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Emphysema

Emphysema is a disease characterized by the expansion of the chest. The name of this chronic diseases comes from the word emphysao – inflate (Greek). The disease results in collapse of the partitions between alveoli and dilation of the ultimate ramifications of the bronchi. Lungs swell, increasing their volume in the tissue of the organ are formed air voids. This leads to expansion of the chest, acquiring the characteristic barrel shape.

The mechanism of lung damage of emphysema:

  1. The alveoli and bronchioles are stretched, increase in 2 times.

  2. The walls of the vessels become thinner, the stretching of the smooth muscle. Because of zapotevanija capillaries disturbed nutrition in acinose.

  3. Excess air in the alveolar lumen shows no oxygen and the waste gas mixture with a high content of carbon dioxide. Due to the decrease of the area of formation of the gas exchange between the blood and the oxygen in the air is lacking oxygen;

  4. Healthy lung tissue is exposed to pressure from the extended areas, disturbed ventilation of this body with the appearance of shortness of breath and other symptoms.

  5. Leads to increase of pressure inside the lungs, causing compression of the pulmonary arteries. Thus the right chambers of the heart are experiencing a constant heightened burden to overcome this pressure that is the basis of the accompanying restructuring of the heart muscle in the form of chronic pulmonary heart disease;

  6. Causing oxygen starvation of fabrics and signs of respiratory distress.

Speaking about the pathogenesis of emphysema in the classic version, it can be described as: violation of outlet air prevails over the violation of its entrance into the alveoli. As a result, air flows into the lungs, and leave them in the same volume is not capable. In the later stages of the process suffers as a function of inhalation and breath. The lungs are in a constant bloated state and contains high pressure air with high concentration of carbon dioxide. They kind of switch off from the act of breathing.

The content of the article:


Causes of emphysema

The causes of this disease are divided into two groups.

  1. Violation of elasticity and strength of lung tissue:

    • Magnetic resonance imaging (MRI) of the lungs– a study that captures differences in the absorption of radio waves by the cells of the human body. Magnetic resonance imaging provides information about the presence of fluid and foci of pathology, the condition of the bronchi. To create a complete picture are slices 1 cm thick, injected contrast agent in certain areas of the body. The lack of research – accurate visualization prevents the presence of air in small bronchi and the alveoli. The study is carried out for half an hour. The lack of radiation makes MRI possible for pregnant women.

      Indications for:

      • The symptoms indicate the presence of cysts, tumors, but x-ray their showed;
      • Suspected sarcoidosis, tuberculous lesions of the lungs;
      • Swollen lymph nodes in the projection light;
      • There are malformations of the respiratory system.

      Contraindications:

      • Mental illness, preventing the preservation of long stationary;
      • Fear of the closed space;

      • Obesity and severe;

      • The presence of implants, a pacemaker, a cluster of fragments.

      The symptoms of emphysema as determined using MRI:

      • Bullae and cavities of various sizes;
      • Increased lung;
      • The compression of the healthy tissue;
      • Increasing the amount of fluid in the pleura;
      • Damage to the alveoli and their capillaries;
      • Disturbed blood supply;
      • The omission of the diaphragm.

    • Computed tomography (CT) of the lungs. A method of computed tomography based on the reflection of the tissues of the human bodyx-rays. The output is a layered computer image of the structure of the lungs. For more informative contrast medium injected. The procedure is performed for 20 minutes. During this period, the lungs are scanned with x-ray emitter. The disadvantage of this method is a significant irradiation of the patient.

      Indications:

      • Validation of x-ray examination;
      • Suspected emphysema;
      • Preparation for bronchoscopy or biopsy of lung;
      • The rationale of the operation;
      • Diffuse changes in the tissues of the lung.

      Contraindications:

      • Individual intolerance to contrast agents;

      • Diabetes in a severe form;

      • Pregnancy;
      • Marked obesity;
      • Extreme weakness;

      • Renal failure.

      Symptoms of emphysema:

      • Detection area extended areas;
      • Fixing the size and location of bull;
      • Vasodilation at the root of the lung;
      • The appearance samostatnych sites.

    • Peakflowmetry – measurement of maximum expiratory flow to determine the of bronchial obstruction. Method for determination of bronchial obstruction. With peakflowmetry measured expiratory flow rate for 3 times before taking drugs. The drawback of this method is the impossibility of diagnosis of emphysema. The method determines the diseases accompanied by pulmonary obstruction. There are no contraindications.

    • General analysis of blood. Method for determining characteristics of blood cells. The method is informative for all diseases, has no contraindications.

      Abnormalities of emphysema:

      • high red blood cell count of more than 5 1012/l

      • increased levels of hemoglobin over 175 g/l
      • the increase in hematocrit in excess of 47%
      • reduced erythrocyte sedimentation rate 0 mm/hour
      • increased viscosity of the blood: men over 5 GPa in women more than 5.5 GPa

Treatment of emphysema

Directionstreatment:

  • The struggle against further development of disease;
  • The prevention of severe complications (respiratory and heart failure);
  • Improving the quality of life of patients.

Compulsory medical measures:

  • Conservative therapy for easier breathing, better functioning of the lungs;
  • Smoking cessation;
  • The execution of complex therapeutic exercises for the ventilation of the lungs;
  • Treatment of the underlying causes of disease.

Treatment of emphysema (medications)

Group of drugs

Drug names

The mechanism of therapeutic action

Method of application

Inhibitors A1-antitrypsin

Prolactin

The introduction of this protein reduces the level of enzymes that destroy the connective fibers of the pulmonary tissue.

Intravenous injection at the rate of 60 mg/kg of body weight. 1 time a week.

Mucolytic drugs

Acetylcysteine (ACC)

Improves expectoration of mucus from the bronchi, has antioxidant properties – reduces the production of free radicals. Protects lungs from bacterial infection.

Is the inside of 200-300 mg 2 times a day.

Mucosolvan

Thins mucus. Improves its removal from the bronchi. Reduces the cough.

Administered orally or inhaled. Inside while eating on 30 mg 2-3 times a day. In the form of inhalation in the nebulizer at 15-22.5 mg, 1-2 times a day.

Antioxidants

Vitamin E

Improve metabolism and nutrition in the tissues of the lungs. Slows down the process of destruction of walls of alveoli. Regulates protein synthesis and elastic fibers.

Take orally 1 capsule per day. Take courses for 2-4 weeks.

Bronchodilators (bronchodilator) means Inhibitors of phosphodiesterase

Teopek

Relaxes smooth muscles of the bronchi, contributes to the expansion of the lumen. Reduces edema of the bronchial mucosa.

The first two days take one half of tablet 1-2 times a day. Further dose increase 1 tablet (0.3 g), 2 times per day through 12hours. After taking food. The course of 2-3 months.

Anticholinergics

Atrovent

Blocks the acetylcholine receptors in the muscles of the bronchi and prevents them from spasm. Improves respiratory indices.

In the form of inhalations 1-2 ml 3 times a day. For inhalation in nebulizer the drug mixed with saline.

Theophylline

Theophylline prolonged action

Having bronholiticeski effect, reduction of systemic pulmonary hypertension. Increases diuresis. Reduces fatigue of the respiratory muscles.

Initial dose of 400 mg/day. Every 3 days it can be increased to 100 mg until the therapeutic effect. Maximum dose 900 mg/day.

Corticosteroids

Prednisone

Has a strong anti-inflammatory effect on the lungs. Promotes bronchodilation.

Apply the ineffectiveness of bronchodilator therapy. At a dose of 15-20 mg per day. A course of 3-4 days.

Therapeutic measures of emphysema

  • Electrical stimulation through the skin, intercostal muscles and the diaphragm. Is pulsed currents, frequency, 5-150 Hz, tailor-made for each patient. The procedure is aimed at facilitating exhalation, improving circulation of lymph and blood circulation, providing muscles with energy. Effectively being prevention of fatigue of the muscles and further respiratory distress. During electrostimulation arise the smallest muscle contractions not accompanied by pain sensations. Conducted a course of 10-15 sessions.
  • Oxygen inhalations. Lengthy procedure (up to 18 hours) breathing through an oxygen mask. In severe cases, use of oxygen-helium mixtures.
  • Breathing exercises. A set of specially selected exercises for strengthening the respiratory muscles is carried out for 15 minutes 4 times/day.

The complex includes a slow exhale into the water through a straw for a cocktail, the exercise of diaphragmatic breathing with retraction and inflation of the abdomen, and squeezing lying with voltage press.


Surgical treatment of emphysema

Surgical treatment in rare cases, the ineffectiveness of drugs, a large area affectedlungs.

Indications for surgical intervention:

  • Multiple bullae (more than one third of the area of the chest);
  • Heavy shortness of breath;
  • Complications of the disease, pneumothorax, cancer, bloody sputum, accession of infection.
  • Frequent hospitalization;
  • The transition of the disease in a severe form.

Contraindications to surgery can be severe malnutrition, old age, deformity of the chest, asthma, pneumonia, bronchitis, severe.

Types of operations for emphysema easy

  • Transplantation of the lung (lobe, together with the heart), substitution of the donor organ. Is with extensive damage on multiple bulls. Complications – rejection of the donor organ.
  • Reduction to a quarter of the lung with removal of damaged areas by opening the chest. After removal of the affected lobe of the lung overlap of the sealing seams.
  • Minimally invasive technique (thoracoscopy) remove the affected portion of the lung. Is carried out under video control by performing three incisions: for camera and tools of the surgeon.
  • Bronchoscopy. Is performed through the mouth, provided the location of the affected area near the large bronchi.

The result of surgical intervention to restore the ventilation of the lung, it is not compressed by the pathologically increased areas. After 3 months the patient feels significant improvement. Shortness of breath may come back after 7 years after surgery.


Whether hospitalization for treatment of emphysema?

In compliance with doctor's recommendations, the optimal diet and drug therapy may outpatient treatment of the disease.

Reasons for treatment in hospital:

  • clarification of the diagnosis;
  • increased symptoms, appearance of new signs (cyanosis of skin and mucous membranes, weakness, shortness of breath without exertion, sputum with blood);
  • simultaneously occurring severe disease;

  • the appearance of arrhythmias;

  • the inefficiency of outpatient treatment (worsening of indicators peakflowmetry).

Food emphysema (diet)

Diet No. 11 and No. 15 aimed at strengthening the immune system, detoxify the body and replenish the energy reserves of the patient.

Principles of diet:

  • Caloric daily intake not lower than 3500 calories. Diet – 4-6 times a day gradually.
  • fats Intake – no less than 80-90 g. It could be oil and butter, dairy products with high fat content. The proportion of animal fats to vegetable – 2:1.
  • Proteins are used in an amount of up to 120 g per day. Products of animal origin must be at least half (eggs, meat of all kinds, sausages, sea and river fish, seafood, liver). Excludes grilled meat.
  • The amount of carbohydrate in the diet – from 350 to 400 g. It cereals, bread, jam, honey, pasta.
  • The provision of vitamins by eating fresh fruits and vegetables, introduction to food bran.
  • Allowed the use of any beverage: juice, milk, compote of fruit.
  • Limit salt to 6 g for the prevention of edema and complications of cardiac activity.

In the diet of patients with emphysema should not be alcohol, cooking oils, confectionery products with a high content of fat.


The prognosis of the disease

Emphysema refers to the complications of bronchopulmonary diseases. This means that changes in the lung tissue, which in this case occurred, are irreversible. All that remains to slow disease progression and reduce the signs of respiratory failure by improving patency of the bronchi.

Therefore, the prognosis of emphysema depends on:

  1. Timeliness and adequacy of treatment of the disease;

  2. Early and correct therapeutic approach to the treatment of emphysema;

  3. The patient's compliance with all treatment and recommendations for lifestyle;

  4. Duration of the disease.

In any case, to get rid of the emphysema will not succeed under any circumstances. But to affect the progression of the disease. If the underlying disease is bronchopulmonary system, which was the cause of the emphysema is characterized by relatively stable over the forecast to maintain the emphysema to a minimal level, it is quite favorable. If you follow all the recommendations of experts, the signs of respiratory distress are minor and people can live in a familiar rhythm.

Forecast in the case of decompensated diseases of the bronchi with severe emphysema in any case unfavourable. Such people are forced for life to take expensive drugs that are ableonly to maintain basic vital parameters respiration. A noticeable improvement in quality of life occur very rarely. Life expectancy depends on the degree of compensation of the pathological process, age, and restorative resources of the body.


The effects of emphysema

Complications of this disease can lead to death. Any symptoms pointing to the occurrence of complications – the signal for immediate treatment to the doctor.

  • Pneumothorax. The complications of torn leaf of the pleura, which protects the lung. Air escapes into the pleural cavity, the lung collapses and can no longer deal. In the pleural cavity appears liquid. The main symptoms of pneumothorax – severe chest pain, worse when breathing, tachycardia, a sense of panic. If you do not take immediate action for 4-5 days, will need surgery for straightening of the lung.

  • The development of bacterial infections. Due to the reduced local immunity reduced resistance to lung to infection. Pneumonia and bronchitis severe become chronic. Symptoms: hyperthermia, cough with purulent discharge, weakness.
  • Right ventricular heart failure. Destruction of the small capillaries leading to pulmonary hypertension – increase blood pressure. Increased load on the right heart leads to their rapid aging and deterioration. Death due to heart failure is one of the main causes of death of emphysema. Symptoms such as edema, the swelling of the veins in the neck, pain in the heart and liver – a cause for immediate treatment for emergency treatment.

Emphysema has a favorable prognosis under the following conditions:

  • Prevention of lung infections;
  • Avoiding harmful habits (Smoking);
  • Providing a balanced diet;
  • Life in clean air environment.
  • Sensitivity to drugs from the group of bronchodilator drugs.