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IN last years due to the use of new methods x-ray examination X-ray diagnosis of pulmonary emphysema plays a very important role and in many cases allows us to judge the degree functional disorders. When selecting patients for surgical treatment It is especially important to accurately interpret radiographic findings.

X-ray changes in pulmonary emphysema were described in detail by Yu. N. Sokolov, E. V. Neshel, W. Frich a. ass., W. Fray, G. Simon, etc. With widespread emphysema, skeletal changes can be detected chest, but they do not have much diagnostic value.

The most characteristic sign of diffuse emphysema is an increase in the pulmonary fields, mainly due to their vertical size (drooping of the diaphragm, widening of the intercostal spaces) and transverse (more horizontal course of the ribs and protrusion of the sternum). The latter causes the expansion of the retrosternal and retrocardial space, which is clearly visible even on exhalation.

The diaphragm is lowered in emphysema. Its right dome is located at the neck of the 10-11th rib (normally on the ninth). The height of the diaphragm dome is usually 2-3 cm (normal according to W. Frick is at least 4 cm). Flattening of the diaphragm leads to an increase in the size of the lateral and costophrenic sinuses. A lateral sinus greater than 45° indicates emphysema. With severe emphysema, the diaphragm takes on the shape of a tent, “scalloping”, “stepping” appears, which may be associated with adhesions or exposure of the places where the diaphragm attaches to the ribs as it flattens.

Yu. N. Sokolov discovered this symptom in healthy individuals with well-defined diaphragmatic breathing, but in patients with pulmonary emphysema, the diaphragm is little mobile: in a severe form of the disease, the dome moves less than the height of one intercostal space, and in very severe cases, vibrations of the diaphragm are barely noticeable, or it makes paradoxical movements (when inhaling, it rises, following ribs).

Due to the low position of the diaphragm, the heart appears narrow. Even with right ventricular hypertrophy, its diameter does not exceed 11-11.5 cm.

The diplogram (or bigram) allows you to judge the degree of expansion of the chest. One of the pictures is taken while inhaling, the other – while exhaling (possibly on the same film) and, combining them, the dilatation coefficient is determined. According to W. Fray, the inhalation-exhalation area ratio normally does not exceed 72 (according to E.V. Neshel - 65-75). With initial pulmonary emphysema it is 70-80, with emphysema of the second degree - 80-90, with emphysema III degree- more than 90. The digram can also be used to determine the VL. Pulmonary volumes are also calculated using an x-ray kymogram (V.I. Sobolev, E.S. Mutina), which clearly reveals a slower exhalation (the exhalation knee is elongated and deformed) with emphysema.

Changes in the transparency of the lung fields in different phases breathing reflects the ventilation function of the lungs. The methods of this test were developed by Yu. N. Sokolov, E. V. Neshel, A. I. Sadofyev and others. In severe emphysema, the transparency of the pulmonary fields in different phases of breathing almost does not change. Increased transparency of the lungs alone does not indicate emphysema, because it may be due to decreased blood supply to the pulmonary vessels or atrophy of the chest wall due to exhaustion. Against the background of increased transparency of the pulmonary fields, an increase in the pulmonary pattern in the root area characteristic of emphysema and its depletion in the periphery appears, which reflects a decrease in blood supply peripheral parts lungs and increased resistance to blood flow in the pulmonary circle.

Tomography and angiopulmonography play an important role in judging the state of pulmonary circulation. The latter in most cases makes it possible to judge the localization, prevalence and extent of the disease. This method requires special equipment and clinical practice not yet widespread. I. A. Shekhter, M. I. Perelman, F. A. Astrakhaitsev, M. Z. Upinger discovered vasoconstriction in the area of ​​emphysematous fields. They are spread apart, have few vascular branches, which do not extend at an acute angle, as usual, but at a right angle.

A. L. Vilkovsky and Z. M. Zaslavskaya, K. Jensen a. ass., G. Scarow, G. Lorenzen, G. Simon, H. Khuramovich, on angiograms of patients with emphysema, they found dilation of the hilar and lobar arteries, reflecting an increase in vascular resistance, narrowing of blood vessels from the center to the periphery with a very poor vascular network in areas of emphysema. K. Semish also revealed a slowing of capillary flow and arteriovenous anastomoses. M. A. Kuznetsova (1963) discovered similar changes in blood vessels on X-ray tomograms, and V. Lopez-Majano a. ass. - on scangrams.

Changes in the vascular bed increase as the disease progresses. According to L. Read, on angiograms the process seems more widespread than it is revealed at autopsy, which reflects the presence of vasospasm, which, like bronchospasm, plays a significant role in the progression of the disease.

Blistering areas may not be detected on a regular radiograph, especially with peripheral subpleural localization of bullae. Sometimes they are recognized as finely defined ring-shaped shadows or an avascular zone with a cellular pattern and deviation of the shadows of the vascular and bronchial branches. They are visible better on tomograms.

Bronchography for diffuse emphysema has not become widespread - it is difficult to tolerate in this group of seriously ill patients, and the contrast, due to the ineffectiveness of coughing, lingers in the respiratory tract for a long time.

Lung functions in patients with widespread emphysema are noticeably impaired. According to our observations, ventilation is the first to change. In the initial period, the disturbances are small and are manifested by a moderate limitation of vital capacity, MMOP and respiratory reserves, an increase in residual air and MOP. Tidal volume may even increase in the first period of the disease.

An increase in the minute volume of respiration at the onset of the disease ensures sufficient saturation of the blood with oxygen and removal of carbon dioxide; in some patients, hypocapnia is detected. During exercise, especially if it is accompanied by a bronchospastic reaction, ventilation disturbances become more pronounced and may be accompanied by decreased saturation arterial blood oxygen and level off not in 2-3 minutes, as in healthy people, but much later.

Ventilation disturbances increase as emphysema progresses, which is most often associated with an exacerbation of infection - an outbreak of bronchitis or pneumonia. At the same time, shortness of breath and cough intensify, body temperature may rise, weakness, sweating, and severe fatigue may appear. Sputum often becomes purulent in nature and, along with various infectious agents, is found in it a large number of neutrophils.

Exacerbation of infection always worsens bronchial patency due to the accumulation of secretions, swelling of the bronchi and bronchioles, bronchospasm leads to complete or partial destruction of the alveoli and an increase in the area of ​​emphysema.

The deterioration of bronchial obstruction is reflected in ventilation indicators: vital capacity decreases, especially the one-second volume (B. E. Votchal and T. I. Bibikova propose to determine the forced vital capacity in 2 seconds), the power of the air stream and the ratio of MMOD to vital capacity sharply decrease. This indicates increased resistance to air flow in the respiratory tract. Increase in anatomical and especially functional dead space, uneven ventilation (not all areas are affected equally and disruption of air flow does not occur simultaneously) leads to alveolar hypoventilation.

Accordingly, the work of the respiratory muscles increases. Additional muscles that enhance inhalation are located mainly in the upper chest (sternocleidomastoid, scalene, trapezius), muscles that enhance exhalation are located in the lower. Discoordination develops breathing movements or pathological upper thoracic type of breathing. This additionally loads the respiratory muscles, making them less efficient and increasing the energy costs of breathing. Therefore, although the minute volume of breathing is increased, most of the energy goes to ensure the work of the respiratory muscles.

External respiration no longer ensures sufficient saturation of the blood with oxygen and removal of carbon dioxide. However, there is no complete correspondence between the severity of the disease and the degree of impairment of ventilation parameters. But an approximate conclusion about the degree of gas exchange disturbances can be made based on studying the indicators external respiration(residual air, MOD, FVC, MMOD, ventilation reserves and expiratory power). J. Hamm in 155 patients with emphysema and bronchial asthma determined the severity of the disease by spirometric indicators and obtained results that corresponded to the clinic.

Changes in blood gases are indicative. Gas exchange disorders are caused by ventilation disorders, increased work of breathing and desolation of part of the capillary bed. The diffusion of gases through the alveolar-capillary membrane in emphysema without concomitant pneumosclerosis changes little (mainly due to swelling of the alveoli during an exacerbation of bronchorespiratory infection). The difference in oxygen tension in the alveoli and in the arterial blood during emphysema can be increased by 8-10 mmHg compared to the norm. Most often this is due to uneven ventilation (H. Marx, P. Rossier, etc.).

Gas exchange disorders are detected, as a rule, if the volume of residual air is more than 45% and MMOD is less than 50 l/min. Our observations confirm the data of other authors (V. G. Uspenskaya, N. N. Savitsky, N. Marx, etc.) that the severity of the disease is most correlated with indicators of arterial blood oxygen saturation and, to a lesser extent, with the oxygen content in arterial blood.

Oxygen capacity reflects the ability to transport oxygen by hemoglobin. It increased moderately in only 1/3 of our patients with hypoxemia. According to V. G. Uspenskaya, on early stages diseases, oxygen capacity decreased, but in general changes hers were small.

The presence of hypercapnia always indicates an unfavorable prognosis and a very severe phase of the disease. If a patient with emphysema has hypercapnia due to a hypoventilation crisis due to abdominal surgery or an exacerbation of a bronchorespiratory infection, then after the crisis is eliminated, the carbon dioxide content in the blood may again become normal. But chronic hypercapnia is always accompanied by a sharp and persistent depression of ventilation.

Functional studies after exercise allow a more accurate assessment of the extent of the disease, reserves and prognosis. Exercise tolerance in patients with pulmonary emphysema is significantly less than in patients with heart disease. With moderately severe emphysema, a small load may initially lead to an increase in blood oxygen saturation, as the minute volume of respiration increases. In healthy people, MOD increases to 100-130 liters per minute, further increase in ventilation is useless, everything is spent on the work of breathing. In patients with emphysema, MOD, in which further increase in ventilation is useless, is achieved much earlier (especially in those patients in whom MOD at rest is significantly increased). Similar conditions are apparently created at a respiratory rate of 45 per minute.

In seriously ill patients, exercise testing is risky. N. Marx considers exercise tests contraindicated in cases of circulatory decompensation, prolonged and severe bronchospasm, exacerbation of bronchorespiratory infection, if MMOD is less than 30 l/min, vital capacity is less than 2 liters, 1" volume is less than 50% of vital capacity, residual volume is more than 50% of the total capacity, O2 tension in arterial blood is less than 70 mm Hg, arterial CO2 is more than 45 mm Hg.

To judge the degree of bronchospasm, spirographic studies can be performed after using bronchodilator drugs.

We observed mainly 2 types of disease:
1. Slowly progressive when increasing clinical picture occurs over many years, often unnoticed by the patient, symptoms for a long time are limited to ventilation disorders and moderate hypoxemia, exacerbations of bronchorespiratory infection are sluggish, with normal temperature bodies. Patients usually seek treatment 1-2 times a year. medical assistance, more often treat themselves various antibiotics and bronchodilators and may maintain limited ability to work for a long time.

2. A rapidly progressing type of course, which is usually observed in younger people and is characterized by frequent, rapidly flowing periods of exacerbation of bronchorespiratory infection. Hypoxemia develops quickly, and in the next 2-3 years hypercapnia also develops, that is, global P. Rossier deficiency is formed, from which patients cannot be completely eliminated. In such patients, as a rule, more pronounced disturbances in the blood supply to the lungs are observed in the section and the blistering form of emphysema is more common.

Emphysema is a nonspecific chronic disease, the characteristic feature of which is the irreversible expansion of the air space of the bronchioles with changes in the walls of the alveoli. The prevalence of the disease is less than 5% of all patients; it is 2 times less common among women. Patients with COPD (chronic obstructive pulmonary disease) have a significantly higher risk of developing emphysema than relatively healthy people. The peculiarity of the disease is that this pathology with a severe course greatly affects the patient’s ability to work. In addition, the resulting bronchopulmonary syndrome in some cases can even lead to disability.

Emphysema occurs in only 5% of patients

Causal factors leading to the development of emphysema

Almost any exposure leading to chronic inflammatory phenomena in the alveoli, stimulates the development of emphysema. The development of this pathology is more likely in the presence of certain factors:

• COPD and bronchial;
• Inflammatory phenomena in the respiratory bronchi and alveoli;
• Deterioration of microcirculation in the lung tissues;
• Congenital deficiency of the enzyme α-1 antitrypsin;
• Surfactant-related disorders;
• Occupational hazards (constant increase in air in the alveoli and bronchi);
• Chronic intoxication (tobacco smoke and other pollutants).

The influence of these factors leads to damage to the elastic tissue, reduction and/or loss of the ability to fill with air and its collapse. Lungs that are overfilled with air lead to ventilation pathologies such as obstruction and sticking together of small-caliber bronchi during exhalation. Overstretching of the lung tissue, its swelling, as well as a bull (air cyst) occurs due to the formation of a valve mechanism. Thus, obstructive pulmonary emphysema occurs. The danger of bullae is that their rupture is accompanied by the phenomena spontaneous pneumothorax prone to relapse.

Because emphysema is characterized serious increase lung, it looks like a sponge with large pores. At microscopic examination lung tissue reveals destruction of the alveolar septa.

Smoking is one of the common reasons occurrence of emphysema

Classification

Emphysema is classified as:

• Primary (congenital) – an independent pathological process;
• Secondary (acquired) - as a consequence of other lung pathologies, for example, obstructive or bronchial.

According to the prevalence of the pathological process, the following forms are distinguished:

• Diffuse pulmonary emphysema;
• Localized.

Based on the involvement of changes in the acinus (structural unit of the lungs), emphysema can be:

• Panlobular or panacinar - the acinus is completely affected;
• Centrilobular or centriacinar - the acinus is affected in the central section;
• Perilobular or periacinar - the acinus is affected in the distal part;
• Peri-scar or irregular, that is, uneven;
• Bullous pulmonary emphysema - if bullae are found.

Note! Also separately noted are congenital lobar emphysema and McLeod syndrome - a unilateral lesion with an unknown cause.

Symptoms of emphysema

The main signs of pulmonary emphysema:

• Expiratory (difficulty breathing) shortness of breath. Depends on the degree respiratory failure;
• A significant expansion of the chest with a decrease in its respiratory movements (barrel chest) is visually determined;
• The intercostal spaces are enlarged;
• The supraclavicular areas are smoothed;
• Cyanosis. Blue tint of the nasolabial triangle due to oxygen deficiency.
• “Pink puffer” - that’s what it’s called appearance patient with this pathology. Skin on the face Pink colour, the patient is in a forced orthopneic position (the body is tilted forward, legs are lowered, arms are supported in front of him).

With emphysema, a person's skin turns pink

• Thickening of the fingers like “drumsticks”.
• Loss of body weight.

Complications

Untreated emphysema can lead to severe and pathological changes in the cardiopulmonary system. Capillary disorders lead to hypertension in the pulmonary circulation with an increase in the load on the heart, in particular the right sections. In this case, right ventricular failure with edema and enlargement of the liver may develop. It is also possible that an emergency condition of spontaneous pneumothorax may occur, which requires mandatory medical care.

Diagnostics

The diagnosis must be made. He can make a primary diagnosis based on complaints, examination and examination. These are the simplest and most basic methods to determine the disease, but they are not exhaustive. Therefore, to make an accurate clinical diagnosis, we use additional methods. First of all, this is an x-ray of the lungs. An X-ray machine allows you to determine the density of the tissue and differentiate it from other changes in the lungs. Spirometry is always used, this allows you to determine the degree of impairment in lung function. The most accurate but expensive method () can also be used.

Chronic intoxication of the body leads to emphysema

Current treatment methods

Specific therapy for pulmonary emphysema this moment not developed. First of all, it is necessary to completely eliminate those factors that lead to the development of this disease. That is, you definitely need to give up habitual intoxications. If emphysema is severe, it may even be necessary to change jobs if the patient is exposed to toxic effects that lead to the development of the disease.

Often this disease does not require hospitalization of the patient if he is in satisfactory condition. Treatment is carried out in outpatient setting with mandatory supervision of the attending physician or therapist. The patient is hospitalized in the pulmonology department of the hospital only if an infectious component has appeared or a complication has developed. Because these conditions require urgent measures, which should be carried out by a highly specialized specialist in a hospital setting.

If you detect the first symptoms of pulmonary emphysema, you should urgently consult a pulmonologist

Treatment of emphysema, like any other disease, should be carried out comprehensively. For achievement best result it should consist of the following components:

1. Diet therapy. Nutrition of the patient in mandatory must be correct and balanced. It is advisable to adhere to a low-calorie diet with high content raw fruits and vegetables. It is necessary to reduce consumption, since these elements can lead to a lack of oxygen in the patient’s body, which will further aggravate his condition.
2. Medicines. Treatment is mainly symptomatic. In case of exacerbation of the process, therapy is indicated for the patient antibacterial agents wide spectrum of action. Also if the patient suffers chronic form disease, then he must use bronchial dilator drugs on an ongoing basis. Such drugs include salbutamol, theophylline, which can be either in tablet form or in the form of inhalation. If there are problems with sputum discharge, patients should use a mucolytic agent.
3. Oxygen therapy. Used to improve gas exchange in the lungs. The procedure involves the patient inhaling an air mixture with a reduced amount of oxygen, and then breathing air with a normal oxygen content. Such procedures should be carried out in cycles of 15-20 days. This therapy is especially indicated if emphysema occurs in children.

Methods that alleviate the general condition of the patient

There are many techniques that help alleviate the condition of a patient with emphysema, the main ones are:

• Massage. Classic, segmental, point and drainage massages. With the help of these massages, the bronchial system expands and this facilitates easy discharge of mucus. Besides, massotherapy promotes excellent relaxation of the entire muscle frame, which leads to improved external respiration.
• Physical therapy complex. Helps prevent overstrain of the muscular system, because with emphysema the muscular frame is in constant tone. Exercise therapy contains a simple set of exercises that anyone can repeat. Exercises can be used to create positive exhalation, as well as complexes for training diaphragmatic breathing and its rhythm. Such breathing exercises for pulmonary emphysema must be carried out under the supervision of a specialist in medical rehabilitation.

When treating emphysema, it is necessary to deal physical therapy(physical therapy)

Treatment with folk remedies

It should be remembered that remedies for traditional treatment are auxiliary and in no case should be monotherapy. Nowadays the following recipes are very common:

1. Using wild rosemary for inhalation. First, pour boiling water over the plant and leave for 15 minutes. Inhalations are carried out 2 times a day.
2. Mix licorice root, marshmallow root, sage and anise in equal proportions. tablespoon this fee should be brewed in a glass of boiling water and left for an hour. This tincture you need to take 3 times a day, 3 ml.

Depending on what means and how to treat this disease, the prognosis of the patient’s life will directly depend. If therapy is started on time and carried out in full, it can significantly improve the patient’s quality of life and save him long time from relapses of the disease.

Emphysema is an anatomical alteration of the lungs characterized by pathological expansion air spaces located distal to the terminal bronchioles, and accompanied by destructive changes in the alveolar walls.

Classification of pulmonary emphysema:

• According to pathogenesis, it is divided into primary and secondary.
• According to their prevalence, they are divided into diffuse and focal.
• According to pathomorphology, they are divided into panacinar (panlobular), centriacinar (centrilobular), periacinar (perilobular), paraseptal, irregular and bullous.

Etiology and pathogenesis

There are primary emphysema, which develops in intact lungs, and secondary emphysema, which occurs when irreversible changes in the structure of the respiratory part of the lungs are caused by various diseases of the bronchopulmonary system.

Primary pulmonary emphysema is diffuse destructive emphysema, which is an independent pathological form in which widespread damage to the elastic framework of the lungs develops with a decrease in elastic properties. Currently, the importance of proteolytic enzymes has been proven, in particular the deficiency of α1-antitrypsin, which is birth defect, in the development of primary pulmonary emphysema.

Secondary pulmonary emphysema can be diffuse or focal. In secondary emphysema, great importance is attached exogenous factors- smoking and industrial pollutants, which activate alveolar macrophages and lymphocytes producing elastase, neutrophil protease, acid hydrolase, which have a proteolytic effect, and inhibit α1-antitrypsin, a proteolysis inhibitor. All this leads to the destruction of the thin structures of the lung parenchyma.

The main cause of secondary diffuse emphysema is chronic obstructive bronchitis, in which the resulting bronchospasm, swelling of the mucous membrane and blockage of the lumen of the small bronchi with mucus contribute to the development of the “air trap” phenomenon. The essence of this phenomenon is a decrease in intrathoracic pressure during inspiration, accompanied by passive stretching of the bronchial lumen, and an increase in intrathoracic pressure during exhalation, creating additional compression of the bronchial branches and increasing bronchial obstruction. As a result, air is retained in the alveoli and hypertension occurs. The alveoli first stretch, and then trophic changes develop in their walls. Great importance with secondary diffuse emphysema, the transition of the inflammatory-dystrophic process from bronchioles to alveoli with the development of alveolitis and destruction of alveolar septa is attributed.

Focal forms of secondary destructive emphysema can be peri-scar, developing around a scar-altered area of ​​lung tissue after pneumonia, tuberculosis, sarcoidosis, or occupational lung diseases.

Congenital lobar emphysema is characterized by sharp increase volume of one lobe in children early age. There is an opinion that the disease is caused by impaired bronchial obstruction due to atrophy of bronchial cartilage with the formation of valve obstruction.

McLeod syndrome is characterized by unilateral emphysema, hypoplasia of the branches pulmonary artery and obstruction of small bronchi.

Paraseptal emphysema is a focus of emphysematous-changed lung tissue adjacent to a compacted connective tissue septum or pleura. The main reason for the development of this form of emphysema is bronchial obstruction during focal bronchitis and bronchiolitis.

Bullous emphysema is characterized by the formation of air cavities more than 1 cm in diameter, most often with peri-scar or paraseptal emphysema.

In the pathogenesis of respiratory failure developing with primary emphysema, two factors are of primary importance. The first is to reduce the total lung surface as a result of destruction of the interalveolar septa, which leads to a decrease in the diffusion capacity of the lungs. The second pathogenetic factor is a change in the elastic properties of the lungs, the elastic return of which decreases, making it difficult to exhale. A special variant of obstructive disorders is formed, in which bronchial resistance increases only on exhalation with the appearance of a valve mechanism bronchial obstruction.

Symptoms

With secondary diffuse pulmonary emphysema, patients complain of shortness of breath, decreased exercise tolerance; sometimes there is a decrease in body weight. The condition of the patients remains satisfactory for a long time. On examination, cyanosis is revealed skin and mucous membranes, the severity of which depends on the degree of disruption of gas homeostasis. The chest is increased in volume ("barrel-shaped" chest) with a predominantly asthenic physique, its respiratory excursions are reduced. The intercostal spaces are widened, the subclavian spaces are smoothed or bulging.

On palpation, the resistance of the chest is reduced, and the vocal tremor is weakened. Upon percussion, a box tone is determined, the boundaries of the lungs are expanded, the mobility of the lower edge of the lungs is limited to 2-3 cm. The boundaries of cardiac dullness are reduced, sometimes completely disappearing. On auscultation, weakened vesicular breathing is heard, and bronchophony is weakened. Heart sounds are weakened.

However, the diagnosis of secondary diffuse emphysema that has developed against the background of chronic obstructive bronchitis can be difficult due to persistent cough, shortness of breath, the absence in many patients of a “barrel-shaped” chest, the presence of hard vesicular breathing with scattered buzzing wheezing, and sometimes with moist fine bubbling.

Primary pulmonary emphysema has similar symptoms, but differs from secondary emphysema in the absence of symptoms chronic bronchitis or other lung pathology and signs of inflammation. Patients exhibit moderate cyanosis due to normal gas composition blood for a long time. Their expiratory resistance is also normal, but the compliance of the lungs and ELC are increased. The diffusion capacity of the lungs is sharply reduced, hypoxemia and hypercapnia are detected only during exercise.

Peri-scar, lobar, unilateral (McLeod's syndrome), paraseptal and bullous emphysema are asymptomatic and are detected only when X-ray examination or with the development of pneumothorax.

Diagnostics

X-ray examination reveals characteristic signs - increased transparency of the pulmonary fields and weakening of the vascular pulmonary pattern, up to its disappearance in the presence of large bullous formations. The diaphragm is flattened and low. The heart is not enlarged in size, but is located vertically. During the tomorespiratory test, the transparency of the lungs does not change during the breathing phase.

A functional study allows us to detect in patients with emphysema a decrease in vital capacity with a simultaneous increase in FRC and TLC due to a decrease in expiratory PO, a decrease in FEV 1 and an increase in bronchial resistance with calm breathing. Relatively early sign there may be a decrease in the diffusion capacity of the lungs. Subsequently, the patients' TLC steadily increases and the lung retraction index decreases.

Study of the flow-volume diagram makes it possible to identify obstruction of the distal segments of the bronchi in the early stages of the disease.

Treatment

There are no effective methods for treating pulmonary emphysema, since the reverse development of morphological and functional changes is impossible. Therefore, early identification and treatment of patients with chronic bronchitis and improvement of bronchial patency, preventing respiratory acidosis, are of primary importance.

From medications for emphysema, aminophylline is effective when intravenous administration 2.4% solution 5-7.5 ml 2-3 times a day for 10-12 days with a transition to long-acting theophylline preparations (retafil, sporphylline retard, theotard). It is possible to prescribe an M-anticholinergic drug - ipratropium bromide, but it is not very effective. β2-agonists are indicated short acting(salbutamol, Berotec) and long-term (salmeterol, formoterol). But these drugs for emphysema can worsen ventilation parameters.

In case of respiratory failure, patients with pulmonary emphysema are advised to take courses of oxygen therapy with careful monitoring of the blood ABS. It is recommended to inhale 30% of the oxygen concentration in the inhaled air with a gradual increase to 50% over 2-3 days. The general complex of treatment should include the inclusion of therapeutic exercises, which should be strictly individual. Therapeutic gymnastic exercises include general strengthening and special exercises aimed at increasing primarily exhalation by training the muscles of the chest and diaphragm.

Forecast

The course of diffuse pulmonary emphysema is long, but generally unfavorable. Often, patients with all forms of emphysema develop a complication - pneumothorax. The progression of the disease, disability and death of patients have different rates in different patients and are determined by the rate of destruction of lung tissue, which is difficult to recognize and control due to the inability to identify the factors causing this destruction.

Prevention

Primary prevention comes down to preventing progressive chronic bronchial obstruction through anti-relapse treatment of obstructive bronchitis. Secondary prevention includes avoiding smoking, exposure to pollutants, and heavy physical activity. Patients require constant monitoring of blood gas composition, central and peripheral hemodynamics and correction if they are disturbed.

Focal emphysema does not require special treatment. The development of repeated pneumothorax is an indication for surgical treatment. Large bullae, accompanied by a significant deterioration in respiratory function, also require surgical intervention.

In case of primary emphysema, symptomatic therapy is carried out aimed at reducing respiratory failure (physical therapy, repeated courses of oxygen therapy), smoking and contact with polluted air are avoided.

Pulmonary emphysema is called chronic illness, which is accompanied by changes in the properties and structure of the alveoli. Similar disease extremely dangerous. Why does it occur, what is it and what are its main symptoms? What treatments are used modern medicine? Is it possible to avoid complications? These questions are very relevant.

what is it and what are its causes?

As already mentioned, this disease is associated with a change in the structure of the alveoli, as a result of which they become overstretched and lose their ability to contract. Indeed, this is quite dangerous Emphysema develops slowly and imperceptibly, but leads to the same thing - development

As for reasons like this pathological changes, then they can be completely different. First of all, it is worth noting that emphysema is often the result of other diseases, in particular tuberculosis, asthma and chronic bronchitis. On the other hand, smokers suffer from the disease, since cigarette smoke gradually destroys the structure of the alveoli.

Risk factors include the characteristics of certain professions. In particular, emphysema is often found in production workers, construction workers, repairmen, etc. Constant inhalation of smoke, construction dust and cement, and chemically aggressive substances - all this eventually leads to the destruction of lung tissue. Currently, the list of causes of the disease in question also includes an unfavorable living environment.

Pulmonary emphysema: what is it and what are its symptoms?

Stretching of the alveoli, loss of elasticity and contractility lead to disruption normal operation respiratory system. Therefore, the very first symptom of emphysema is shortness of breath. Patients complain of a feeling of suffocation. And if at first shortness of breath appears only during physical exertion, then over time breathing problems become a common companion for a sick person. Often deep breaths or exhalations are accompanied by wheezing.

As the disease progresses, even changes are observed human body, in particular, the chest becomes barrel-shaped, and the fingers thicken like

Due to a lack of oxygen, chronic fatigue develops - patients complain of drowsiness, fatigue, and decreased performance. Sudden weight loss is also considered one of the symptoms of the disease.

Pulmonary emphysema: what is it and how to treat it?

As already mentioned, the disease is fraught with serious complications. That is why treatment in this case is simply necessary. Of course, first of all it is worth determining what caused the changes in the lung tissue and eliminating the root cause. For example, smokers need to quit their habit as soon as possible, and workers exposed to hazardous substances should carefully monitor protection using other devices.

Drug treatment boils down to taking drugs that eliminate bronchospasm. Acupressure is a good therapeutic effect. Breathing exercises for pulmonary emphysema help eliminate the main symptoms and prevent further changes in the alveoli. Oxygen therapy is also considered effective, in which the patient alternately inhales normal air and then breathes air with a reduced amount of this gas.

It is worth noting that with the right therapy, many people lead completely normal lives.

Emphysema is a disease characterized by pathological expansion of the terminal sections of the lungs - bronchioles and alveolar sacs. According to statistics, pathology is diagnosed in 4% of patients who see a pulmonologist.

What happens with emphysema?

main reason primary emphysema - smoking.

The human lungs can be compared to a bunch of grapes. The thick branches are the bronchi, the stalks on which the berries sit are the bronchioles, and the grapes themselves are the alveoli, in which gas exchange occurs. During inhalation, the alveoli fill with air as much as possible and inflate. The oxygen that enters them is transferred to the blood, and carbon dioxide is released from the blood.

Normally, during exhalation, the alveoli should give up almost all the air and collapse, preparing for the next respiratory cycle, but with emphysema this does not happen. Gas with a high carbon dioxide content is retained in the lungs, preventing the entry of new portions of air into them. The walls of the alveoli and bronchioles stretch more and more, gradually losing their elasticity.

Over time, the partitions between adjacent respiratory sacs tear, resulting in the formation of large cavities () that are not capable of gas exchange. Blood flow in the pulmonary capillaries becomes difficult, the bronchi narrow, and metabolism in the lung tissue is disrupted. All this leads to deterioration of organ function and the development of respiratory failure.

Causes of the disease

There are 2 forms of emphysema:

• primary (occurs as an independent disease),
• secondary (is a consequence of others).

The main “merit” in the development of primary emphysema belongs to. It has been established that the resins contained in tobacco smoke, have a direct destructive effect on the interalveolar septa. According to doctors' observations, the disease is guaranteed to occur in people who smoke more than 18 cigarettes a day every day.

Unfavorable factors also play an important role environmental factors. Industrial waste, exhaust gases and dust, which are rich in the air of megacities, irritate the mucous membranes respiratory tract, leading to a weakening of their protective properties.

In some cases, primary emphysema develops due to a genetic defect. People with an inherited deficiency of the enzyme alpha-1-antitrypsin have an increased susceptibility to bronchopulmonary diseases. Their frequent occurrence leads to damage to the alveolar sacs and the formation of numerous bullae. The genetically determined disease first appears in young or middle age and, as a rule, is diagnosed in several family members at once.

Secondary emphysema may result from:

• acute or
• tuberculosis,

The likelihood of acquiring the disease increases with age, when lung tissue begins to lose its elasticity. In addition to older people, the risk group includes people whose professional activities involve a high workload. respiratory organs: glassblowers, singers, brass band musicians.

Symptoms

Patients with pulmonary emphysema are bothered by a feeling of lack of air, shortness of breath and an unproductive cough.

Patients with emphysema complain of shortness of breath and lack of air. In the early stages of the disease, shortness of breath occurs only after physical activity, in the later stages it is felt constantly. The condition is accompanied by scanty sputum.

With primary emphysema, the breathing pattern changes. The inhalation becomes fast, the exhalation becomes longer. When exhaling, such patients open their mouths slightly and puff out their cheeks, as if puffing.

At moderate and severe stages, significant weight loss occurs due to high energy costs for the work of the respiratory muscles. The chest takes on a cylindrical (barrel) shape.

In severe respiratory failure, symptoms associated with oxygen starvation tissues and organs:

• cyanosis of the skin and nails,
• swelling of the neck veins,
• puffiness of the face,
• irritability,
• insomnia.

With obvious damage to the lungs, the load on the diaphragm increases, so patients with emphysema are often forced to sleep in a sitting position.

Diagnostics

The diagnosis is made based on characteristic symptoms and examination of the lungs. The doctor examines the patient, performs auscultation (listening) and percussion (tapping) of the chest. To identify the degree of pathological changes, the patient is prescribed:

• . The images confirm increased airiness of the lungs and expansion of the chest space. The presence of bullae is revealed.
• CT scan of the lungs. Volume x-ray method helps to clarify the location of air cavities.
• . Functional indicators of the lungs (vital capacity, inhalation and exhalation speed) are determined. Large deviations from the norm indicate the development of respiratory failure.

Therapy methods

The main measures are aimed at combating provoking factors. Quitting smoking is of great importance, otherwise, despite all the treatment, the disease will continue to progress. For primary emphysema caused by a lack of alpha-1-antitrypsin, it is prescribed replacement therapy. If detected, measures are taken to eliminate inflammatory process in the bronchi.

On initial stages To alleviate the illness, patients are prescribed expectorants (Ambroxol, Bromhexine) and bronchodilators (Salbutamol, Berotec). These drugs help cleanse the airways and improve ventilation. If necessary, it is recommended to take anti-inflammatory hormones - corticosteroids (prednisolone).

In case of developed respiratory failure, oxygen therapy is indicated. Thanks to it, despite the reduced lung area, the patient receives required amount oxygen.

Exercises are useful at all stages of the disease breathing exercises. Special exercises aimed at teaching the patient the technique correct breathing, strengthening the respiratory muscles and increasing the mobility of the chest. Medical complex selected by the doctor individually.

In severe cases it is carried out surgery. The patient is removed lung segment, subjected to bull formation. The rest of the organ straightens, which leads to improved gas exchange.