted, and ultimately they cease to participate in the respiratory process.

Causes of emphysema

The occurrence of pulmonary emphysema is due to various reasons. The disease can develop as a result of disruption of the structure of the lung tissue and loss of elastic qualities. This can happen due to:

• availability birth defects leading to collapse of bronchioles and increased pressure in the alveoli;
• hormonal imbalance between androgens and estrogens, as a result of which the bronchioles are stretched and voids are formed in the pulmonary parenchyma;
• poor ecology and constant impact on the body harmful substances which may be related to professional activities. These may include toxins, chemicals and contaminants, tobacco smoke, dust, factory emissions and exhaust gases. Particles that enter the body during breathing settle on the bronchiole walls, affecting the pulmonary arteries and epithelial cells organ. As a result, alveolar macrophages are activated, the production of proteolytic enzymes increases and neutrophils increase. All this leads to the destruction of the alveolar walls;
• congenital pathology caused by alpha-1 antitrypsin deficiency. Instead of getting rid of bacteria, enzymes destroy the alveoli. The normal function of antitrypsin is to neutralize these manifestations;
• circulatory disorders and loss of the ability of lung tissue to regenerate and recover as a result of age-related changes;
• infectious diseases respiratory system, such as pneumonia, bronchitis, etc. In the process of illnesses, the protein of the alveoli dissolves, and sputum secretions prevent air from leaving them. As a result, the tissues stretch and lose elasticity, and the alveolar sacs become overfilled.

Acute pulmonary emphysema can develop when pulmonary pressure increases. The causes of the pathology are as follows:

• chronic form of obstructive bronchitis;
• blockage of the bronchial lumen by a foreign object.

Symptoms

The development of pulmonary emphysema is accompanied by a number of characteristic signs that appear quite clearly. One of the pronounced symptoms of the disease is paleness of the skin: the nail plates, ears and even the tip of the nose acquire a bluish tint. IN medical terminology These manifestations are called cyanosis, the cause of which is oxygen starvation of the body, accompanied by bleeding of small capillaries.

Pulmonary emphysema is almost always accompanied by expiratory shortness of breath, in which the patient experiences difficulty in inhaling. And if at the beginning of the disease breathing difficulty is mild, then as it progresses it tends to increase. In this case, short inhalations are noted, and the exhalation time is increased due to mucus accumulated in the lungs.

In patients with emphysema, there is a need for additional tension in the abdominal muscles when lowering and raising the diaphragm. As a result of increased thoracic pressure, they experience enlarged neck veins during exhalation and coughing. In cases where the disease is complicated by heart failure, the veins also enlarge during inhalation. Cough with emphysema is almost always accompanied by pinkness of the face. In this case, patients produce small amounts of sputum.

A characteristic symptom of this disease is a sharp decline weight, which is caused by intense tension of the muscle group responsible for the respiratory process. With a long course of the disease, patients experience an enlarged liver due to blood stagnation and a decrease in the level of the diaphragm.

Among the external signs of chronicity of the process can be identified: sagging abdomen, the appearance of a meek neck, protrusion of the supraclavicular fossa and chest. In this case, the intercostal spaces are retracted during inhalations.

Classification

Pulmonary emphysema is classified depending on the nature of its course, etiology, degree of prevalence and features of the anatomical structure of the respiratory system.

There are acute and chronic forms of the disease. Acute pulmonary emphysema can occur with increased physical activity, against the background of bronchial asthma, or if a foreign body enters the bronchi. Its characteristic signs are swelling of the lungs and distension of the alveoli. This disease is treatable if emergency measures are taken.

The transition of the disease to a chronic form occurs gradually and in the absence of proper treatment at an early stage. In most cases, the process ends with the patient's disability.

Depending on the origin, primary and secondary emphysema are distinguished. The primary form of the disease is due to a congenital predisposition. Pathology is a disease with an independent course, which can affect people at any age. Infants are no exception. A feature of primary emphysema is its rapid development.

Secondary emphysema develops against the background of chronic obstructive pulmonary pathologies. For some time the disease is asymptomatic. As it develops, the signs of the disease become more pronounced. And if you do not resort to timely treatment, this can lead to chronicity of the process.

Based on their prevalence, emphysema is classified into diffuse and focal emphysema. The first form is characterized by damage to large areas of lung tissue or the entire organ. The process is accompanied by total destruction of the alveoli. A severe form of the disease often ends in the death of the patient. The only way out of the situation is donor organ transplantation.

The focal form of emphysema develops against the background of pulmonary tuberculosis. Parenchinal changes are observed in the area of ​​inflammatory foci, at the site of scarring and blockage of the bronchi. Symptoms of the disease are mild.

Depending on the anatomical features, pulmonary emphysema is divided into:

• Vesicular, the signs of which are respiratory failure and lack of inflammation. The disease is severe.
• Centrilobular. Distinctive feature The disease is damage to the alveoli of the central lobe of the lung and an increase in the size of the entire organ. The disease is characterized by an active inflammatory process, accompanied by copious mucus secretion. The affected walls of the acini are replaced by fibrous tissue, and areas of undamaged parenchyma continue to function.
• Paraseptal, developing with active form tuberculosis and characterized by damage to the extreme pulmonary sections located next to the pleura. A complication of this form of the disease is pneumothorax - rupture of the affected part of the organ.
• Peri-scar, in which pathological changes are observed near scars and fibrous pulmonary foci. It is characterized by a sluggish course and the manifestation of mild symptoms.
• Bullous. This form of emphysema is characterized by a violation of the structure of the lungs, accompanied by destruction of the interalveolar septa. With bullous disease, bullae are formed on the surface of organs or throughout the parenchyma, including the area near the pleura, vesicles whose diameter can reach 20 cm. Patients experience all the symptoms of pulmonary emphysema, including respiratory failure.
• Interstitial, in which ruptures of the alveolar walls occur and the formation of blisters under the skin. They can be transported to the neck and head through the lymphatic tract. In this case, some of the bubbles remain in the lungs. This form is dangerous due to the sudden occurrence of pneumothorax.
• Senile, which developed as a result of age-related changes in the pulmonary structure.
• Lobar, developing in newborns with bronchial obstruction.

This classification of pulmonary emphysema is the most complete.

Diagnostics

Pulmonary emphysema requires high-quality diagnosis, the first stage of which is to collect an anamnesis. A detailed survey of the patient is carried out, taking into account all his complaints, during which all important points are clarified. During the examination, the periscussion method is used - tapping the chest through the palm in order to determine the degree of mobility of the lungs, the presence of airiness in the organs and confirm the likelihood of drooping of their lower edges. Listening with a fundescope is mandatory, through which the breathing pattern is determined and the heart rhythm is assessed.

If the suspicion of emphysema is confirmed, the patient is prescribed additional studies using instrumental and laboratory methods, such as:

• X-ray. It is expected to obtain an image of the lungs in a direct projection. The presence of pathology and the degree of spread of the process are determined by the pulmonary fields.
• Magnetic resonance imaging (MRI) of the lungs, which is performed to obtain information about the condition of the bronchi and lung tissue and identify pathological foci.
• CT scan(CT) with the introduction of a contrast agent. Allows you to visualize a layered image of the affected organ, on which you can see its structure in a computer version.
• Scintigraphy. The study is carried out using a rotating chamber around the patient after radioactive isotopes are injected into the patient's lungs. With its help, it is possible to obtain information about the condition of blood vessels, evaluate the surgical field and exclude the presence of cancerous tumors.
• Spirometry. It is carried out to determine the volume of breathing by recording the air during inhalation and exhalation.
• Piclometry. Using this method, the highest expiratory flow rate is determined to identify bronchial obstruction.

The patient is prescribed blood tests to assess the main indicators and determine its gas composition.

Treatment

Emphysema is a reversible process only at the initial stage of its development. Treatment of the disease involves eliminating the causative factor, limiting physical activity, quitting smoking, and adjusting lifestyle and nutrition. In this situation, it is possible to speed up the healing process with the help of breathing exercises and traditional treatment.

In the future, when disorders associated with emphysema lead to structural and functional disorders in the lungs, the reverse development of which is impossible, it is advisable to carry out symptomatic treatment.

In this case, drug therapy will be aimed at improving the patient’s quality of life, preventing further progression of the disease, preventing complications such as heart failure, acute respiratory infections etc. Measures such as giving up bad habits and minimizing other influences should be taken.

The following groups of drugs are used in the treatment of emphysema:

• Antitrypsin and phosphodiesterase inhibitors (bronchodilators). Prescribed to prevent the destruction of connective tissue in the lungs, relax the muscles of the bronchi, increase their lumen and eliminate swelling of the respiratory mucosa. Prolastin and Teopek are used in the treatment of emphysema.
• Antioxidants. Act as a regulator of protein and elastic tissue synthesis in the lungs, inhibit the destruction of alveoli and improve metabolic processes. Most often, patients are prescribed vitamin E.
• Anticholinergic drugs. These are antispasmodics for the bronchi, with the help of which breathing is restored.
• Glucocorticosteroids. Relieves inflammation and dilates the bronchi. In this case, patients are given prednisolone.
• Theophyllines. They reduce the manifestations of pulmonary hypertension, stimulate urination and are used as bronchodilators.
• Antitussives with expectorant effect. Mucolytics thin mucus, improve its removal from the bronchi, help neutralize toxins, reduce cough, and prevent the development of bacterial infection. The most popular medications are ACC and Lazolvan.

If emphysema is complicated by infectious diseases, antibiotics are prescribed.

In addition to conservative treatment To improve the condition of patients, the following activities are carried out:

• electrical stimulation with pulsed currents;
• oxygen inhalations;
• breathing exercises.

With their help, you can get rid of critical conditions, make breathing easier, improve blood circulation and oxygenation of the respiratory muscles.

Traditional treatment

In addition to drug therapy, with emphysealFolk remedies are actively used in the lungs. There are a large number of effective medicines made on the basis of natural ingredients which can be used to improve general state patient and relieve anxiety symptoms.

It is advisable to consider some recipes in more detail:

• Garlic infusion. To prepare it, take 10 medium-sized heads of garlic, 1 kg of natural bee honey and 10 lemons. The garlic is cut into slices and the juice is squeezed out of the lemons. The ingredients are mixed and transferred to a glass jar. The medicine must be placed in a dark place for 10 days. Take 2 tbsp daily. l.
• Juice from potato tops. Juice is squeezed out of green tops. On the first day, the dose should be 1/2 tsp. On the second day it must be increased fourfold, and so every day. After 10 days daily norm should be half a glass.
• Herbal infusion. Prepare as follows: take equal parts spring adonis, fennel fruits, caraway seeds and horsetail. Horsetail you can take twice as much. Pour a tablespoon of the mixture into a glass of boiling water, cover with a lid and leave to steep until it cools completely. Take 1/3 cup three times a day for a three-month course of treatment.
• Decoction. Using this remedy you can get rid of shortness of breath. Prepare like this: take 1 tbsp. l. potato color and pour 250 ml. boiling water Infuse for 2 hours, strain. It is recommended to take the medicine three times a day, half an hour before meals, half a glass. The course of treatment is one month.

Diet

Organization is of no small importance in case of pulmonary emphysema. therapeutic nutrition. In this case it is provided special diet, aimed at strengthening the immune system and cleansing the body.

Meals must be split and eaten at least six times a day. Products must be high in calories and contain sufficient quantity fats, proteins, carbohydrates, vitamins and minerals. The daily calorie content should be at least 3500 kcal.

Patients are allowed to consume butter and vegetable oil, milk, fermented milk products, meat, fish, and eggs. Seafood, sausages and liver are not excluded.

You should definitely include porridge in your diet, White bread, bran, honey, pasta, as well as fresh vegetables and fruits. You can drink juices, compotes and jelly.

It is necessary to exclude fried and spicy foods, confectionery, alcoholic drinks and coffee. Limit salt intake.

Disease prognosis

It should be borne in mind that emphysema is an incurable disease, from which it is completely impossible to get rid of it. The prognosis directly depends on the duration of the pathological process, the timeliness of treatment, the degree of obstructive changes in the lungs and the nature of the disease.

If the disease that caused pulmonary emphysema progresses steadily, then the prognosis can be considered favorable. To minimize the manifestations of respiratory failure, it is necessary to follow all medical recommendations, carry out treatment on time and adhere to the right lifestyle. Such patients can live quite a long time. According to statistics, the mortality rate for pulmonary emphysema is 2.5% of the total number of patients.

In case of decompensated bronchial diseases accompanied by emphysema, the prognosis is unfavorable in any case. Such people are indicated for continuous maintenance therapy, in which improvement in condition is extremely rare. Their life expectancy depends on the individual characteristics of the organism and its compensatory abilities.

Emphysema - frequent illness, which predominantly affects middle-aged and elderly men, occurring with significant impairment of pulmonary ventilation and blood circulation, in contrast to the conditions listed in the differential diagnosis, which have only an external resemblance to true emphysema.

Frequency. The prevalence in the population is more than 4%.

Emphysema is an increase in the volume of the airways located distal to the bronchioles. Centrilobular emphysema is characterized by dilation of predominantly alveolar ducts and respiratory bronchioles. In contrast, with panlobular emphysema, the terminal alveoli expand. They speak of a “flabby” lung if only elastic traction decreases. Pathological changes can affect only a limited area (local emphysema) or the entire lung (diffuse emphysema). Emphysema is one of the most common causes of human death.

Causes of emphysema

Emphysema, as shown by observations of cases of rapid development of the disease in young people following a chest injury, can be a consequence of severe damage to the bronchi and interstitial tissue of the lungs. Apparently, a violation of bronchial patency, especially the terminal branches of the bronchi, due to blockage with mucus and spasm, along with a decrease in the nutrition of the alveoli when their blood circulation is impaired (or vascular damage), can lead to stretching of the alveoli with persistent changes wall structures and their atrophy.

When the bronchi are not completely closed, the mechanism described in the section devoted to the description of bronchial obstruction disorders comes into play, when air enters the alveoli during inhalation, but does not find an outlet during exhalation, and the intra-alveolar pressure increases sharply.

Experimentally, emphysema was obtained by stenosis of the trachea after just a few weeks. A similar mechanism is believed to underlie true emphysema, which develops in old age without obvious preliminary inflammatory diseases or bronchial obstruction. Apparently, this also concerns chronic, sluggish bronchitis and interstitial inflammatory processes, possibly with vascular lesions, accompanied by functional spasm, which is why the name obstructive emphysema is currently considered rational for true emphysema.

Pulmonary emphysema often accompanies both bronchial asthma, peribronchitis, and various types of pneumosclerosis, with which it thus has a close pathogenetic and clinical affinity. Peri-bronchitis and inflammatory-degenerative lesions of the pulmonary parenchyma, according to a number of authors, are a necessary condition for the development of pulmonary emphysema with loss of elastic properties (Rubel).

Previously, in the origin of pulmonary emphysema, priority was given to individual constitutional weakness, premature wear and tear of the elastic tissue of the lungs and even changes in the skeleton, ossification of the cartilage of the chest, which seems to stretch the lungs in the inhalation position; emphysema was related to atherosclerosis and metabolic disorders. They also attached great importance to purely mechanical inflation of the lungs (glassblowers, musicians on wind instruments, etc.). However, as clinical experience shows, without obstruction of the bronchial tubes and bronchioles and damage to the lungs, these moments are not enough for the development of emphysema.

There is no doubt that in the origin of pulmonary emphysema, as well as bronchial asthma and bronchiectasis, a violation of the nervous regulation of the entire activity of the bronchopulmonary system, which occurs as reflexively from adjacent organs and from the receptor fields of the respiratory tract, and due to disruption of the activity of the central nervous system, as evidenced, for example, by the development of acute emphysema and cerebral contusion.

Pulmonary ventilation, gas exchange and the lungs are impaired in emphysema due to poorer ventilation of the alveoli. In fact, although the minute volume of air, due to the frequency and tension of respiratory movements, can even be increased, the air is exchanged mainly in large airways, less fresh air penetrates into the depths of the bronchioles, mixes and changes less well in the alveoli, and the unventilated “dead” increases. space. The volume of residual air in emphysema can increase to 3/4 of the total lung capacity (instead of 1/4 normally). The increase in residual air, as well as the decrease in additional air, is explained by stretching of the lungs due to the loss of elasticity of the lung tissue. Due to these mechanisms, oxygen uptake during high ventilation may be abnormally low (uneconomical use). The force of the stream of incoming and especially outgoing air, due to small expiratory movements of the chest, is insignificant: a patient with emphysema is not able to blow out candles. The respiratory muscles of the chest, like the diaphragm, are the most important respiratory muscle, due to DC voltage as a result of stimulation of the respiratory center by the altered composition of the blood, they hypertrophy and subsequently degenerate, which contributes to respiratory decompensation.

At the same time, blood circulation in the pulmonary circulation suffers, which further reduces external respiration. Increased intra-alveolar pressure bleeds the pulmonary capillaries embedded in the thin-walled interalveolar septa; the capillaries disappear with the progressive atrophy of these septa. “In addition, the inflammatory process often affects the vessels of the bronchial and pulmonary systems embedded in the interstitial tissue of the lungs, which carry blood for the nutrition and respiratory function of the lungs.

This decrease in the blood capillary bed of the pulmonary circle causes a corresponding increase in the work of the right ventricle, compensating for blood circulation at a higher hemodynamic level; the pressure in the pulmonary artery system and its branches increases several times, what is called pulmonary hypertension occurs, which ensures the pressure in the pulmonary artery system necessary to transfer the entire amount of blood entering the right ventricle into the left ventricle; the velocity of blood flow in the pulmonary circle does not change during powerful contractions of the sharply hypertrophied right ventricle.

The experiment shows that when one main branch of the pulmonary artery in an animal is ligated, the pressure in the artery trunk almost doubles.

Due to the greater pressure in the lesser circle, the arteriovenous anastomoses of the lungs open to a greater extent, transferring non-arterialized blood into the bronchial veins of the systemic circle. The resulting congestion of the bronchi contributes to chronic course bronchitis. Of course, all altered conditions of gas exchange and blood circulation in the lungs lead to hypoxemia and hypercapnia characteristic of emphysema. Already in the aorta or in the radial artery, which is more accessible to research, the blood in emphysema is undersaturated with oxygen (central or arterial pulmonary cyanosis). Retention of carbon dioxide in the blood occurs with great difficulty due to its easier release in the lungs (greater diffusion capacity).

During this period of emphysema, despite the violation pulmonary function gas exchange or external respiration, we can talk about cardio-compensated pulmonary emphysema (similar to the idea of ​​compensated heart defects and cardiac compensation of hypertension).

However, the very long-term overstrain of the myocardium, along with the reduced oxygen content in the arterial blood supplying the heart muscle (and other organs), creates the prerequisites for cardiac decompensation, which is facilitated by incident infections, bronchitis, pneumonia, often simultaneously existing atherosclerosis of the coronary arteries of the heart, etc. .; this decompensation of the heart in pulmonary emphysema is discussed in the section on cor pulmonale.

It should be added that the very increase in intrathoracic and intrapleural pressure in patients with emphysema, lower suction force and functional shutdown of the diaphragm cause an adaptive increase in venous pressure in the vena cava, ensuring an approximately normal drop in pressure as blood passes into the chest; therefore, only a moderate increase in venous pressure does not definitely indicate myocardial weakness. Due to a decrease in the capillary bed of the pulmonary circle, even with left heart failure, the lungs do not give a pronounced picture of stagnation, in particular, a sharp veiling of the pulmonary fields.

Centrilobular emphysema develops mainly against the background of obstructive pulmonary disease: in the case of a “flabby” lung, the mass of connective tissue is reduced, and with diffuse emphysema, there is also a rupture of the interalveolar septa. With age, the ratio between the volume and area of ​​the alveoli usually increases. In some cases (approximately 2% of patients), there is deficiency of an α 1 -proteinase inhibitor (α 1 -antitrypsin), which normally inhibits the activity of proteinases (eg, leukocyte elastase, serine proteinase-3, cathepsin and matrix metalloproteinase). Insufficient inhibition of proteinases leads to increased protein breakdown and, as a result, loss of elasticity of lung tissue. Impaired secretion and accumulation of defective proteins can cause liver damage. Finally, as a result of a lack of proteinase inhibitors, pathology of other tissues, such as glomeruli of the kidneys and pancreatic cells, may develop. Smoking causes oxidation and therefore inhibition of agantitrypsin, which accelerates the development of emphysema even in the absence of a genetic predisposition.

In addition to the lack of inhibitors, the development of emphysema can be caused by increased production of elastase (for example, the formation of serine elastase by granulocytes, metalloproteinases by alveolar macrophages and various proteinases pathogenic microorganisms). Excessive elastase content during chronic inflammation leads, in particular, to the destruction of the elastic fibers of the lungs.

Considering the changes that occur with pulmonary emphysema, it becomes obvious how significant the decrease in elastic traction of the lung tissue is. To exhale, elastic traction of the lungs creates positive pressure in the alveoli relative to the external environment. External compression (as a result of contraction of the respiratory muscles) causes positive pressure not only in the alveoli, but also in the bronchioles, which creates additional resistance to air flow. Hence, maximum speed expiratory flow (V max) depends on the relationship between elastic traction (T) and resistance (R L). Thus, as a result of a decrease in elastic traction, changes occur similar to those in obstructive pulmonary disease. Elastic traction increases by increasing the volume of inhaled air, which ultimately leads to a shift of the resting point towards inhalation (barrel chest). If the volume of inspired air remains constant, the FRC and residual volume (and sometimes dead space) increase. However, due to a decrease in expiratory volume, vital capacity decreases. Shifting the rest point leads to flattening of the diaphragm and, according to Laplace’s law, requires increased muscle tension. When the interalveolar septa are destroyed, the diffusion area decreases; a reduction in the number of pulmonary capillaries leads to an increase in functional dead space and an increase in pulmonary arterial pressure and vascular resistance, with the eventual development of cor pulmonale. Different resistance to air flow in individual bronchioles in centrilobular (non-extended) emphysema causes disturbances in its distribution. The result of the abnormal distribution is hypoxemia. In patients with centrilobular emphysema against the background of obstructive pulmonary disease, diffuse cyanosis develops. In contrast, with widespread emphysema, the skin takes on a pink tint, which is explained by the need for deeper breathing due to increased functional dead space. However, impaired diffusion leads to hypoxemia only if there is a significant decrease in diffusion capacity or an increase in O 2 demand.

Pathoanatomically the lungs are pale, swollen, inelastic, and retain impressions from the ribs. The wall of the right ventricle of the heart, as well as the trabecular muscles, are sharply thickened, even without a pronounced increase in the cavity. The wall of the left ventricle is often thickened due to concomitant hypertension.

Classification. According to pathogenesis, primary (congenital, hereditary) and secondary pulmonary emphysema are distinguished, which occurs against the background chronic diseases lungs (usually chronic obstructive pulmonary disease); by prevalence - diffuse and localized pulmonary emphysema; according to morphological characteristics - proximal acinar, panacinar, distal, irregular (irregular, uneven) and bullous.

Symptoms and signs of emphysema

The clinical picture is characterized by shortness of breath, cyanosis, cough, and changes in the chest.

Shortness of breath, the most constant complaint of those suffering from emphysema, appears at first only during physical work, which becomes possible in smaller and smaller amounts, as well as with exacerbations of bronchitis and incident pneumonia, with asthmatic spasms of the bronchi. Later, shortness of breath does not leave the patient even in a position of complete rest, intensifying even after eating, with excitement, and conversation. Since hypoxemia is already present in a resting state, it is clear that physical work further worsens the composition of the blood and, pumping blood from the skeletal muscles into the vena cava, into the right heart, further increases the pressure in the pulmonary circulation, which also reflexively increases shortness of breath.

Cyanosis is a constant sign of emphysema. In accordance with persistent hypoxemia with normal blood flow velocity and unchanged peripheral circulation, with emphysema, unlike the state of cardiac decompensation, cyanosis is not accompanied by coldness of distant parts of the body (the hands remain warm).

The cough is of a peculiar nature due to the weakness of the chest excursions, the weakness of the expiratory air stream and therefore is often especially painful and persistent. The causes of cough are varied: inflammatory bronchitis, asthmatic bronchospasms, high pressure in the vessels of the pulmonary circulation, which also causes cough by neuroreflex.

Often patients have characteristic appearance: purplish-cyanotic face with a pattern of dilated skin veins, a shortened neck due to expansion of the chest, as if inhaling, swollen neck veins, especially during coughing fits, when the cyanosis of the face increases sharply. Characterized by interrupted speech due to lack of air, muscle tension during exhalation, and often a barrel-shaped chest with an increased anteroposterior size.

The most important clinical sign of emphysema is almost complete absence respiratory mobility of the chest, which often decides the diagnosis of emphysema even in the absence of a barrel-shaped chest itself. A rim of dilated small veins is visible on the chest along the line of attachment of the diaphragm and along the edge of the heart in front. Patients, even with severe cyanosis, usually maintain a low position of the upper body in bed (orthopnea is not observed), possibly due to the absence of any significant enlargement of the heart. The apical impulse is not detected, but under the xiphoid process on the left it is possible to feel an increased impulse of the right ventricle. Percussion of the lung produces, instead of the normal, very different intensity, a typical loud box, or pillow sound, caused by excess air in the alveoli, especially in the lower part of the lungs along the axillary line. Inflated lungs push the liver down and cover the heart, which makes determining its size by percussion impossible (the lungs also push the apex of the heart away from the chest wall).

The excursion of the lower edge of the lungs along the anterior axillary line and the increase in chest circumference during breathing, which are normally 6-8 cm, fall to 2-1 cm. Weakened, usually harsh breathing with prolonged exhalation, dry rales, whistling and buzzing, are often heard. focal pneumonia with greater sonority of moist rales and increased bronchophony.

Heart sounds are muffled due to displacement hearts and lungs, which weakens the emphasis of the second tone of the pulmonary artery.

At x-ray examination They find horizontally running ribs with wide intercostal spaces, often ossification of the costal cartilages, and a flattened, poorly mobile diaphragm. The normal pulmonary pattern is poorly expressed due to the poverty of the lungs with blood vessels. Heaviness and enlargement of the bronchial lymph nodes are also often found. It should be emphasized that the lungs are anemic; expansion of the root shadow is possible due to enlargement of the lymph nodes (wheezing in the lungs of inflammatory origin).

The heart itself is often not dilated, perhaps also due to difficulty in the flow of blood into the left and right hearts due to increased intrathoracic pressure, limiting the suction of blood into the heart; rather, the small heart of patients with emphysema is characteristic with bulging of the pulmonary artery arch as a result high blood pressure in the system of this artery.

It is not possible to directly measure the pressure in the pulmonary artery, although this has recently been attempted by catheterizing the chambers of the right heart through the jugular or cubital vein. Blood pressure in the systemic circle is rather reduced, possibly due to the transfer of blood through the anastomoses and a decrease in blood flow to the left heart. The liver is usually prolapsed.

From the blood: erythrocytosis up to 5,000,000-6,000,000 - a consequence of irritation of the bone marrow by the hypoxemic composition of the blood; sometimes eosinophilia (usually in sputum).

Course, forms and complications of emphysema

As a rule, the onset of pulmonary emphysema is gradual, the course is chronic, usually many years. During emphysema, three periods can be schematically distinguished.

The first period is the so-called bronchitis, when prolonged or repeated bronchitis, as well as focal bronchopneumonia, creates conditions for the development of emphysema. There may be signs of asthmatic bronchitis. The well-being of patients fluctuates sharply, improving significantly in the summer, in a dry, warm climate.

The second period is severe emphysema with constant pulmonary insufficiency, cyanosis, shortness of breath, even worse with inflammatory complications; lasts for many years, up to 10 or more, which is rarely observed in other diseases with the same sharp cyanosis.

The third, relatively short period is cardiac, or, more precisely, pulmonary-cardiac failure, when a patient with emphysema develops congestion - in a large circle, painful swelling of the liver, edema, stagnant urine, simultaneously with expansion of the heart, tachycardia, slowing of blood flow, etc. ... (the so-called chronic pulmonary heart).

According to the forms, in addition to classic senile or presenile emphysema, which mainly affects men 45-60 years old who do not have obvious bronchopulmonary diseases in the anamnesis, emphysema of young age should be distinguished. In this form of emphysema, often more acute, occurs due to obvious diseases of the bronchi and lungs, such as gas poisoning, gunshot wounds of the chest (with pneumothorax and hemoaspiration), kyphoscoliosis, bronchial asthma, etc., when during the course of the disease In addition to emphysema as such, the underlying lung disease with its immediate consequences also plays a major role. Essentially, in the classical form there are similar changes in the lungs in the form of peribronchitis and pneumosclerosis, but a slower, less clinically pronounced course.

Complications of emphysema include the rarely observed pneumothorax and interstitial emphysema.

Diagnosis and differential diagnosis of emphysema

Although a common and well-defined disease, emphysema nevertheless often leads to misdiagnosis. It is not recognized where it undoubtedly exists and is detected only at autopsy; Along with this, sometimes a diagnosis of emphysema is made, which is not justified by the entire clinical and anatomical picture. It is important not only to correctly recognize emphysema in general, but to correctly indicate the period of the disease, possible complications and concomitant (or primary) diseases, as this determines prognosis, disability and treatment methods.

Very often, in addition to pulmonary emphysema, a patient is mistakenly diagnosed with cardiac decompensation or myocardial dystrophy on the basis of existing shortness of breath, cyanosis, muffled heart sounds, emphasis on the pulmonary artery, sharp epigastric pulsation, wheezing in the lungs, protrusion of the liver from under the ribs in the presence of sensitivity in the liver areas. Meanwhile, these false cardiac signs are characteristic of emphysema as such without heart failure. In these cases, the wheezing in the lungs is bronchitis and not congestive, the liver is sunken and not enlarged, the tenderness refers to the abdominal muscles. The absence of orthopnea is also characteristic. A patient with emphysema is essentially a pulmonary patient, and he remains so for many years, while heart failure (pulmonary heart failure) is only the end of the disease, accompanied by completely undoubted cardiac signs.

In the presence of heart enlargement, systolic murmur at the apex, liver enlargement, edema, etc., the diagnosis of decompensated mitral valve disease or decompensated atherosclerotic cardiosclerosis, etc. is often mistakenly made without taking into account the whole picture of the development of the disease, the presence of severe cyanosis, erythrocytosis, low blood pressure pressure, absence of arrhythmias, etc.

With emphysema with cyanosis in an elderly patient, atherosclerotic coronary sclerosis is recognized on the basis of pain in the heart area, although these pains can be pleural, muscular, and in rare cases, true angina pectoris is caused by the hypoxemic composition of the blood (the so-called blue angina pectoris).

Due to a sharp change in percussion sound and weakened, almost absent breathing in the lungs, pneumothorax is mistakenly recognized, although with emphysema the damage is bilateral and uniform.

The box sound in the sloping parts of the lungs does not always indicate pulmonary emphysema as a specific pathological condition.

Such changes can cause:

1. The so-called functional pulmonary emphysema with left ventricular failure of the heart, when, due to overstretching of the small circle vessels by stagnant blood, the chest becomes almost motionless during respiratory movements, and the lungs are definitely dilated. Persistent organic changes—atrophy of the septa in the alveoli—are not detected; a decrease in blood mass during bloodletting, under the influence of Mercusal, with increased contractile force of the myocardium, stops this condition. The presence of a gallop rhythm, angina pectoris, pallor of the face, and relief under the influence of nitroglycerin also speak against emphysema. This explains why in acute nephritis or coronary sclerosis occurring with cardiac asthma, the doctor is often inclined to diagnose pulmonary emphysema (or bronchial asthma).
2. The so-called senile emphysema, depending on age-related atrophy of the elastic tissue of the lungs in the absence of obstruction of the bronchi and increased intra-alveolar pressure, therefore, not accompanied by the most significant disturbances of pulmonary ventilation and pulmonary circulation; in addition, a slight decrease in external respiration may correspond to decreased tissue metabolism - decreased “internal” respiration in old age. Therefore, although the box sound of the sloping parts of the lungs is established by percussion and the x-ray shows a large airiness of the corresponding pulmonary fields, there is no shortness of breath, cyanosis, wheezing, and essentially this condition does not deserve the name of lung disease. In these forms, due to relative atrophy of the lung tissue, overextension of the lungs may occur, since the chest remains of normal volume or is even enlarged due to calcification of the ribs. A similar state of atrophy of the lung tissue, in a certain sense of an adaptive nature, is found regardless of the age of the patients and in other dystrophies - nutritional, wound, cancer, which also occur with a decrease in tissue metabolism.
3. The so-called compensatory emphysema, limited to the part of the lung adjacent to the affected area or one lung when the other is affected.

   Basically, the disease is explained by a change in the normal ratio of intrathoracic elastic forces, as discussed in the section on atelectasis, effusion pleurisy, and therefore only partially deserves the name “compensatory” emphysema.

4. Interstitial, or interstitial, pulmonary emphysema is mentioned by us only for the purpose of completeness and systematic presentation. It occurs after a lung injury as a result of rupture of the alveoli inside the lung with the release of air forced into the lungs into the intermediate tissue of the lungs, the mediastinum, and into the subcutaneous tissue of the neck and chest. Interstitial emphysema is easily recognized by the crunchy swelling of tissue on the neck and other characteristic signs.

Prognosis and work ability. Emphysema lasts for many years: infectious factors, working and living conditions are important for progression. In the first period, the patient can engage in usual, even physical work; in the second period, emphysema leads to significant, sometimes complete, and in the third period, always to complete loss of ability to work.

Most often, patients die from severe heart failure or from acute pulmonary diseases - lobar or focal pneumonia, from general acute infectious diseases, in the postoperative period, etc.

Prevention and treatment of emphysema

Prevention of true pulmonary emphysema consists in preventing inflammatory, traumatic lesions of the bronchial tree and interstitial vascular tissue of the lungs, in the fight against asthma, etc.

Treatment of advanced pulmonary emphysema is not very successful. In the early stages, various foci of irritation that reflexively disrupt the coordinated activity of the bronchopulmonary system should be eliminated, and measures should also be taken to regulate the activity of the central nervous system. Based on these general provisions, it is necessary to persistently treat bronchitis and focal pneumonia; for inflammatory exacerbations, chemotherapeutic agents and antibiotics are indicated; with a spastic component, which almost always occurs, antispastic ones: ephedrine, belladonna. Climatic treatment is indicated, especially in the autumn and early spring months, as with bronchiectasis, at dry, warm climatic stations.

Previously, they tried to enhance exhalation by compressing the chest with devices or to ensure exhalation into a rarefied space, but it is more advisable to strive to improve the patency of the bronchi (with antispasmodic agents, in extreme cases, suction of viscous mucus through a bronchoscope) and treat interstitial pneumonia.

Attempts at surgical treatment were abandoned.

In advanced cases - peace, oxygen treatment; Morphine is prohibited.

The topic of today's article is emphysema. You will learn what it is, as well as how to treat it with medications and folk remedies. Let's look at all the symptoms and causes. We will also talk about life prognosis, gymnastics, diagnosis and prevention of the disease. Reviews are also possible.

What is pulmonary emphysema?

is a disease that is a violation of lung ventilation and blood circulation. It lasts quite a long time. Very often a person with such a disease becomes disabled.

Signs of emphysema:

• chest expansion
• shortness of breath
• expansion of intercostal spaces

ICD 10 code- J43.9.

Men are more susceptible to this disease. People over 60 years of age are also at risk. The risk of this problem also increases in those who have chronic obstructive diseases of the pulmonary system.

This disease is also dangerous due to complications that can lead to disability and death.

Classification of the disease

The classification of pulmonary emphysema is divided into several large sections.

By origin:

• Primary - due to congenital abnormalities in the body. This type is very difficult to treat. It appears even in newborns.
• Secondary - more light form diseases. It may occur unnoticed by the patient himself. However, advanced stages can greatly impact a person’s ability to work. Occurs due to chronic lung diseases.

According to the nature of the flow:

• Acute - a very rapid change in the lungs as a result of extreme physical exertion or asthma.
• Chronic - changes do not appear so quickly.

Due to the occurrence:

• Laboratory - appears in newborns due to obstruction of one of the bronchi.
• Senile - due to age-related changes in blood vessels and impaired elasticity of the walls of the alveoli.

By prevalence:

• Focal - changes in the parenchyma appear around foci of tuberculosis, the site of bronchial blockage, scars.
• Diffuse - tissue damage and destruction of the alveoli occurs throughout the lung tissue.

According to anatomical features and relation to the acinus:

• Bullous (bubbly) - large or small blisters appear where damaged alveoli are located. The blisters themselves can burst and become infected. Also, due to their large volume, neighboring tissues are subject to compression.
• Centrilobular - the center of the acinus is damaged. A lot of mucus is released. Inflammation also appears due to the large lumen of the alveoli and bronchi.
• Panacinar (hypertrophic, vesicular) is a severe form of emphysema. Inflammation does not appear. However, there is significant respiratory distress.
• Interstitial (subcutaneous emphysema) - air bubbles appear due to rupture of the alveoli under the skin. Through the gaps between the tissues and the lymphatic pathways, these bubbles move under the skin of the neck and head.
• Peri-scar - occurs near fibrous foci and scars in the lung. The disease occurs with minor symptoms.
• Periacinar (distal, perilobular, parasepital) - occurs with tuberculosis. The extreme parts of the acinus near the pleura are affected.

Bullous emphysema

Bullous emphysema is a serious disorder of the structure of the lung tissue with subsequent destruction of the interalveolar septa. In this case, a huge air cavity appears.

This form of the disease occurs due to purulent and inflammatory processes in the lungs.

With single bullae (blisters), the disease is very difficult to diagnose. It cannot be seen even with a regular x-ray. It is detected only when there are a large number of bullae throughout the lung tissue.

The biggest danger of bullous emphysema is that there is a high risk of blisters bursting. As a rule, it occurs due to severe cough or during heavy physical exertion.

When the bulla ruptures, air from the lungs enters the pleural cavity. Thus, pneumothorax occurs. The accumulated air creates a lot of pressure on the lung.

At large defect lung tissue, the lung will not be able to close. As a result, there is a continuous flow of air into the pleural cavity.

At the very critical level air begins to enter the subcutaneous tissue and mediastinum. As a result, respiratory failure and cardiac arrest may occur.

Causes

There are many causes of pulmonary emphysema. However, they can all be divided into two main types.

First type, includes what leads to impaired elasticity and strength of lung tissue. The main one from this category will be a violation of the system responsible for the formation of enzymes. In this case, the properties of the surfactant change and a lack of A1-antitrypsin appears in the body.

The presence of gaseous toxic substances in the inhaled air significantly affects the body. Frequent incidence of infectious diseases reduces the ability of the lungs to protect. Therefore, they are more quickly exposed to harmful effects.

Smoking is the main reason why emphysema can develop. Plumes of tobacco smoke in the lungs accumulate inflamed cells, from which substances are released that can destroy the partitions connecting the cells.

People who smoke are more vulnerable to the manifestation of this disease; emphysema in smokers has more complex forms.

Co. second type include factors that can cause an increase in pressure in the alveoli of the lungs. These include previous pulmonary diseases. For example, chronic obstructive bronchitis or bronchial asthma.

Since emphysema has two types, it can be primary or secondary.
All factors lead to the fact that the elastic tissue of the lungs is damaged and loses the ability to fill the lungs with air and release it.

The lungs become overfilled with air, causing the small bronchi to stick together when exhaling. Pulmonary ventilation is also impaired.

With emphysema, the lungs increase in size and take on the appearance of a large-pored sponge. If you examine emphysematous lung tissue using a microscope, you can observe the destruction of the alveolar septa.

Let's talk about the symptoms of emphysema. It should be said right away that this disease often has hidden initial forms. Therefore, a person may not even suspect that he is sick.

The presence of symptoms appears already at the stage of severe lung damage.

Usually, the appearance of shortness of breath observed at the age of 50-60 years. This symptom is initially noticed during execution physical work. And later it manifests itself even in a calm state.

During an attack of shortness of breath, the skin of the face becomes pinkish. Most often, the patient takes a sitting position and leans slightly forward. Constantly holding onto something in front of him.

Emphysema makes breathing difficult. When exhaling, various sounds are heard, since this process is very difficult for the patient.

Inhalation occurs without difficulty.

However, it is difficult to exhale. Therefore, it is often observed that the lips are folded into a tube to facilitate the exhalation process.

Since the appearance at moments of shortness of breath is characteristic, such patients are called “pink puffers.”

After the onset of symptoms of shortness of breath, after a certain time it is observed presence of cough which is not too long.

A clear sign that will indicate pulmonary emphysema will be significant weight loss. Indeed, in this case, the muscles become very tired, working exhaustingly to facilitate exhalation. If body weight has decreased, then this is an unfavorable sign of the course of the disease.

Patients also have expanded chest, having the shape of a cylinder. She seemed to freeze while inhaling. Its figurative name is barrel-shaped.

If you pay attention to the area above the collarbones, you will notice expansion here, and the spaces between the ribs seem to sink.

When examining the skin, a bluish tint is noted, and the fingers take on a shape resembling Drumsticks . Such existing external changes are typical in the presence of prolonged oxygen starvation.

Diagnosis of the disease

Respiratory function tests are of great importance in diagnosing pulmonary emphysema. To assess how narrowed the bronchi are, it is used peak flowmetry.

The patient should be at rest, inhale twice and exhale into the peak flow meter. He will record the degree of narrowing.

Obtaining this data will make it possible to determine whether a person really suffers from emphysema or whether he has bronchial asthma or bronchitis.

Spirometry determine how much the tidal volume of the lungs changes. This helps in identifying inadequate breathing.

Carrying out additional tests, in which they are used bronchodilators, makes it possible to say what kind of disease is present in the lungs. In addition, the effectiveness of treatment can be assessed.

At x-ray, it is possible to identify the presence of dilated cavities that are located in different pulmonary sections. You can also determine increased lung capacity. After all, in this case the dome of the diaphragm moves, and it becomes denser.

Carrying out computed tomography will make it possible to diagnose the presence of cavities in the lungs, which will also be more airy.

Now let's look at the main methods of treating pulmonary emphysema. It is worth saying that all treatment procedures should be aimed at facilitating the respiratory process. In addition, it is necessary to eliminate the disease whose action led to the development of this problem.

Treatment procedures are mainly carried out on an outpatient basis. But there should be an opportunity to be observed by doctors such as pulmonologist or therapist.

Lifelong use of bronchodilators, in the form of inhalations or tablets, is recommended. If there is cardiac and respiratory failure, then oxygen therapy is carried out, after which diuretics are taken. Breathing exercises are also recommended.

If a person is diagnosed with an infection, he is hospitalized in the hospital. He may also be hospitalized if respiratory failure is severe or if any surgical complications arise.

Emphysema can also be treated surgically.

An operation is performed in which the volume of the lungs is reduced. The technique involves eliminating damaged areas of lung tissue, which leads to a decrease in pressure on the remaining part. After this procedure, the patient's condition improves significantly.

Emphysema - treatment with folk remedies

If you have emphysema, you should not miss out on treatment with folk remedies.

Here are some methods:

1. Phytotherapy. Some plants have expectorant and bronchodilator properties. For emphysema, they are used to prepare infusions and decoctions, which are later taken orally. Such plants include: licorice, caraway, fennel, thyme, lemon balm, eucalyptus, anise, sage and many others.
2. Potato. Carrying out hot inhalations over boiled potatoes helps cough up and relaxes the bronchial muscles.
3. Aromatherapy. The air is saturated with medicinal components essential oils dill, oregano, wormwood, chamomile, thyme, sage and others. For spraying, you can use a diffuser or aroma maker (5 - 8 drops of ether per 15 square meters of room). This helps in improving the patient's condition. You can also apply a few drops of these oils to your feet, palms and chest. In 1 tbsp. l. Add 2-3 drops of vegetable oil or a mixture of several drops.

If a person has emphysema, he should periodically visit a pulmonologist. Folk remedies are used only as a supplement to the main methods of treatment. You should not use only them, as they will not bring the desired effect.

Use of oxygen therapy

To improve gas exchange at the very beginning of the disease, oxygen therapy is prescribed. During this technique, the patient inhales air with a reduced amount of oxygen for 5 minutes.

Treatment is carried out once every day. The course is 15-20 days.

If this method is not possible, then a nasal catheter is inserted into the patient. It is through this that oxygen is supplied to alleviate the patient’s condition.

Breathing exercises for emphysema

Good breathing exercises also help a lot with emphysema.

Here are some exercises:

1. You should inhale and hold your breath. Next, exhale sharply using the mouth opening. At the very end of exhalation, change the position of the lips to a tube.
2. Also hold your breath. Next, exhale using small bursts, folding your lips in the form of a tube.
3. Breathe in and don't exhale. Extending your arms and clenching your fingers into fists, move them to your shoulders, then stretch them to the sides and lower them back to your shoulders. Thus, do this a couple of times, and then exhale strongly.
4. Inhale for 12 seconds, hold your breath for 48 seconds. and exhale for 24 s. Repeat this three times.

Drug treatment

If there is an exacerbation of the inflammation process, then drugs with an antibacterial effect may be prescribed.

Treatment of bronchial asthma or bronchitis occurs with drugs that dilate the bronchi. To facilitate the removal of mucus, mucolytic drugs should be taken.

Diet for emphysema

The diet for pulmonary emphysema should be balanced. It should contain many vitamin components and microelements. The diet must necessarily consist of vegetable and fruit dishes. In addition, these products should be consumed raw.

Also, the main rule is to avoid nicotine. It's better to quit smoking right away. That is, do not stretch it out for a long cessation. In addition, you should not be in a room where other people smoke.

Application of massage

The use of classical, segmental and acupressure techniques leads to the fact that the sputum leaves faster and the bronchi expand.

In this case, preference is often given to acupressure massage, since it is more effective.

Therapeutic exercises for emphysema

Pulmonary emphysema is accompanied by the muscles always being in tension, which leads to their fatigue. To prevent muscles from becoming overstrained, you should do therapeutic exercises.

Here are some exercises:

1. For example, exercises that create positive pressure as you exhale. To do this, take a tube. One end of it is placed in water. The second person takes it into his mouth and slowly exhales through it. An obstacle in the form of water puts pressure on the exhaled air.
2. To train your diaphragm, you need to stand up and take a deep breath. As you exhale, point your arms forward and bend. When exhaling, the stomach should be pulled up.
3. Another task: lie on the floor, put your hands on your stomach. When exhaling, press on the peritoneum.

Complications of the disease

This disease sometimes leads to various complications. Among them:

• Infectious complications. Pneumonia often develops, and lung abscesses occur.
• Inadequate breathing. Since there is a violation metabolic process between oxygen and carbon dioxide in the lungs.
• Heart failure. In severe cases of the disease, an increase in pulmonary pressure is observed. In this regard, there is an increase in the right ventricle and atrium. All parts of the heart gradually change. Therefore, there is a disruption in the blood supply to the heart.
• Surgical complications. If the cavity, which is located near a large bronchus, ruptures, then air can enter it. Pneumothorax forms. If the septum between the alveoli is damaged, bleeding will occur.

Emphysema - life prognosis

What is the prognosis for life with emphysema? It is impossible to say exactly how long they live. It all depends on the nature of the disease and its treatment.

However, it should be said right away that it is impossible to completely recover from this disease. The peculiarity of the disease is its constant progression. Even if treatment is being carried out.

If you seek help from a medical facility in time and follow all procedures, the disease will be slightly slowed down. The condition improves, and disability is postponed.

If emphysema developed due to the fact that there was a defect in the congenital enzyme system, then no one can give a positive prognosis.

Favorable outcome factors:

• Detection of the disease at an early stage
• The disease passes in a moderate form
• The patient strictly follows the diet prescribed by doctors
• Complete smoking cessation

Prevention of emphysema

To prevent emphysema, you should do the following:

1. Stop consuming tobacco products.
2. Treat pulmonary diseases in a timely manner to prevent the development of the disease.
3. Maintaining healthy image helps in life to improve the condition and maintain the body in healthy shape. Playing sports, performing breathing exercises, walking in the fresh air, visiting the bathhouse - all this contributes to the normal functioning of the bronchi and lungs.
4. In order for your lungs to be healthy, you need to be in the forest more often, inhaling the healing aromas of pine needles. Sea air is also beneficial. Such places help open the lungs and saturate the blood with oxygen.
5. Watch your diet. It must contain fresh fruits. There should also be foods with a high amount of vitamin elements and nutrients.

Conclusion

And with this we finish talking about pulmonary emphysema. Now you know what it is and how to treat it. We looked at the main symptoms and causes. We also touched a little on the life prognosis of this disease. In the future, there may be reviews on this disease below.

The girl consulted a doctor about her father’s illness: “Recently, my family was faced with a diagnosis: pulmonary emphysema. My father, who is only 60 years old, fell ill. The disease progresses rapidly. How dangerous is this disease?

Emphysema is pathological increase lung volume. Up to 4% of the population suffers from this disease, mainly older men.

Risk of developing the disease:

1. congenital forms associated with whey protein deficiency. More often detected in residents of Northern Europe;
2. in people who smoke, the risk of developing emphysema is 15 times higher than in non-smokers, passive smoking is just as dangerous;
3. microcirculation disorders in lung tissues;
4. and alveoli;
5. professional activity associated with a gradual increase in pressure in the bronchi and alveolar tissue,

Under the influence of these factors, the elastic tissue of the lung is damaged and its ability to fill with air is lost.

Stretching of bronchioles and alveoli, their size increases.

Smooth muscles are stretched, the walls of blood vessels become thinner, nutrition in the acinus (the smallest formations that make up the lung tissue), where gas exchange occurs between air and blood, is disrupted, and the body experiences oxygen deficiency. The enlarged areas compress healthy lung tissue, which further impairs their ventilation, causing shortness of breath and other symptoms of emphysema.

To compensate and improve respiratory function, the respiratory muscles are actively involved.

Emphysema is almost always a consequence of diseases such as bronchitis. And only in rare cases the disease is inherited. It develops unnoticed by the patient. Symptoms appear when there is significant damage to the lung tissue, so early diagnosis of emphysema is difficult. If, during periods of remission of chronic lung diseases, shortness of breath increases, and during exacerbations, physical activity is sharply limited, you should immediately consult a doctor. All these symptoms may indicate the development of the initial symptoms of emphysema.

As a rule, shortness of breath begins to bother the patient after 50-60 years. First it appears during physical activity, later at rest. During an attack of shortness of breath, the face turns pink. The patient, as a rule, sits leaning forward, often holding on to the back of the chair in front of him. The exhalation with emphysema is long, noisy, the patient purses his lips into a tube, trying to ease his breathing. When inhaling, patients do not experience difficulty, but exhaling is very difficult. Due to the characteristic appearance During an attack of shortness of breath, patients suffering from emphysema are sometimes called “pink puffers.”

Cough occurs after shortness of breath, which distinguishes emphysema from bronchitis. The cough is not prolonged, the sputum is scanty and transparent. The chest is expanded, as if frozen while inhaling. It is often figuratively called barrel-shaped. A characteristic sign of 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.

The apices of the lungs bulge in the supraclavicular areas, expanding and sinking into the intercostal spaces. The fingers become like drumsticks. The tip of the nose, earlobes, and nails become bluish. As the disease progresses, the skin and mucous membranes turn pale because small capillaries are not filled with blood and oxygen starvation occurs.

Men, as I already said, suffer from this pathology more often, especially if they work in hazardous industries with high level air pollution.

The second factor provoking the development of the disease, especially with a genetic predisposition, is smoking, since nicotine activates the release of destructive enzymes in the respiratory organs.

It is also important to take age-related changes into account. The blood circulation of an elderly person changes over the years, sensitivity to air toxins increases, and lung tissue recovers more slowly after pneumonia.

First of all, carry out peak flowmetry, which determines the volumetric flow rate of exhalation, and spirometry, revealing changes in the tidal volume of the lungs and the degree of respiratory failure. The latter is carried out using a special device - a spirometer, which records the volume and speed of inhaled (exhaled) air.

X-ray examinations of the chest organs reveal dilated cavities and determine an increase in lung volume. Computed tomography shows increased “airiness” of the lungs. Emphysema is classified into several categories. The nature of the course is acute (it can be caused by exercise stress, attack of bronchial asthma; requires surgical treatment) and chronic (changes in the lungs occur gradually, and at an early stage a complete cure can be achieved).

In origin - primary (due to the congenital characteristics of the body, it is an independent disease, diagnosed even in newborns; difficult to treat, secondary emphysema also progresses quickly (due to obstructive pulmonary diseases in a chronic form; leads to loss of ability to work).

Based on anatomical features, they are distinguished panacinar(in the absence of inflammation, respiratory failure is noted), periacinar(develops with tuberculosis), peri-scar(manifests near fibrotic foci and scars in the lungs) and subcutaneous(air bubbles form under the skin) shape.

The most dangerous - bullous(bubble) form, in which one large cavity is formed filled with air. Inflammatory and suppurative processes occur in the lungs (chronic abscess, tuberculosis). The danger of bullous emphysema is associated with severe thinning of the surface shell of the bulla (formations in the form of air bubbles in the lung tissue), rupture of which is possible if sharp changes pressure in the chest (cough). Arises dangerous condition called pneumothorax, which can result in respiratory failure and cardiac arrest.

Treatment is carried out on an outpatient basis under the supervision of a pulmonologist or therapist. Hospitalization is indicated for severe respiratory failure and if complications occur (pulmonary hemorrhage, pneumothorax).

For cupping inflammatory process Antibacterial drugs are prescribed. For bronchial asthma or bronchitis with attacks of difficulty breathing, bronchial dilators are indicated ( theophylline, berodual, salbutamol). To facilitate sputum production - mucolytics ( ambrobene, lazolvan, acetyl-cysteine, fluimicin). To improve gas exchange at the initial stage of the disease, it is used oxygen therapy. This treatment involves inhaling air with a reduced amount of oxygen for 5 minutes. Then the patient breathes air with a normal oxygen content for the same amount of time. The session includes six such cycles once a day for 15-20 days.

Nutrition for a patient with emphysema

A balanced diet will help strengthen your immune system and remove toxins from your body. For respiratory failure use large quantity carbohydrates can lead to an even greater lack of oxygen. Therefore, a low-calorie diet is recommended. The diet is divided, 4-6 times a day.

Fats - at least 80-90 g. This can be vegetable oil, butter, and high-fat dairy products.

Proteins - up to 120 g per day. Eggs, meat of any kind, sausages, sea and river fish, seafood, liver.

Carbohydrates - about 350 g. Fruits, berries, vegetables, flour bread coarse, honey

Drinks include juices, kumiss, rosehip compote.

Limiting salt (up to 6 g) to prevent edema and cardiac complications.

The diet of patients with emphysema should not contain alcohol, cooking fats, or high-fat confectionery products.

With emphysema, the respiratory muscles are in constant tone, so they quickly get tired. Classic, segmental (stroking, kneading, rubbing) and acupressure (pressure on certain points of the body) massages help remove mucus and dilate the bronchi.

An important role is given to physical therapy. A set of specially selected exercises to strengthen the respiratory muscles is performed for 15 minutes 4 times a day. It includes exercises for training diaphragmatic breathing and its rhythm:

• The patient exhales deeply and slowly through a tube, one end of which is in a jar of water. The water barrier creates pressure when you exhale.
• Starting position: standing, feet shoulder-width apart. The patient takes a deep breath and, as he exhales, stretches his arms in front of him and leans forward. During exhalation, you need to pull in your stomach.
• Starting position: lying on your back, hands on your stomach. As you exhale, press on the anterior abdominal wall with your hands.
• Take a deep breath, hold your breath. Exhale air in small bursts through pursed lips. At the same time, the cheeks should not puff up.
• Take a deep breath, hold your breath. Then exhale in one sharp burst through your open mouth. At the end of the exhalation, fold your lips into a tube.
• Take a deep breath, hold your breath. Extend your arms forward, then clench your fingers into a fist. Bring your arms to your shoulders, slowly spread them to the sides and return them to your shoulders again. Repeat 2-3 times, then exhale forcefully.

Forecast

Emphysema leads to irreversible changes in the structure of lung tissue. The development of right ventricular heart failure, myocardial dystrophy, edema of the lower extremities, and ascites is possible. Therefore, the prognosis directly depends on the timely start of therapy and strict implementation of all medical recommendations. In the absence of necessary therapeutic measures, the disease progresses and leads to loss of ability to work, and subsequently to disability.

A feature of emphysema is its constant progression, even with treatment. But if all treatment measures are followed, it is possible to slow down the progression of the disease and improve the quality of life.

Prevention of emphysema

The main preventive measure is anti-nicotine propaganda. Quitting smoking, which destroys the structure of the lungs, is the most effective way to prevent the disease. Let me remind you that staying in a smoky room, so-called passive smoking, is even more dangerous than the process of inhaling tobacco smoke itself.

Do active sports (swimming, running, skiing, football), do breathing exercises, walk in the fresh air, visit the steam room. Walking in the forest and near salt ponds is very beneficial for lung health. The air, saturated with the aroma of pine needles and salt, opens the lungs and saturates the blood with oxygen.

Folk recipes

Inhalations with a decoction of potato root vegetables “in their jacket” have an expectorant and relaxing effect on the bronchial muscles. The temperature of the liquid should not exceed 85°C to prevent burns to the mucous membrane. To carry out the procedure, take several potatoes, wash them, put them in a pan and cook until tender. Then remove the pan from the heat, place it on a stool, cover with a towel and breathe in the steam for 10 to 15 minutes.

Saturation of the air with medicinal components of essential oils of marjoram, dill, eucalyptus, oregano, wormwood, thyme, sage, chamomile, cypress, cedar improves the condition of patients suffering from emphysema.

Use a special device for fine spraying (diffuser) or a regular aroma diffuser (5-8 drops of ether per 15 square meters of room). The same oils are used to rub the feet, palms, and chest. To do this, in 1 tbsp. a spoonful of jojoba oil, vegetable or olive, add 2-3 drops of ether or a mixture of several oils.