Emphysema | Emphysema Symptoms | Emphysema Treatment

What is emphysema?

Emphysema is a type of COPD (chronic obstructive pulmonary disease). COPD is a group of lung diseases that make it hard to breathe and get worse over time. The other main type of COPD is chronic bronchitis. Most people with COPD have both emphysema and chronic bronchitis, but how severe each type is can be different from person to person.

Emphysema affects the air sacs in your lungs. Normally, these sacs are elastic or stretchy. When you breathe in, each air sac fills up with air, like a small balloon. When you breathe out, the air sacs deflate, and the air goes out.

In emphysema, the walls between many of the air sacs in the lungs are damaged. This causes the air sacs to lose their shape and become floppy. The damage also can destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones. This makes it harder for your lungs to move oxygen in and carbon dioxide out of your body.

What causes emphysema?

The cause of emphysema is usually long-term exposure to irritants that damage your lungs and the airways. In the United States, cigarette smoke is the main cause. Pipe, cigar, and other types of tobacco smoke can also cause emphysema, especially if you inhale them.

Exposure to other inhaled irritants can contribute to emphysema. These include secondhand smoke, air pollution, and chemical fumes or dusts from the environment or workplace.

Rarely, a genetic condition called alpha-1 antitrypsin deficiency can play a role in causing emphysema.

Who is at risk for emphysema?

The risk factors for emphysema include

• Smoking. This the main risk factor. Up to 75 percent of people who have emphysema smoke or used to smoke.
• Long-term exposure to other lung irritants, such as secondhand smoke, air pollution, and chemical fumes and dusts from the environment or workplace.
• Age. Most people who have emphysema are at least 40 years old when their symptoms begin.
• Genetics. This includes alpha-1 antitrypsin deficiency, which is a genetic condition. Also, smokers who get emphysema are more likely to get it if they have a family history of COPD.

What are the symptoms of emphysema?

At first, you may have no symptoms or only mild symptoms. As the disease gets worse, your symptoms usually become more severe. They can include

• Frequent coughing or wheezing
• A cough that produces a lot mucus
• Shortness of breath, especially with physical activity
• A whistling or squeaky sound when you breathe
• Tightness in your chest

Some people with emphysema get frequent respiratory infections such as colds and the flu. In severe cases, emphysema can cause weight loss, weakness in your lower muscles, and swelling in your ankles, feet, or legs.

How is emphysema diagnosed?

To make a diagnosis, your health care provider

• Will ask about your medical history and family history
• Will ask about your symptoms
• May do lab tests, such as lung function tests, a chest x-ray or CT scan, and blood tests

What are the treatments for emphysema?

There is no cure for emphysema. However, treatments can help with symptoms, slow the progress of the disease, and improve your ability to stay active. There are also treatments to prevent or treat complications of the disease. Treatments include

• Lifestyle changes, such as
  • Quitting smoking if you are a smoker. This is the most important step you can take to treat emphysema.
  • Avoiding secondhand smoke and places where you might breathe in other lung irritants
  • Ask your health care provider for an eating plan that will meet your nutritional needs. Also ask about how much physical activity you can do. Physical activity can strengthen the muscles that help you breathe and improve your overall wellness.
• Medicines, such as
  • Bronchodilators, which relax the muscles around your airways. This helps open your airways and makes breathing easier. Most bronchodilators are taken through an inhaler. In more severe cases, the inhaler may also contain steroids to reduce inflammation.
  • Vaccines for the flu and pneumococcal pneumonia, since people with emphysema are at higher risk for serious problems from these diseases
  • Antibiotics if you get a bacterial or viral lung infection
• Oxygen therapy, if you have severe emphysema and low levels of oxygen in your blood. Oxygen therapy can help you breathe better. You may need extra oxygen all the time or only at certain times.
• Pulmonary rehabilitation, which is a program that helps improve the well-being of people who have chronic breathing problems. It may include
  • An exercise program
  • Disease management training
  • Nutritional counseling
  • Psychological counseling
• Surgery, usually as a last resort for people who have severe symptoms that have not gotten better with medicines. There are surgeries to
  • Remove damaged lung tissue
  • Remove large air spaces (bullae) that can form when air sacs are destroyed. The bullae can interfere with breathing.
  • Do a lung transplant. This is might be an option if you have very severe emphysema.

If you have emphysema, it’s important to know when and where to get help for your symptoms. You should get emergency care if you have severe symptoms, such as trouble catching your breath or talking. Call your health care provider if your symptoms are getting worse or if you have signs of an infection, such as a fever.

Can emphysema be prevented?

Since smoking causes most cases of emphysema, the best way to prevent it is to not smoke. It’s also important to try to avoid lung irritants such as secondhand smoke, air pollution, chemical fumes, and dusts.

NIH: National Heart, Lung, and Blood Institute

Emphysema: Basics and Common Causes

Emphysema is a form of chronic (long-term) lung disease. This and chronic bronchitis are the two main types of chronic obstructive pulmonary disease (COPD), the third-leading cause of death in the United States.

These conditions are called “obstructive” because it’s as though something is blocking the smooth flow of air in and out of the lungs.

Doctors estimate that more than 24 million people in the United States have emphysema or another form of COPD. Many of them don’t know it.

How Does It Happen?

You get emphysema when the linings of the tiny air sacs in your lungs become damaged beyond repair. Over time, your lung damage gets worse. Here’s what happens:

• The fragile tissues between air sacs are destroyed and air pockets form in the lungs.
• Air gets trapped in these pouches of damaged tissue.
• The lungs slowly get larger, and you find it harder to breathe.

If you have symptoms of emphysema, your doctor will do tests to see how well your lungs work. If you have the condition, you won’t be able to empty your lungs of air as quickly as you should. Doctors call this “airflow limitation.”

What Are the Causes?

There are two major known causes of emphysema:

Smoking. Most of the time, tobacco is the main culprit. Doctors don’t know exactly how smoking destroys air sac linings, but studies show that smokers are about six times more likely to develop emphysema than are nonsmokers.

Doctors don’t know why some smokers get emphysema and others don’t.

There is no cure for emphysema, but if you’re a smoker with the disease, kicking the habit might help slow down the damage it does to your lungs.

AAT deficiency: Alpha-1 antitrypsin (AAT) is a natural protein that circulates in human blood. Its main function is to keep white blood cells from damaging normal tissues. The body needs these cells to fight infections.

An estimated 100,000 people in the United States were born with a condition that keeps their bodies from making enough AAT. If you have AAT deficiency, your normal white blood cells will damage your lungs. The harm is even worse if you smoke.

Over time, most people with severe AAT deficiency develop emphysema. If you have this disease, you may also develop liver problems.

Other Possible Causes

Secondhand smoke. Doctors have long known that being around cigarette smoke — even if you aren’t a smoker — can lead to lung damage over time. Several studies suggest that people exposed to high amounts of secondhand smoke probably have higher odds of getting emphysema.

Air pollution. Scientists believe this plays a role, but it’s hard to measure. That’s because most people are exposed to pollution, but emphysema takes years to develop.

Causes, Symptoms, Diagnosis & Treatments

Overview

What is emphysema?

Emphysema is a disease of the lungs that usually develops after many years of smoking. Both chronic bronchitis and emphysema belong to a group of lung diseases known as chronic obstructive pulmonary disease (COPD). Once it develops, emphysema can’t be reversed. This is why not smoking or stopping smoking is very important.

Emphysema is a condition that involves damage to the walls of the air sacs (alveoli) of the lung. Alveoli are small, thin-walled, very fragile air sacs located in clusters at the end of the bronchial tubes deep inside the lungs. There are about 300 million alveoli in normal lungs. As you breathe in air, the alveoli stretch, drawing oxygen in and transporting it to the blood. When you exhale, the alveoli shrink, forcing carbon dioxide out of the body.

When emphysema develops, the alveoli and lung tissue are destroyed. With this damage, the alveoli cannot support the bronchial tubes. The tubes collapse and cause an “obstruction” (a blockage), which traps air inside the lungs. Too much air trapped in the lungs can give some patients a barrel-chested appearance. Also, because there are fewer alveoli, less oxygen will be able to move into the bloodstream.

Who gets emphysema?

Over 3 million people in the United States have been diagnosed with emphysema. Over 11 million Americans have COPD. Emphysema is most common in men between the ages of 50 and 70.

Symptoms and Causes

What causes emphysema?

Smoking is the number one factor. Because of this, emphysema is one of the most preventable types of respiratory diseases. Air pollutants in the home and workplace, genetic (inherited) factors (alpha-1 antitrypsin deficiency), and respiratory infections can also play a role in causing emphysema.

Cigarette smoking not only destroys lung tissue, it also irritates the airways. This causes inflammation and damage to cilia that line the bronchial tubes. This results in swollen airways, mucus production, and difficulty clearing the airways. All of these changes can lead to shortness of breath.

What are symptoms of emphysema?

Symptoms of emphysema may include coughing, wheezing, shortness of breath, chest tightness, and an increased production of mucus. Often times, symptoms may not be noticed until 50 percent or more of the lung tissue has been destroyed. Until then, the only symptoms may be a gradual development of shortness of breath and tiredness (fatigue), which can be mistaken for other illnesses. People who develop emphysema have an increased risk of pneumonia, bronchitis, and other lung infections. See your doctor if any of these symptoms arise:

• Shortness of breath, especially during light exercise or climbing steps
• Ongoing feeling of not being able to get enough air
• Long-term cough or “smoker’s cough”
• Wheezing
• Long-term mucus production
• Ongoing fatigue

Diagnosis and Tests

How is emphysema diagnosed?

The diagnosis of emphysema cannot be made solely on symptoms. Several tests are used to make the diagnosis. One simple test is to tap on your chest and listen with a stethoscope for a hollow sound. This means that air is being trapped in your lungs. Other tests include:

• X-rays: X-rays are generally not useful for detecting early stages of emphysema. However,
  X-rays can help diagnose moderate or severe cases. Either a plain chest X-ray or a CAT (computer-aided tomography) scan can be used. Once the test is completed, the readings are compared to X-rays of healthy or normal lungs.
• Pulse oximetry: This test is also known as an oxygen saturation test. Pulse oximetry is used to measure the oxygen content of the blood. This is done by attaching the monitor to a person’s finger, forehead, or earlobe.
• Spirometry and pulmonary function tests (PFT): This is one of the most useful tests to determine airway blockage. A spirometry or PFT tests the lungs’ volume by measuring airflow while a patient inhales and exhales. This test is done by taking a deep breath and then blowing into a tube that is hooked up to a specialized machine. These tests are compared to normal results from people of similar gender, age, height, weight and ethnic background.
• Arterial blood gas: This test measures the amount of oxygen and carbon dioxide in blood from an artery. It is a test often used as emphysema worsens. It is especially helpful in determining if a patient needs extra oxygen.
• Electrocardiogram (ECG): ECGs check heart function and are used to rule out heart disease as a cause of shortness of breath.

You might also talk to your doctor about whether testing for alpha-1 antitrypsin deficiency is appropriate for you.

Management and Treatment

How is emphysema treated?

Because emphysema can worsen over time and there is no known cure, treatment is focused on slowing the speed of decline. The type of treatment will depend on the severity of the disease.

Quitting smoking: If you smoke, quit. This is the most important step you can take to protect your lungs. It is never too late to quit. Your doctor can help you find the best smoking quitting method for you.

Bronchodilator medications: These medicines relax the muscles around the airways. They are often used to treat asthma. Bronchodilators, given through hand-held inhalants, produce more immediate results and have fewer side effects than oral medications.

Anti-inflammatory medication: These medications reduce inflammation in the airways. However, long-term side effects of these drugs include osteoporosis, hypertension, high blood sugar, and fat redistribution.

Oxygen therapy: Oxygen therapy is prescribed for patients whose lungs are not getting enough oxygen to the blood (hypoxemia). These patients can’t absorb enough oxygen from the outside air and need to get more oxygen through a machine (a nasal catheter or a facemask).

Lung volume reduction surgery: Lung volume reduction surgery involves removing a portion of diseased lung tissue, then joining together the remaining tissue. Doing this may relieve pressure on the breathing muscles and help improve lung elasticity (or stretch). The results of the surgery have been very promising. Not all patients with emphysema are candidates for this surgery.

What are some tips for managing emphysema?

The best way to prevent or reduce further problems is to prevent respiratory infections by:

• Practicing good handwashing methods
• Brushing and flossing teeth daily, and using an antibacterial mouth rinse after meals
• Keeping breathing equipment clean
• Keeping your house clean and free of dust
• Getting a flu shot every year
• Following a doctor-prescribed exercise program
• Avoiding irritants such as:
  • Cigarette smoke
  • Exhaust fumes
  • Strong perfumes
  • Cleaning products
  • Paint/varnish
  • Dust
  • Pollen
  • Pet dander
  • Pollution

Symptoms, stages, causes, treatments, and outlook

Emphysema is a type of chronic obstructive pulmonary disease (COPD). In this condition, the air sacs in the lungs become damaged and stretched. This results in a chronic cough and difficulty breathing.

Smoking is the most common cause of emphysema, but other factors can also cause it. There is currently no cure, but quitting smoking can help improve the outlook.

In the United States, around 3.8 million people (1.5% of the population) have received a diagnosis of emphysema. In 2017, 7,085 people (2.2 people in every 100,000) died with the condition.

Keep reading to learn more about emphysema, including the causes, symptoms, and treatment options.

Emphysema is a type of COPD. With emphysema, lung tissue loses elasticity, and the air sacs and alveoli in the lungs become larger.

The walls of the air sacs break down or are destroyed, narrowed, collapsed, stretched, or over-inflated. This means that there is a smaller surface area for the lungs to take oxygen into the blood and remove carbon dioxide from the body.

This damage is permanent and irreversible, but there are ways of managing the condition.

The key symptoms of emphysema include:

• shortness of breath, or dyspnea
• a chronic cough that produces mucus
• wheezing and a whistling or squeaky sound when breathing
• tightness in the chest

At first, a person may notice these symptoms during physical exertion. However, as the condition progresses, they can also start to happen during rest.

Emphysema and COPD develop over a number of years.

In the later stages, a person may have:

• frequent lung infections and flare-ups
• worsening symptoms, including shortness of breath, mucus production, and wheezing
• weight loss and reduced appetite
• fatigue and a loss of energy
• blue-tinged lips or fingernail beds, or cyanosis, due to a lack of oxygen
• anxiety and depression
• sleep problems

Learn more about late stage COPD here.

The Emphysema Foundation of America have expressed concern about how COVID-19 might affect people with emphysema.

They urge people with COPD to familiarize themselves with the symptoms of COVID-19. These can resemble the symptoms of COPD and emphysema. A person should contact their doctor if they have any unusual symptoms or a high fever.

They recommend taking full precautions to avoid exposure to the virus, including:

• frequently washing the hands and encouraging others to do the same
• avoiding people who may have had contact with the virus
• frequently wiping surfaces
• wearing a face covering such as a mask in public places
• avoiding crowded gatherings

They also advise:

• maintaining at least a 30-day supply of medication
• keeping a stock of household necessities, including food and other basics
• checking with local providers about plans to maintain oxygen supplies
• making a plan in case of sickness

Learn more about CODID-19 and COPD here.

The Global Initiative for Chronic Obstructive Lung Disease sets out the stages of COPD.

Generally, the stages are based on a combination of airflow limitation, symptoms, and exacerbations.

A doctor can use a breathing test to measure lung capacity. The test measures the forced expiratory volume in 1 second (FEV1).

Based on FEV1, the stages are as follows:

• Very mild, or stage 1: FEV1 is about 80% of normal.
• Moderate, or stage 2: FEV1 is 50–80% of normal.
• Severe, or stage 3: FEV1 is 30–50% of normal.
• Very severe, or stage 4: FEV1 is less than 30% of normal.

The stages help describe the condition, but they cannot predict how long a person is likely to survive. Doctors can carry out other tests to learn more about how serious a person’s condition is.

In most cases, emphysema and COPD result from cigarette smoking. However, up to 25% of people with COPD have never smoked.

Other causes appear to be genetic factors, such as an alpha-1 antitrypsin deficiency, and exposure to environmental irritants, including secondhand smoke, workplace pollutants, air pollution, and biomass fuels.

People with small airways in proportion to their lung size may be more at risk than those with wider airways, according to a 2020 study.

In addition, not all people who smoke develop emphysema. It may be that genetic factors make some people more susceptible to the condition.

Emphysema is not contagious. One person cannot catch it from another.

Treatment cannot cure emphysema, but it can help:

• slow the progress of the condition
• manage the symptoms
• prevent complications
• boost a person’s overall health and well-being

Supportive therapy includes oxygen therapy and help with quitting smoking.

The sections below will look at some specific treatment options in more detail.

Drug therapies

The main medications for emphysema are inhaled bronchodilators, which can help relieve symptoms. They relax and open the airways, making it easier for a person to breathe.

The inhaler delivers the following bronchodilators:

• beta-agonists, which relax bronchial smooth muscle and help clear mucus
• anticholinergics, or antimuscarinics, such as albuterol (Ventolin), which relax bronchial smooth muscle
• inhaled steroids, such as fluticasone, which help reduce inflammation

If a person uses them regularly, these options can improve lung function and increase exercise capacity.

There are short-acting and long-acting drugs, and people can combine them. Treatment may also change over time and as the condition progresses.

Lifestyle therapies

People can take steps to manage their symptoms, improve their quality of life, and slow the progression of emphysema. The sooner a person takes these steps, the more helpful they will be.

Some things to try include:

• quitting or avoiding smoking
• avoiding places where there are air pollutants, if possible
• following or developing an exercise program
• consuming a healthful diet
• drinking plenty of water, to loosen mucus and help keep the airways open
• breathing through the nose in cold weather or using a face covering to keep out cold air
• practicing diaphragmatic breathing, pursed-lip breathing, and deep breathing

Pulmonary rehabilitation is a program of care that encourages people with emphysema to learn about and manage their condition. There is a focus on developing and maintaining healthful lifestyle choices.

Making these changes may not alter the overall course of the condition, but it can help people manage the symptoms, improve their exercise capacity, and boost their quality of life.

People should also ensure that they meet with their healthcare provider regularly and receive their routine vaccinations, including those for flu and pneumonia.

Oxygen therapy

In time, breathing can become more difficult, and a person may need oxygen therapy some or all of the time. Some people use oxygen overnight, for example.

Various devices are available, including large tanks for home use and portable oxygen kits for traveling.

People should discuss the most suitable options with their healthcare provider.

Surgery

People with severe emphysema may sometimes need to undergo surgery to remove damaged lung tissue and reduce large spaces that develop in the lungs due to the condition.

Transplantation of one or both lungs can improve a person’s quality of life. However, there are some risks involved, such as the chance of infection.

A healthcare provider will help the person decide whether or not surgery is a good idea for them.

Treating exacerbations

Other treatment options can help during a flare-up or if complications arise. These options may include:

• oxygen therapy, to relieve worsening symptoms
• antibiotics, to treat a bacterial infection
• corticosteroid drugs, to reduce inflammation
• other medications, to relieve severe coughing and pain

The outlook for a person with emphysema will depend on individual factors and how well they manage their condition. It takes several years to progress to the final stages of COPD or emphysema, but lifestyle factors play a role.

Quitting smoking can significantly improve the outlook. According to the National Heart, Lung, and Blood Institute, COPD can progress quickly in people with alpha-1 antitrypsin deficiency who also smoke.

Research suggests that for those who have never smoked, COPD will modestly reduce their life span. People who do smoke, however, can expect their life span to be significantly shorter.

Emphysema and COPD affect not only life span, but also a person’s quality of life. Taking lifestyle measures to manage the condition can help a person maintain a good quality of life for longer.

How does COPD affect life expectancy? Learn more here.

Emphysema is a type of COPD, and there are different types of emphysema, depending on which part of the lungs it affects.

These are:

• paraseptal emphysema
• centrilobular emphysema, which affects mainly the upper lobes and is most common in people who smoke
• panlobular emphysema, which affects both the paraseptal and centrilobular areas of the lungs

During diagnosis, a CT scan can show which type of emphysema is present. The type does not affect the outlook and treatment.

A doctor will carry out a physical examination and ask about the person’s symptoms, lifestyle habits, and medical history.

They may also recommend tests to confirm the diagnosis and rule out other conditions.

If the person has never smoked but appears to have emphysema, the doctor may suggest testing for an alpha-1 antitrypsin deficiency.

The following sections will look at some diagnostic tests for emphysema in more detail.

Lung function tests

Lung function tests measure the lungs’ capacity to exchange respiratory gases. They can:

• confirm a diagnosis of emphysema
• monitor disease progression
• assess response to treatment

Spirometry is one type of lung function test. It assesses airflow obstruction by measuring FEV.

For this test, a person blows as fast and hard as they can into a tube. The tube is attached to a machine that measures the volume and speed of the air that they blow out. FEV1 determines the stages of emphysema.

Other tests

Other tests include imaging, such as a chest X-ray or CT scan of the lungs, and arterial blood gas analysis, to assess oxygen exchange and carbon dioxide levels.

Avoiding or quitting smoking is the best way to prevent emphysema from developing or getting worse.

Other strategies include:

• eating a healthful diet
• establishing and maintaining a moderate weight
• avoiding air pollution, if possible
• taking steps to prevent infection, such as receiving routine vaccinations

Emphysema involves irreversible damage to the lungs, which can eventually be life threatening. It mostly affects people who smoke, but people who do not smoke can develop it, too.

Seeking early treatment and taking measures to manage the condition can help enhance a person’s health and well-being and may improve their life span.

Pulmonary Emphysema | Johns Hopkins Medicine

What is pulmonary emphysema?

Emphysema is a chronic lung condition in which the air sacs (alveoli) may be:

• Collapsed
• Destroyed
• Narrowed
• Overinflated
• Stretched

Overinflation of the air sacs is a result of a breakdown of the alveoli walls. It
causes a decrease in respiratory function and breathlessness. Damage to the air sacs
can’t be fixed. It causes permanent holes in the lower lung tissue.

Pulmonary emphysema is part of a group of lung diseases called COPD (chronic
obstructive pulmonary disease). COPD lung diseases cause airflow blockage and breathing
problems. The 2 most common conditions of COPD are chronic bronchitis and emphysema.

What causes pulmonary emphysema?

Pulmonary emphysema occurs very slowly over time. It’s caused by:

• Smoking (the main cause)
• Exposure to air pollution, such as chemical fumes, dust, and other substances
• Irritating fumes and dusts at work
• A rare, inherited form of the disease called alpha 1-antitrypsin (AAT) deficiency-related pulmonary emphysema or early onset pulmonary emphysema

What are the symptoms of pulmonary emphysema?

Symptoms may be slightly different for each person. The following are the most common symptoms for pulmonary emphysema.

Early symptoms of pulmonary emphysema may include:

• Cough
• Rapid breathing
• Shortness of breath, which gets worse with activity
• Sputum production
• Wheezing

Other symptoms may include:

• Anxiety
• Depression
• Extreme
  tiredness (fatigue)
• Heart problems
• Over-inflation of the lungs
• Sleep problems
• Weight loss

The symptoms of pulmonary emphysema may look like other lung conditions or health problems. See a healthcare provider for a diagnosis.

How is pulmonary emphysema diagnosed?

Along with a complete health history and physical exam, your healthcare provider may
request pulmonary function tests. These tests help measure the lungs’ ability to
exchange oxygen and carbon dioxide. The tests are often done with special machines into
which you breathe. They may include:

Spirometry

A spirometer is a device used to check lung function. Spirometry is one of the simplest, most common tests. It may be used to:

• Determine the severity of a lung disease
• Find
  out if the lung disease is restrictive (decreased airflow) or obstructive
  (disruption of airflow)
• Look for lung disease
• See how well treatment is working

Peak flow monitoring

This device measures how fast you can blow air out of your lungs. Cough, inflammation, and mucus buildup can cause the large airways in the lungs to slowly narrow. This slows the speed of air leaving the lungs. This measurement is very important in seeing how well or how poorly the disease is being controlled.

Blood tests

These are done to check the amount of carbon dioxide and oxygen in the blood.

Chest X-ray

This test takes pictures of internal tissues, bones, and organs.

CT scan

This test uses a combination of X-rays and computer technology to make images of
the body. CT can show details such as the width of airways in the lungs and the
thickness of airway walls.

Sputum culture

This test is done on the material that is coughed up from the lungs and into the mouth. A sputum culture is often used to see if an infection is present.

ECG

This is a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias), and can help find heart muscle damage.

How is pulmonary emphysema treated?

The goal of treatment for people with pulmonary emphysema is to live more comfortably with the disease, control symptoms, and prevent the disease from getting worse, with minimal side effects. There is no way to repair or regrow the damaged lung tissue.

Treatment may include:

• A
  pulmonary rehab program. This may include breathing exercises to strengthen the
  muscles you use for breathing, and exercises for the rest of your body.
• Antibiotics for bacterial infections
• Staying
  away from the smoke of others and removing other air pollutants from your home and
  workplace
• Medicines (bronchodilators) that widen the airways of the lungs, and can be either
  taken by mouth (oral) or inhaled
• Getting the flu and pneumococcal vaccines
• Lung transplant
• Nutritional support since you may develop malnutrition and lose weight
• Other
  types of oral and inhaled medicines that are used to treat symptoms such as coughing
  and wheezing
• Oxygen therapy from portable containers
• Quitting smoking
• Surgery to remove the damaged area of the lung

Key points about pulmonary emphysema

• Pulmonary emphysema is a chronic lung condition. It’s often part of COPD, a group of
  lung diseases that cause airflow blockage and breathing problems.
• It
  develops very slowly over time. It’s most often caused by smoking.
• It
  causes shortness of breath that often gets worse with activity and many other
  symptoms, such as wheezing, cough, anxiety, and heart problems.
• There is
  no way to repair or regrow the damaged lung tissue. The goal of treatment for people
  with pulmonary emphysema is to live more comfortably, control symptoms, and prevent
  the disease from getting worse.
• A key
  part of treatment is to quit smoking.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions.

Emphysema – Better Health Channel

Emphysema and another lung condition known as chronic bronchitis (persistent cough with phlegm) are both features of a common lung disease called chronic obstructive pulmonary disease (COPD).

Emphysema is generally caused by cigarette smoking or long-term exposure to certain industrial pollutants or dusts. A small percentage of cases are caused by a familial or genetic disorder, alpha-1-antitrypsin deficiency. While damaged airways don’t regenerate and there is no cure, emphysema is preventable and treatable.

Symptoms of emphysema

The symptoms of emphysema include: 

• breathlessness with exertion, and eventually breathlessness most of the time in advanced disease
• susceptibility to chest infections
• cough with phlegm production
• fatigue
• barrel-shaped chest (from expansion of the ribcage in order to accommodate enlarged lungs)
• cyanosis (a blue tinge to the skin) due to lack of oxygen.

Structure of the lungs

The lungs are sponge-like structures that lie within the chest, protected by the ribcage. They are made up of progressively branching air passages. The largest of these is the windpipe (trachea), which divides into the two bronchi, which divide into the smaller bronchioles.

Bronchioles end in minute air sacs (alveoli), where inhaled oxygen is transferred to the blood stream and carbon dioxide is transferred from the blood into the exhaled breath. This exchange of oxygen and carbon dioxide takes place via a fine mesh of capillaries.

Damaged airways and lungs

After repeated exposure to chemical irritants, such as cigarette smoke, the air passages and air sacs of the lungs become inflamed and damaged. 

The airways of healthy lungs have elastic properties, but in lungs that are repeatedly exposed to irritants, the airways lose their elasticity and become thickened and swollen. This swelling means that the passageway for air becomes narrower.

If the same person also has chronic bronchitis (ongoing inflammation of the lining of the bronchial tubes), the mucus present can further contribute to narrowing of the air passages and clogging of the air sacs, further reducing their ability to function. As the number of functional air sacs reduces, the number of capillaries servicing the damaged alveoli also gradually reduces. 

These changes result in:

• partial blockage of the passages carrying inhaled and exhaled breath
• reduced capacity for the lungs to extract the oxygen from inhaled air.

This means that the person has to breathe harder to get enough oxygen. 

Complications of emphysema

Complications of emphysema can include: 

• pneumonia – this is an infection of the alveoli and bronchioles. People with emphysema are more prone to pneumonia
• collapsed lung – some lungs develop large air pockets (bullae), which may burst, resulting in lung deflation (also called pneumothorax)
• heart problems – damaged alveoli, reduced number of capillaries and lower oxygen levels in the blood stream may mean that the heart has to pump harder to move blood through the lungs. Over time, this can place considerable strain on the heart.

Diagnosis of emphysema

Chronic obstructive pulmonary disease, including emphysema, is diagnosed mainly using a lung function test called spirometry. Other tests that may help in diagnosis of emphysema include: 

• other lung function (or breathing) tests
• chest x-rays
• CT scans.

Treatment for emphysema

There is no cure for emphysema, although it is treatable. Appropriate management can reduce symptoms, improve your quality of life and help you stay out of hospital.

Management includes: 

• stopping smoking immediately and completely – this is the most effective treatment for COPD and emphysema
• avoiding other air pollutants
• respiratory (pulmonary) rehabilitation programs
• oxygen treatment, in advanced cases
• medications such as
  • anti-inflammatory medications
  • medicine to widen the airways (bronchodilators) and loosen the phlegm
  • antibiotics
• stress management techniques
• gentle, regular exercise to improve overall fitness
• influenza vaccination (yearly) and pneumococcal vaccination to protect against certain types of respiratory infection.

Respiratory rehabilitation programs

A person with emphysema can take part in a respiratory rehabilitation program, commonly known as ‘pulmonary rehab’. These programs: 

• provide information and education on emphysema
• introduce people to a supervised exercise program proven to improve emphysema symptoms 
• improve lung function through specific breathing exercises
• teach stress management techniques
• offer advice on adapting to life with emphysema
• provide emotional support through shared experiences.

To find out about a program near you, call Lung Foundation Australia on 1800 654 301.

Oxygen treatment for emphysema

If a person with emphysema is found to have exceptionally low levels of oxygen in their blood, they will be given oxygen to use at home. The oxygen is usually breathed through the nose via nasal prongs (cannulae). The person will need to use the oxygen treatment for at least 16 hours every day.

Where to get help

COPD | NHLBI, NIH

COPD has no cure yet. However, lifestyle changes and treatments can help you feel better, stay more active, and slow the progress of the disease.

The goals of COPD treatment include:

• Relieving your symptoms
• Slowing the progress of the disease
• Improving your exercise tolerance or your ability to stay active
• Preventing and treating complications
• Improving your overall health

To assist with your treatment, your family doctor may advise you to see a pulmonologist. This is a doctor who specializes in treating lung disorders.

Managing COPD. Learn treatment options and healthy living tips to help manage COPD symptoms.

Learn more tips for managing COPD.

Lifestyle Changes

Quit Smoking and Avoid Lung Irritants

Quitting smoking is the most important step you can take to treat COPD. Talk with your doctor about programs and products that can help you quit.

If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit.

Also, try to avoid secondhand smoke and places with dusts, fumes, or other toxic substances that you may inhale.

For more information about how to quit smoking, read Smoking and Your Heart and the National Heart, Lung, and Blood Institute’s Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).

Other Lifestyle Changes

If you have COPD, especially more severe forms, you may have trouble eating enough because of symptoms such as shortness of breath and fatigue. As a result, you may not get all of the calories and nutrients you need, which can worsen your symptoms and raise your risk for infections.

Talk with your doctor about following an eating plan that will meet your nutritional needs. Your doctor may suggest eating smaller, more frequent meals; resting before eating; and taking vitamins or nutritional supplements.

Also, talk with your doctor about what types of activity are safe for you. You may find it hard to remain active with your symptoms. However, physical activity can strengthen the muscles that help you breathe and improve your overall wellness.

Medicines

Bronchodilators

Bronchodilators relax the muscles around your airways. This helps open your airways and makes breathing easier.

Depending on the severity of your COPD, your doctor may prescribe short-acting or long-acting bronchodilators. Short-acting bronchodilators last about 4–6 hours and should be used only when needed. Long-acting bronchodilators last about 12 hours or more and are used every day.

Most bronchodilators are taken using a device called an inhaler. This device allows the medicine to go straight to your lungs. Not all inhalers are used the same way. Ask your health care providers to show you the correct way to use your inhaler.

If your COPD is mild, your doctor may only prescribe a short-acting inhaled bronchodilator. In this case, you may use the medicine only when symptoms occur.

If your COPD is moderate or severe, your doctor may prescribe regular treatment with short- and long-acting bronchodilators.

Combination Bronchodilators Plus Inhaled Glucocorticosteroids (Steroids)

In general, using inhaled steroids alone is not a preferred treatment. If your COPD is more severe, or if your symptoms flare up often, your doctor may prescribe a combination of medicines that includes a bronchodilator and an inhaled steroid. Steroids help reduce airway inflammation. 

Your doctor may ask you to try inhaled steroids with the bronchodilator for a trial period of 6 weeks to 3 months to see whether the addition of the steroid helps relieve your breathing problems.

Vaccines

Flu Shots

The flu, or influenza, can cause serious problems for people who have COPD. Flu shots can reduce your risk of getting the flu. Talk with your doctor about getting a yearly flu shot.

Pneumococcal Vaccine

This vaccine lowers your risk for pneumococcal pneumonia and its complications. People who have COPD are at higher risk for pneumonia than people who do not have COPD. Talk with your doctor about whether you should get this vaccine.

Learn more about vaccines you may need if you have COPD.

Pulmonary Rehabilitation

Pulmonary rehabilitation or rehab is a broad program that helps improve the well-being of people who have chronic breathing problems.

Rehab may include an exercise program, disease management training, and nutritional and psychological counseling. The program’s goal is to help you stay active and carry out your daily activities.

Your rehab team may include doctors, nurses, physical therapists, respiratory therapists, exercise specialists, and dietitians. These health professionals will create a program that meets your needs.

Oxygen Therapy

If you have severe COPD and low levels of oxygen in your blood, oxygen therapy can help you breathe better. For this treatment, oxygen is delivered through nasal prongs or a mask.

You may need extra oxygen all the time or only at certain times. For some people who have severe COPD, using extra oxygen for most of the day can help them:

• Do tasks or activities while experiencing fewer symptoms
• Protect their hearts and other organs from damage
• Sleep more during the night and improve alertness during the day
• Live longer

Surgery

Surgery may benefit some people who have COPD. Surgery usually is a last resort for people who have severe symptoms that have not improved from taking medicines.

Surgeries for people who have COPD that is mainly related to emphysema include bullectomy and lung volume reduction surgery (LVRS). A lung transplant might be an option for people who have very severe COPD.

Bullectomy

When the walls of the air sacs are destroyed, larger air spaces called bullae form. These air spaces can become so large that they interfere with breathing. In a bullectomy, doctors remove one or more very large bullae from the lungs.

Lung Volume Reduction Surgery

In LVRS, surgeons remove damaged tissue from the lungs. This helps the lungs work better. In carefully selected patients, LVRS can improve breathing and quality of life.

Lung Transplant

During a lung transplant, doctors remove your damaged lung and replace it with a healthy lung from a donor.

A lung transplant can improve your lung function and quality of life. However, lung transplants have many risks, such as infections and rejection of the transplanted lung.

If you have very severe COPD, talk with your doctor about whether a lung transplant is an option. Ask your doctor about the benefits and risks of this type of surgery.

Managing Complications

COPD symptoms usually worsen slowly over time. However, they can worsen suddenly. For instance, a cold, flu, or lung infection may cause your symptoms to quickly worsen. You may have a much harder time catching your breath. You also may have chest tightness, more coughing, changes in the color or amount of your sputum or spit, and a fever.

Call your doctor right away if your symptoms worsen suddenly. He or she may prescribe antibiotics to treat the infection, along with other medicines, such as bronchodilators and inhaled steroids, to help you breathe.

Some severe symptoms may require treatment in a hospital. For more information, read Signs and Symptoms.

Emphysema of the lungs | University Hospital Freiburg

Description

Pulmonary emphysema is a chronic disease, which is based on an imbalance of enzymes (proteases – antiproteases or protective proteins) in the lungs. In this case, the alveoli, which make up the lung tissue, expand and lose the ability to contract sufficiently, as a result of which the flow of oxygen into the blood and the removal of carbon dioxide from it is disrupted. With emphysema, there is a pathological increase (swelling) of the lung tissue.Currently, there are three main types of the disease:

• centrilobular emphysema, which mainly affects the upper part of the lungs,
• panlobular, caused by a deficiency of the enzyme alpha-1 protease (it affects the lower lungs, forming scars and scars on the lung tissue ),
• and senile emphysema caused by natural age-related changes in the vessels of the lungs and impaired elasticity of the alveoli.

Symptoms

In the initial stages of the disease, signs of emphysema can appear with significant physical exertion in the form of shortness of breath, and at a later stage, respiratory failure occurs even at rest.Then dry cough with phlegm is added to shortness of breath. At the same time, the supply of oxygen to the body is disrupted due to stretching of the tissues of the alveoli, which, increasing in volume, cannot fully contract, therefore air accumulates in them. The patient experiences in this case:

• fatigue,
• rapid fatigability,
• general deterioration of health,
• his working capacity decreases.

Causes and risks

The main reasons leading to the development of pulmonary emphysema are:

• penetration into the respiratory tract of dust particles, vehicle exhaust gases, other pollutants, the inhalation of which is often associated with professional activities (miners, construction workers, etc.)
• tobacco smoke when smoking also aggressively affects the alveoli, gradually destroying them with toxins,
• frequent respiratory infections,
• hereditary predisposition to the disease.

Pulmonary emphysema often occurs on the basis of excessive smoking in the course of chronic obstructive bronchitis, which is currently included in the diagnosis of COPD (Chronic Obstructive Pulmonary Disease).

Examination and diagnosis

The standard examination procedures include, first of all:

• general medical examination of the patient
• and study of the medical history.

Further diagnostics in case of suspected emphysema includes a study of the function of external respiration using, first of all, spirometry and bodyplethysmography. These procedures also measure the volume of air in the lungs remaining after exhalation. In order to clarify the diagnosis of emphysema, an analysis of the so-called diffusion capacity of the lungs can be carried out. To perform this test, the patient must inhale a mixture with a low content of CO2 gas and hold his breath for 10 seconds, during which the gas enters the blood.In this case, the amount of CO2 in the alveoli is measured before and after holding the breath. Changes in lung tissue are determined using computed tomography (CT), and chest x-ray or magnetic resonance imaging, along with other methods, serve to increase the information content of the diagnosis. Based on a general blood test, it is possible to identify the presence of an inflammatory process, as well as a deficiency of the enzyme alpha-1 protease as a possible cause of pulmonary emphysema.By examining the gas composition of arterial blood (quantitative content of oxygen, carbon dioxide, pH value), it is possible to determine the degree of impairment of the patient’s respiratory capacity.

Treatment

Therapy of emphysema should be aimed mainly at improving the patient’s quality of life and slowing the progression of the disease. Treatment includes many different methods used depending on the severity and individual parameters of the disease.

• Unconditional smoking cessation is of prime importance here.
• Inhalation of dust, exhaust fumes, etc. should be avoided, if possible.
• As medicinal therapy, drugs (bronchodilators) are prescribed to help widen the airways to improve oxygen supply to the body, as well as cortisone-containing drugs as anti-inflammatory drugs.
• Physiotherapy procedures, breathing exercises, also help to increase the functionality of the lungs and improve the patient’s well-being.
• In case of a progressive stage of the disease, a long course of oxygen therapy is recommended
• or, in extreme cases, surgery to reduce the volume or even a lung transplant.

Forecast

Emphysema is an incurable disease. However, a timely visit to a doctor and a quick start of treatment will counteract the development of the disease.

Comments

Along with pulmonary emphysema, it is often necessary to treat such concomitant diseases as chronic bronchitis, diabetes mellitus, heart failure.Complex therapy of pulmonary emphysema should also include additional preventive measures to prevent infectious respiratory diseases. This includes the annual vaccination against influenza and pneumococcal viruses.

Pulmonary emphysema: symptoms, causes, treatment

Emphysema of the lungs is a chronic pulmonary disease. Progresses rapidly. Pathology affects the final sections of the respiratory tract, leads to a change in the p tissues of the bronchioles and alveoli.With emphysema, the distal bronchioles expand, which leads to disruption of gas exchange, causing breathing problems. The disease is a common cause of patient disability. Most often, the disease is diagnosed in people of middle and mature age.

Reasons

The development of the disease is provoked by the following factors:

• burdened heredity;
• work in hazardous production;
• infectious diseases of the respiratory tract leading to complications in the lungs;
• long-term smoking experience;
• living in contaminated areas;
• mature age (60+).

Most people develop emphysema against the background of bronchial asthma or chronic obstructive pulmonary disease. Often such a diagnosis is made to workers in hazardous industries. Inhalation of sulfur dioxide, nitrogen dioxide, dust is especially dangerous. With regular exposure to lung tissue, they lead to damage to the membranes of epithelial cells.

Smokers with a long history of smoking are also at risk: people who smoke 18 cigarettes per day, after 15-20 years, face changes in lung tissue, including emphysema.

Symptoms

Symptoms of emphysema are similar to other obstructive diseases, such as obstructive bronchitis.

Main symptoms:

• cough and shortness of breath, which appears even with little physical exertion;
• breathing problems at rest;
• weight loss (non-specific signs).

The diagnosis of “emphysema” is established using hardware diagnostics.The examination reveals the destruction of the elastic fibers of the lung tissue, and this process is irreversible.

Diagnostics and treatment

To make a diagnosis, respiratory functions are examined, inhalation tests are performed, an X-ray of the lungs is prescribed, and a general clinical blood test is prescribed.

There are no specific drugs for the treatment of emphysema. First of all, it is necessary to eliminate factors that negatively affect the lungs: smoking, polluted air.To relieve symptoms, mucolytic and antioxidant agents, bronchodilators, and corticosteroids are prescribed.

Pay attention!

The information presented on the site should not be used for self-diagnosis and treatment and cannot serve as a substitute for an in-person consultation with a doctor.
90,000 Spontaneous pneumothorax. Pneumothorax treatment, surgery.

Pneumothorax is the accumulation of air in the pleural cavity due to a violation of the integrity of the pleura (lung rupture).The most common cause of spontaneous pneumothorax is bullous emphysema.

Symptoms and Diagnosis

Until the first episode of pneumothorax, the disease does not manifest itself in any way, and the patients feel absolutely healthy. When the bull ruptures, air from the lung enters the pleural cavity, the lung collapses. Shortness of breath and chest pain occurs. Diagnosis can be made using conventional radiography. Most often, spontaneous pneumothorax occurs in tall, thin men between the ages of 20 and 40.Other lung diseases can also lead to the development of pneumothorax, so one of the tasks is also to establish a diagnosis of a pulmonary disease.

Possibility of recurrence of pneumothorax. It is difficult to accurately predict whether the disease will recur in each individual patient. However, it is known that with each episode of pneumothorax, the likelihood of the next increases and is: after the first episode 30-50%, and after the third – 90%.

Treatment of pneumothorax

The method of treating pneumothorax depends on many factors: how qualified the clinic is, what kind of pneumothorax you have, whether there is a suspicion of a rare lung injury, etc.d.

Ideally, it is necessary to solve 3 problems: to straighten the lung, establish an accurate diagnosis and prevent a relapse of the disease.

As a first aid for spontaneous pneumothorax, anesthesia and drainage of the pleural cavity is performed – a thin tube is passed into the pleural cavity, the free end of which is lowered under water (a so-called “water lock” is created). When the air completely leaves the pleural cavity, the defect in the lung is sealed and the lung straightens, the tube is removed.

To prevent relapses and final diagnosis, an operation is used – resection of bulls and pleurectomy (removal of the pleura from the inner surface of the chest to create uniform adhesions and heal the pleural cavity). The operations are performed in a thoracoscopic minimally invasive way through 2 small incisions in the chest. Usually, patients are discharged after a few days and can return to full life in 1-2 weeks. This type of treatment gives good results in 98% of cases.

A special type of pneumothorax is pneumothorax in women associated with menstruation. It is called endometriosis-associated (formerly catamenial). Its development is due to diaphragm endometriosis. Several clinics have experience in treating this disease in our country. In such patients, not surgery on the lung is required, but a resection of the diaphragm and treatment by a gynecologist.

Registration for consultation and examination by phone: +7 (921) 919-07-49

90,000 What to do in case of shortness of breath.Causes, treatment and symptoms

A young man, a little over 40 years old, barely climbs to the second floor – suffers from shortness of breath . But a couple of years ago, he ran up the stairs. What happened? “This is developing emphysema – one of the most serious diseases of the lungs.” Natalya Kraskovskaya, a pulmonologist of the highest category.

In recent years, the incidence of pulmonary emphysema has been increasing, especially among the elderly. Men suffer from this ailment twice as often as women.This disease is characterized by a long course and very often leads to disability.

Emphysema (from the Greek word “blow in”, “inflate”) of the lungs is a disease that occurs with the development of increased airiness of the lung tissue, leading to impaired respiration and gas exchange in the lungs.

The development of emphysema is associated with irreversible changes in the lungs and the bronchial wall. All factors under the influence of which pulmonary emphysema can form can be divided into two large groups.

The first group includes factors that disrupt the elasticity and strength of the lung tissue:

– congenital defects of the body’s enzyme system, when the properties of the surfactant are changed;

– gaseous toxic substances: compounds of cadmium, nitrogen, dust particles that enter the lungs when breathing;

– repeated viral infections of the respiratory tract reduce the protective properties of lung cells;

– tobacco smoke, since smoking is the most common cause of pulmonary emphysema.

All these factors lead to destructive changes in the wall of the alveoli. They lose elasticity, they can no longer fully contract. After exhalation, more air begins to remain in the alveoli. This leads to overstretching and bloating of the lungs. Excess air does not participate in respiration, it takes the place of new portions of air, as a result, the supply of oxygen and the removal of carbon dioxide are disrupted. In addition, small bronchioles that do not have a cartilaginous frame collapse, the patency of the bronchi is impaired – exhalation is sharply obstructed.In the future, the overstretched interalveolar septa are destroyed, a single cavity is formed, the lung tissue becomes more airy. Since the surface area of ​​the alveoli sharply decreases, gas exchange is disturbed even more, and severe pulmonary insufficiency develops. Compensatory, in order to improve the excretion of carbon dioxide, there is shortness of breath . In smokers, pulmonary emphysema is more severe than in non-smokers. Tobacco smoke promotes the accumulation of inflammatory cells in the lung tissue, which in turn release substances that destroy the septa between the lung cells.

The second group of factors contributes to an increase in pressure in the entire respiratory apparatus of the lungs, starting with the large bronchi and ending with the alveoli. High pressure in the bronchial tree is the result of severe chronic diseases of the lungs, such as bronchial asthma, chronic obstructive pulmonary disease, in which a sharp narrowing of the bronchi develops due to edema and infiltration of the walls of the bronchi, as well as blockage of the bronchi with thick viscous secretions. High pressure in the bronchial tree and further leads to all the destructive changes in the lungs, which are described above.

Lung emphysema formed under the influence of the first group of factors is called primary, the second group, against the background of chronic diseases – secondary. In both cases, with emphysema, the exchange of oxygen and carbon dioxide suffers, and respiratory failure occurs.

The disease develops unnoticed by the patient. All symptoms appear with significant damage to the lung tissue. As a rule, shortness of breath begins to bother the patient after 40 and 50 years. First, it appears during physical exertion, then it begins to bother and at rest.

Characteristic of the patient’s appearance at the time of the attack shortness of breath . When inhaling, patients do not experience difficulty, exhaling is very difficult. The patient, as a rule, sits, leaning forward, often holding onto the back of the chair in front of him. Exhalation with emphysema is long, noisy. Trying to make breathing easier, the patient folds his lips with a tube, covers his mouth, puffs out his cheeks. The skin of the face turns pink. Because of the characteristic appearance during an attack of shortness of breath, patients with pulmonary emphysema are sometimes called “pink puffers”.The agonizing shortness of breath without prior cough is especially characteristic of primary emphysema. The cough, as a rule, occurs some time after shortness of breath has already developed, which distinguishes pulmonary emphysema from bronchitis. A characteristic sign of pulmonary emphysema is weight loss. This is due to fatigue of the respiratory muscles, which work at full strength to facilitate exhalation. A pronounced decrease in body weight is an unfavorable sign of the development of the disease.In patients with emphysema, attention is drawn to the expanded, cylindrical shape, as if frozen on inspiration, the chest. Often it is figuratively called barrel-shaped. In advanced cases, the tops of the lungs begin to bulge over the collarbones, there is an expansion and retraction of the intercostal spaces.

Noteworthy is the cyanotic color of the skin and mucous membranes, as well as the characteristic change in the fingers like drumsticks. These external signs indicate prolonged oxygen starvation.

Developing pulmonary insufficiency leads to a complete inability to work – a person suffocates even at rest. With severe emphysema, the pressure in the pulmonary artery rises. The right ventricle and the right atrium are enlarged compensatory. Over time, changes affect all parts of the heart. The pumping function of the heart suffers sharply – heart failure develops. In both cases, the result will be disability, which carries a sharp deterioration in the quality of life.

Due to the fact that ventilation of the lung tissue suffers significantly in emphysema, the lungs become much more vulnerable to bacterial aggression.Any infectious diseases of the respiratory system often turn into chronic forms, foci of permanent infection are formed, which greatly complicates treatment.

A there may be an acute threat to life when, when a cavity ruptures next to a large bronchus, a large volume of air can penetrate into this cavity. Pneumothorax develops, requiring immediate surgical treatment. It is even more terrible when the integrity of the blood vessel in the lungs is violated – pulmonary hemorrhage occurs – without a surgical operation, the patient’s life cannot be saved.

Dyspnoea (dyspnea) is a violation of the frequency and depth of breathing, accompanied by a feeling of lack of air. Breathing becomes frequent: over 20 breaths per minute, noisy. There is a feeling of suffocation.

For information:

The Russian name for the organ – “lungs” – is associated with the fact that this organ is kept on the water, while other organs sink, and “pulmo” is translated from Latin as “that which floats on water ”. The lungs are the organ where gas exchange takes place: carbon dioxide is released from the blood, and the blood is saturated with oxygen.This process takes place in the alveoli – small vesicles with a very thin wall, braided by a network of blood capillaries.

Between adjacent alveoli there is a surfactant – a special fatty film that prevents friction. Normally, the alveoli are elastic, expand and collapse in accordance with the phases of breathing – inhalation and exhalation. And air enters the alveoli through the air ducts – the bronchioles, which, when combined, form the bronchi. With the correct functioning of the respiratory system, inhaled oxygen from the lungs enters the bloodstream and is carried throughout the body.

***

If shortness of breath starts to bother you, especially if you smoke, you need to urgently consult a therapist. Do not run your condition until, due to shortness of breath, you cannot climb one flight of stairs.

If you suspect pulmonary emphysema, your doctor will prescribe a chest x-ray and spirography. An increase in the volume of the lungs and their increased airiness on the roentgenogram are considered confirmation of emphysema. The spirogram examines the function of respiration, allows you to determine the degree of narrowing of the bronchi and the degree of respiratory failure.Computed tomography allows you to diagnose cavities in the lungs, as well as assess the density of the lung tissue.

Complete cure for pulmonary emphysema is impossible. A feature of the disease is its constant progression, even during treatment. With timely access to medical help and adherence to medical measures, the disease can be somewhat slowed down, the quality of life improved, and disability can be delayed. All therapeutic measures for emphysema are aimed at alleviating the manifestations and reducing the progression of respiratory failure, as well as treating the lung disease that led to the development of emphysema.The patient is treated by a pulmonologist or therapist, usually on an outpatient basis. Hospitalization in a hospital is indicated when an infection is attached, a severe form of respiratory failure, as well as when surgical complications occur (pulmonary hemorrhage with a ruptured cavity, pneumothorax).

All drug treatment will be prescribed to the patient by a pulmonologist. A physical therapist will also treat such a patient. It is he who will prescribe oxygen therapy, a course of massage and therapeutic exercises.The patient’s task is to strictly follow all the doctor’s recommendations.

Quitting smoking, active and passive, is of great importance. One-time smoking cessation has the best effect compared to gradual cessation. Currently, there is a large arsenal of medical products (chewing gums, plasters) that can help a patient in this difficult task.

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

Once again, we recall that the main cause of the development of pulmonary emphysema is smoking.You can contact Health Centers for free help and advice on getting rid of tobacco dependence. They work in every district of our city. To prevent the child from starting to smoke, try to captivate him with some kind of sport, and try to stay in the fresh air as much as possible. Use every opportunity to go out of town, walk in the park or on the embankments. The main thing is to stay away from numerous cars with their exhaust gases! If your work involves harmful gaseous substances, do not forget about the rules of personal hygiene and make full use of them.

Timely treatment of lung diseases, such as bronchitis, bronchial asthma, will help prevent the development of pulmonary emphysema.

THERAPEUTIC EXERCISE FOR LUNG EMFYSEMA

With emphysema, the respiratory muscles are in constant tone, so they quickly get tired. To prevent muscle overstrain, exercise therapy has a good effect. These exercises will be taught in the classroom of remedial gymnastics, and then they should be performed at home all the time.

Exercises for training diaphragmatic breathing.

Starting position: standing, feet shoulder-width apart. Take a deep breath and as you exhale, stretch your arms in front of you and lean forward. During exhalation, the stomach should be drawn in.

Starting position: lying on your back, hands on your stomach. On exhalation, hands press on the anterior abdominal wall.

Exercises for training the rhythm of breathing.

1. After a deep breath we hold our breath for a while, then we exhale the air in small jerks through the lips folded into a tube.In this case, the cheeks should not puff up.

2. After a deep breath we hold our breath, then exhale with one sharp push through our open mouth. At the end of exhalation, the lips must be folded into a tube.

3. Take a deep breath, hold your breath. Stretch your arms forward, then clench your fingers into a fist. Bring your arms to your shoulders, slowly spread apart and again return to your shoulders. Repeat this cycle two or three times, then exhale with force.

4. We count in the mind. Inhale for 12 seconds, holding the breath for 48 seconds, exhaling for 24 seconds.Repeat this cycle two to three times.

Rare complication of tonsillectomy: subcutaneous emphysema and pneumomediastinum | Svistushkin V.M., Dobrotin V.E., Kochetkov P.A., Karapetyan L.S., Avetisyan E.E.

A clinical case of a rare complication of tonsillectomy is presented

Chronic tonsillitis (CT) remains a very common problem at the present time [1], especially considering that the main group of patients with CT are people of working age [2]. In different countries, according to various epidemiological studies, this disease affects from 4 to 15% of the population, and among all diseases of the pharynx, CT is up to 35% [1, 3].There is a tendency to an increase in the number of patients with CT, and the highest incidence is observed in the age group 16–20 years old [3].
Tonsillectomy (TE) is a routine operation in the practice of an otorhinolaryngologist. And although this operation is considered very safe, nevertheless it is associated with such possible complications as bleeding, infections, swelling of the tongue, trauma of the glossopharyngeal nerve, carotid artery. Very rare complications of TE are subcutaneous emphysema of the face and neck, pneumomediastinum, and pneumothorax [4].

A little more than 30 cases of the development of subcutaneous emphysema after TE are described in the literature [5]. Subcutaneous emphysema is a potentially life-threatening condition, because it can progress, obstructing the passage of air in the upper respiratory tract, or spread into the mediastinum, resulting in the development of pneumomediastinum or pneumothorax and inhibition of cardiorespiratory function [4]. According to the literature, the first described case of subcutaneous emphysema of the face and neck after TE refers to 1933.[6]. Subcutaneous emphysema can develop either as a result of a pressure difference on both sides of the injured mucosa, or when gas is released by body tissues in a closed cavity [7]. Neck emphysema and pneumomediastinum are usually caused by rupture of the tracheobronchial tree or esophagus. Subcutaneous emphysema is characterized by crepitus and can be easily detected by x-ray. The presence of pneumomediastinum can be assumed if symptoms such as dyspnea, dysphagia, chest and back pain, cyanosis, and Hamman’s symptom — crepitus, synchronous with heartbeats, are observed, and is best heard when the patient is turned to the left side [8].
A literature review demonstrated that indications for TE are frequent sore throats or a history of peritonsillar abscesses.
The amygdala niche is bounded in front by the palatine-lingual muscle, on the sides – by the palatopharyngeal muscle, and from above – by the upper pharyngeal constrictor. In this regard, a possible reason for the development of subcutaneous emphysema after TE may be that the muscle layer, consisting of the upper constrictor of the pharynx, does not reach the upper pole of the amygdala, in this place the pharyngeal wall consists of the mucous membrane and the aponeurosis of the pharynx (internal and external).With TE, the external aponeurosis can be damaged. Thus, during the operation, conditions are created for the penetration of air (when swallowing, coughing, vomiting) into the parapharyngeal space through the resulting opening. Through the tissue of the vascular bundle, emphysema spreads down the neck [9]. There are reports in the literature that deep in the amygdala, the superior pharyngeal constrictor creates a path through the soft tissues of the neck to the parapharyngeal, retropharyngeal and prevertebral spaces. If damaged in this place, air can enter the mediastinum through the deep cervical spaces and cause pneumomediastinum.In some rare cases, air that has entered the mediastinum can then descend into the abdominal cavity through the diaphragmatic opening [10].

Clinical observation

The patient, 29 years old, was admitted to the ENT clinic with complaints of frequent tonsillitis, recurrent pain in the pharynx, snoring. From the anamnesis it was known that he had been ill for a long time, sore throats were noted from childhood, 3-4 times a year. The courses of conservative treatment were carried out: washing the lacunae of the tonsils with antiseptic solutions, repeated courses of antibiotic therapy without significant effect.Over the past year, she suffered 3 sore throats, the last one in November 2015, was treated on an outpatient basis, and received antibiotic therapy. Objectively on admission: the general condition is satisfactory, the skin and visible mucous membranes are of normal color. The soft palate is symmetrical. Signs of Zak, Giese, Preobrazhensky are positive. The palatine tonsils are enlarged (II – III degrees), dense, caseous masses in the lacunae (Fig. 1). Regional lymph nodes are not enlarged, painless. The rest of the ENT organs were normal.

TE was performed under combined endotracheal anesthesia, intubation was performed through the right half of the nose. The palatine tonsils were removed by the cold method, there was a pronounced cicatricial process, especially on the left. Hemostasis – using a bipolar coagulator. Due to bleeding from the upper pole of the left amygdala niche, the palatine arches were sutured. The bleeding volume was up to 200 ml. There were no other peculiarities during the operation. The patient woke up in the operating room, was transferred to the ward.The patient presented complaints of swelling, pain and pressure in the left half of the face 5 hours after the operation.
No coughing, no difficulty in breathing was noted, the act of swallowing was painful, but completely preserved. Physical examination revealed swelling and crepitus in the left half of the face that extended to the submandibular, periorbital region on the same side, and to the upper neck (Fig. 2). There was no redness in the swollen area. Examination of the pharynx did not reveal any pathological findings.Indirect laryngoscopy, anterior and posterior rhinoscopy revealed no pathological changes. Body temperature – 36.7 ° C. In a clinical blood test: leukocytes – 13.9 × 10 ⁹ / l, erythrocytes – 4.12 × 10 ¹² / l, platelets – 271 × 10 ⁹ / l, hemoglobin – 128 g / l, hematocrit – 35.0%, neutrophils – 77.0%; ASLO (antistreptolysin-O) – 359 IU / ml.

On the same day, the patient was transferred from the ENT department to the intensive care unit for follow-up.
According to ultrasound data: air is determined in the soft tissues of the left cheek, the angle of the lower jaw on the left and in the submandibular region at a depth of 7 mm from the skin surface. No accumulations of fluid were found.
According to the MSCT data of the pharynx, larynx and chest organs, subcutaneous emphysema was extended to the left buccal region, extending downward into the left submandibular region, the side of the left orbit, the region of the parotid gland, neck and mediastinum. Air bubbles were detected in the posterior mediastinum along the esophagus and the descending aorta (Fig.3).

Therapy included meropenem 1 g 3 r. / Day IV drip for 5 days, famotidine 20 mg IV drip for gastroprotection, Ringer’s solution, ketoprofen 2.0 i / m for pain. Against the background of therapy, positive dynamics was noted: resolution of subcutaneous emphysema (Fig. 4), with pharyngoscopy – amygdala niches are covered with fibrin plaque (Fig. 5). There was a slight soreness when swallowing.

Conclusions

Thus, taking into account the literature data and our observation, the treatment of patients with subcutaneous emphysema and pneumomediastinum includes a regular assessment of respiratory function and the degree of emphysema.Any situation that increases the pressure in the upper respiratory tract (cough, vomiting, voluntary tension in the muscles of the pharynx and neck) or vigorous physical activity should be avoided. Bed rest and sedation, restriction of oral food intake, and cough control and stool regulation are recommended. Broad-spectrum antibiotics may be prescribed. In some cases, oxygen therapy is used to more quickly resolve subcutaneous emphysema [5, 11].
We assume that the cause of subcutaneous emphysema was trauma to the external aponeurosis of the pharynx due to a pronounced adhesive process.During the operation, noticeable adhesions were found between the tonsils and amygdala niches, which made the operation more laborious and traumatic.
Postoperative factors that can contribute to the formation of emphysema are vomiting, coughing, constipation, when air can pass into the interfascial spaces through the damaged mucosa [12]. Other possible pathogenetic mechanisms include rupture of the tracheobronchial tree anywhere [13], resulting in the formation of pneumomediastinum, after which air spreads in a cephalic direction, leading to subcutaneous emphysema of the neck again.
A defect in the tracheobronchial tree may be a consequence of the existing pathology: bullous alveoli, laryngocele. A defect can also occur as a result of injury to the laryngotracheal mucosa during intubation [14]. In our observation, subcutaneous emphysema of the neck, face and pneumomediastinum developed after elective TE. Subcutaneous emphysema and pneumomediastinum are rare complications of TE. The mechanism of their formation is not completely clear; air is believed to penetrate into the tissues through the buccal-pharyngeal fascia [8].
If there is a history of paratonsillar abscesses and / or multiple tonsillitis, one should take into account the high probability of a possible adhesion process between the palatine tonsils and the amygdala, and extremely carefully and carefully cut off the palatine tonsils from the surrounding tissues. This is likely to reduce the risk of postoperative bleeding and also prevent the development of rare postoperative complications such as subcutaneous emphysema and pneumomediastinum.
If the examination reveals any macroscopically obvious mucosal trauma in the niche area, then the damaged mucosa can be sutured to prevent secondary bacterial complications and the development of subcutaneous emphysema or an increase in already formed emphysema.
In most cases, subcutaneous emphysema and pneumomediastinum resolve spontaneously. In the literature, not a single lethal outcome has been described; one patient with the same diagnosis underwent tracheotomy [10], and two patients underwent thoracotomy [6, 11]. However, it should be remembered that subcutaneous emphysema and pneumomediastinum can be potentially fatal complications.

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Treatment of chronic obstructive pulmonary disease (COPD) in Moscow

Chronic obstructive pulmonary disease, or COPD, is a common disease of the respiratory system in adults, which is based on a pronounced chronic inflammatory response of the lungs to the action of pathological particles and gases (primarily tobacco smoke).At the same time, chronic inflammation develops in the walls of the bronchi, the process of excretion of sputum is disrupted, subsequently the air flow rate in the bronchi during exhalation progressively decreases, the lungs are filled with air, which can cause the development of emphysema.

With COPD, the normal function of the immune system, the structure and function of the lining of the bronchi changes. As a result, there is a violation of the patency of the bronchi, emphysema of the lungs, pneumosclerosis develops, and respiratory failure increases.

The production of a large volume of mucus, an increase in its viscosity lead to the creation of a favorable environment for the reproduction of pathogenic microorganisms. As a result, there is a violation of the patency of the bronchi, emphysema of the lungs, pneumosclerosis develops, and respiratory failure increases.

Causes and mechanisms of development of COPD

There are several causes of chronic obstructive pulmonary disease:

• active and passive smoking – this factor is in the first place;

• some environmental and ecological conditions;

• professional harm;

• hereditary predisposition.

An exacerbation of a chronic disease can be triggered by a bacterial or viral infection. The severity of the course and the characteristics of treatment depend on the causative agent of an infectious disease. Frequent SARS lead to a decrease in local defenses, and bacterial complications can develop against their background. Therefore, it is important for people with COPD to see a doctor urgently if symptoms of deterioration appear.

Manifestations of COPD

The symptoms of COPD depend on how impaired the patency of the bronchi.This indicator can be determined by evaluating the function of external respiration – spirometry.

The main manifestations of the disease are productive cough and shortness of breath. Symptoms vary in severity, from mild shortness of breath with intense physical activity to severe at rest. In severe cases, other symptoms are added to the signs, which can indicate the development of not only respiratory, but also heart failure (edema of the lower extremities, enlarged liver, weakness, accumulation of fluid in the pleural and abdominal cavity)

In some people, purulent inflammation in the bronchi predominates, which is manifested by a cough with a large amount of sputum and symptoms of general intoxication.In others, the leading symptoms are the development of emphysema and respiratory failure, and dyspnea predominates.

Features of treatment

Treatment for COPD in adults is always comprehensive. The basis of therapy is bronchodilators – agents that promote the expansion of the bronchi, have an anti-inflammatory effect, as well as drugs to reduce the formation of mucus. It is important to eliminate risk factors that can aggravate the course of the disease. Smoking, work in hazardous work is strictly prohibited.The doctor will definitely recommend getting vaccinated against influenza, pneumococcal infection in order to prevent viral and bacterial diseases and minimize the likelihood of complications.

Get qualified help for COPD at the Family Doctor clinic. We have everything you need for accurate diagnosis and effective treatment.

You can make an appointment with a pulmonologist at a time convenient for you by calling the single contact center of the Family Doctor clinic in Moscow +7 (495) 775 75 66, through the on-line registration form and at the clinic’s registry.

Cost

general practitioner, pulmonologist, functional diagnostics physician

90,000 Lung emphysema in Germany, cost of treatment

Diagnosis of pulmonary emphysema in Germany includes a careful clinical examination and collection of anamnesis, clarification of risk factors. Pulse oximetry, spirometry, and chest x-ray almost always make the diagnosis of emphysema possible.

However, to assess the causes, prevalence of the process and make a decision on the use of a particular treatment option, according to indications, more complex methods can be included in the examination: computed or magnetic resonance imaging, perfusion scintigraphy, as well as bronchoscopy and thoracoscopy.

For effective treatment of pulmonary emphysema in Germany, in addition to establishing the presence of emphysema, doctors always carefully assess the function of the respiratory system as a whole, conduct an active diagnosis of concomitant diseases, and determine the degree of involvement of the cardiovascular system.

Treatment of pulmonary emphysema in Germany, first of all, includes detailed counseling of the patient on measures to eliminate the factors contributing to the development and progression of the disease. Patients who smoke are provided with comprehensive support for smoking cessation efforts.Since the lungs are constantly over-inflated in emphysema, the main respiratory muscles – the intercostal ones – are constantly taut and cannot cope with exhalation. Special gymnastics and physiotherapy allow more use of “diaphragmatic” breathing, which improves breathing effort. Feasible physical activity is recommended, under the supervision of a qualified rehabilitation therapist; they are useful even when the patient is receiving inhalation of supplemental oxygen. A complex of drug therapy and non-drug measures aimed at expanding the bronchi and facilitating exhalation is an important component of the treatment of emphysema.

Prevention, which includes the passage of a pulmonary examination in Germany, and the timely treatment of respiratory infections can prevent the rapid progression of symptoms of respiratory failure.