Emphysema of the lungs - Causes, symptoms and treatment. MF.

Emphysema of the lung is a disease that occurs with the development of increased airiness of the lung tissue. Emphysema of the lungs is characterized by a prolonged course and very often leads to disability. Women are sick less than twice as often as men. In the age groups older than 60 years, emphysema is more common than in young people.

Causes of emphysema

All the factors that can cause lung emphysema to form can be divided into two large groups. The first group includes factors that violate the elasticity and strength of lung tissue. This, first of all, birth defects of the enzyme system of the body( change in the properties of the surfactant, deficiency of a1-antitropicin).Also important role is played by gaseous toxic substances( cadmium, nitrogen compounds, dust particles) that enter the lungs during respiration. Repeated viral infections of the respiratory tract reduce the protective properties of the pulmonary cells and lead to their damage.

It is impossible not to say about smoking, which is one of the main reasons for the development of emphysema. Tobacco smoke promotes the accumulation of inflammatory cells in the lung tissue, which, in turn, secrete substances that destroy the septa between the lung cells. In smokers, emphysema occurs much more often and is more severe, compared with non-smokers. Impress the words of Elizabeth Gyps, a famous writer, radio presenter, died of respiratory failure against a background of long-term smoking. She said: "If any of those who still smoke, could have lived in my body for a couple of minutes, he would never have taken a cigarette in his mouth."

Elizabeth Jips, writer, radio presenter, who studied alternative ancient cultures;died of respiratory failure with prolonged smoking

The second group includes factors that increase the pressure in the pulmonary alveoli. These are, first of all, previous lung diseases, such as chronic obstructive bronchitis, bronchial asthma.

Emphysema, formed under the influence of the first group of factors, is called primary, the second group - secondary.

Symptoms of emphysema

To understand the mechanism of development of emphysema and its symptoms, it is necessary to discuss the main features of the structure of lung tissue. The main structural unit of lung tissue is the acinus.

Schematic structure of the

acinus The acinus consists of the alveolar cells of the lung, the wall of which is closely bounded by the blood capillaries. This is where the exchange of oxygen and carbon dioxide takes place. Between the adjacent alveoli there is a surfactant - a special fatty film, which prevents friction. Normally the alveoli are elastic, expand and subside in accordance with the phases of respiration. Under the influence of pathological factors in primary emphysema, the elasticity of the alveoli decreases, and in the secondary - the pressure in the alveoli and the accumulation of excess air increase. The wall between adjacent alveoli is destroyed, a single cavity is formed.

Diagram of the structure of the alveoli in emphysema. The upper figure shows the alveoli with emphysema. Below are normal alveoli.

Some authors describe cavities whose size is more than 10 cm. When cavities are formed, the lung tissue becomes more airy. By reducing the number of alveoli, the exchange of oxygen and carbon dioxide suffers, respiratory failure occurs. The process of cavity formation is continuous, and eventually affects all parts of the lungs.

The disease develops imperceptibly for the patient. All the symptoms appear with a significant lesion of the lung tissue, so early diagnosis of emphysema is difficult. As a rule, dyspnea begins to disturb the patient after 50-60 years. First she appears with physical exertion, then begins to disturb and at rest. Characterized by the appearance of the patient at the time of attack of breathlessness. The skin of the face becomes pink. The patient, as a rule, sits, leaning forward, often clings to the back of the chair in front of him. Exhalation in emphysema is long, noisy, the patient folds his lips with a tube, trying to facilitate breathing. When inhaled, patients do not experience difficulty, the exhalation is very difficult. Because of the characteristic appearance of a shortness of breath, patients with emphysema are sometimes referred to as "pink puffers".

"Pink Torturer" - a characteristic type of patient with a shortness of breath.

Cough, as a rule, occurs some time after the manifestation of dyspnea, which distinguishes emphysema from bronchitis. Cough is not long, sputum meager, mucous, transparent.

A characteristic feature of emphysema is a decrease in body weight. This is due to fatigue of the respiratory muscles, which work in full force to facilitate exhalation. The expressed decrease in body weight is an unfavorable sign of the development of the disease.

In patients with emphysema, attention is drawn to an enlarged, cylindrical shape, as if frozen on the inspiration, the thorax. Often it is figuratively called barrel-shaped.

Barrel chest in a patient with pulmonary emphysema

The extremities of the lungs bulge in the supraclavicular areas, the intercostal spaces widening and occluding.

Attention is drawn to the cyanotic color of the skin and mucous membranes, as well as the characteristic change in the fingers of fingers like a drumsticks.

Thickening of the end phalanges of fingers by the type of drumsticks

These external signs indicate a prolonged oxygen starvation.

Diagnosis of emphysema

In the diagnosis of emphysema of the lungs, a large role is played by the function of respiration. To assess the degree of constriction of the bronchi, a peakflowmetry is used. In a quiet state, after a couple of breaths, an exhalation is performed in a special recording device-a pyclofometer.

PICFLUMOMETER

The data obtained with pyclofluometry allow distinguishing emphysema from bronchial asthma and bronchitis. Spirometry helps to determine the change in the respiratory volume of the lungs and to determine the degree of respiratory failure. The data are recorded at the moment of quiet breathing, then the doctor asks to perform several forced breaths and exhalations. Tests using bronchodilators also make it possible to distinguish various lung diseases, as well as evaluate the effectiveness of treatment.

Radiographic examination of chest organs is of great importance for the diagnosis of emphysema of the lungs. At the same time, different cavities are revealed in various parts of the lungs. In addition, the increase in lung volume is determined, an indirect indication of which is the low position of the dome of the diaphragm and its flattening. Computer tomography also allows you to diagnose cavities in the lungs, as well as their increased airiness.

Treatment of emphysema

All treatment for emphysema should be aimed at alleviating the manifestations and reducing the progression of respiratory failure, as well as treating lung disease, which led to the development of emphysema. Treatment is carried out, as a rule, on an outpatient basis, under the direction of a pulmonologist or therapist. Hospitalization in the hospital is indicated when infection is attached, severe form of respiratory failure, as well as in the event of surgical complications( pulmonary hemorrhage with rupture of the cavity, pneumothorax).

Diet and lifestyle correction for emphysema

Patients with pulmonary emphysema are recommended a balanced diet with a sufficient content of vitamins and microelements. In the diet should be constantly present raw fruits and vegetables, as well as juices and mashed potatoes from them. With severe respiratory failure, consuming large amounts of carbohydrates can lead to an even greater lack of oxygen. Therefore, in this case, a low-calorie diet with a caloric content of 600 kcal per day is recommended, and then, with a positive dynamics, the calorie content of food expands to 800 calories per day.

Smoking, active and passive is of great importance. One-time quitting has the best effect in comparison with a gradual cessation. Currently, there is a large arsenal of medical products( chewing gums, patches) that can help the patient in this difficult matter.

Drug treatment for emphysema

When the inflammation is aggravated antibacterial drugs are prescribed. With bronchial asthma or bronchitis with bouts of difficulty breathing, drugs that dilate the bronchi( theophyllines, berodual, salbutamol) are recommended. To facilitate the withdrawal of sputum, mucolytics( ambriiformes) are shown.

Oxygen therapy for emphysema

Oxygen therapy is used to improve gas exchange at the initial stage of the disease. This method of treatment consists in inhaling air with a reduced amount of oxygen for 5 minutes, then the same time the patient breathes air with a normal oxygen content. The session includes six such cycles. The course of treatment: a session once a day for 15-20 days. If it is impossible to apply the above method, the inhaled moistened oxygen through the nasal catheter will help alleviate the patient's condition.

Massage with emphysema

Massage promotes sputum and bronchial dilatation. A classic, segmental and acupressure massage is used. It is believed that acupressure has the most pronounced bronchodilator effect.

Physiotherapy for emphysema

With emphysema, the respiratory muscles are in a constant tone, so they quickly get tired. To prevent muscle strain, therapeutic exercise has a good effect.

The following exercises are used:

• exercises with artificial creation of positive exhalation pressure. The patient is asked to perform a deep, extended exhalation through a tube, one end of which is in a jar with water. Water barrier and creates a lot of pressure when exhaling.
• Exercises for training diaphragmatic breathing. Starting position: standing, feet shoulder width apart. The patient needs to take a deep breath and stretch out his arms in front of him and lean forward. During exhalation, it is necessary to draw in the stomach. Starting position: lying on the back, hands on the stomach. On exhalation, the hands are pressed against the anterior abdominal wall.
• Exercises for training the rhythm of breathing.
1. After a deep inhalation, we hold our breath for a short while, then exhale the air with small pushes through the lips that are folded together. In this case, the cheeks should not be inflated.
2. After a deep breath, hold your breath, then with one sharp push you exhale through the open mouth. At the end of exhalation, the lips must be folded with a tube.
3. Take a deep breath, hold your breath. Pull your hands forward, then squeeze your fingers into a fist. Bring your hands to your shoulders, slowly spread them apart, and again bring them back to your shoulders. Repeat this cycle 2-3 times, then exhale forcefully.
4. Consider in the mind. Breathe for 12 seconds, hold breath-48 seconds, exhale 24 seconds. Repeat this cycle 2-3 times.

Possible complications of emphysema

• Infectious complication. Possible development of pneumonia, lung abscess.
• Respiratory failure. It is associated with a disturbance in the exchange of oxygen and carbon dioxide in the altered lungs.
• Heart failure. With severe emphysema, the pressure in the pulmonary artery rises. Compensatory increases the right ventricle, right atrium. Over time, changes affect all parts of the heart. The pumping function of the heart is severely affected.
• Surgical complications. If a cavity is broken alongside a large bronchus, a large volume of air can penetrate into this cavity. A pneumatox is formed. Damage to the wall between the two alveoli can lead to pulmonary hemorrhage.

Prediction with emphysema

Complete cure for pulmonary emphysema is not possible. A feature of the disease is its constant progression, even against the background of treatment. With timely access to medical care and observance of medical measures, the disease manages to slow down a few, improve the quality of life, and also delay disability. When developing emphysema against a background of a congenital defect in the enzyme system, the prognosis is usually unfavorable.

Prevention of emphysema

As preventive measures, it is recommended:
• smoking cessation;
• compliance with personal hygiene rules when working with harmful gaseous substances.
• timely treatment of lung diseases( bronchitis, bronchial asthma), which can lead to the development of emphysema.

Doctor therapist Sirotkina EV