What is emphysema? How does it affect the lungs? What are the symptoms and causes of this chronic lung disease? Explore a detailed overview of emphysema, including comprehensive treatment options.

What is Emphysema?

Emphysema is a chronic lung disease that primarily affects the alveoli, or air sacs, within the lungs. It is one of the two main conditions that fall under the umbrella term of chronic obstructive pulmonary disease (COPD), the other being chronic bronchitis. In emphysema, the alveoli become weakened and eventually break down, reducing the overall surface area of the lungs and the amount of oxygen that can reach the bloodstream.

Symptoms of Emphysema

The hallmark symptom of emphysema is shortness of breath, especially during physical exertion or exercise. As the disease progresses, this breathlessness can become evident even at rest. Other common symptoms include:

• Persistent coughing
• Fatigue and exhaustion
• Weight loss
• Depression
• Bluish discoloration of the lips or fingernails due to lack of oxygen

Causes and Risk Factors of Emphysema

Smoking tobacco is the primary cause of emphysema. The more you smoke, the higher your risk of developing the condition. Smoking cannabis can also contribute to emphysema. Exposure to secondhand smoke, air pollution, chemical fumes, and lung irritants can also increase the risk of developing emphysema.

Additionally, a rare genetic condition called alpha-1 deficiency can lead to a form of emphysema known as alpha-1 deficiency-related emphysema. A history of childhood respiratory infections and a compromised immune system, such as in individuals with HIV, can also be risk factors for emphysema.

Diagnosing Emphysema

To diagnose emphysema, your healthcare provider will begin by taking your medical history, focusing on your smoking habits and exposure to potential lung irritants. They may then order various tests, including:

• Imaging tests, such as X-rays and CT scans, to examine the lungs
• Blood tests to measure oxygen and carbon dioxide levels
• Pulse oximetry to assess the oxygen content in your blood
• Lung function tests to evaluate the capacity and efficiency of your lungs
• Arterial blood gas tests to measure blood and carbon dioxide levels
• Electrocardiogram (ECG) to rule out heart disease

Complications of Emphysema

If left untreated or not properly managed, emphysema can lead to several serious complications, including:

• Pneumonia (bacterial or viral)
• Frequent respiratory tract infections
• Cor pulmonale (right-sided heart failure)
• Pneumothorax (air leakage between the lungs and chest cavity)
• Respiratory acidosis (imbalance of oxygen and carbon dioxide in the blood)
• Hypoxemia (inadequate oxygenation of the blood)

Treatment Options for Emphysema

There is no cure for emphysema, but treatment aims to manage symptoms, slow the progression of the disease, and improve quality of life. The first and most important step in treating emphysema is to quit smoking if you are a smoker. Your healthcare provider may also prescribe various medications, including:

• Bronchodilators to open air passages and relieve shortness of breath
• Steroids to alleviate breathlessness
• Antibiotics to treat infections that can worsen the condition

In addition to medications, therapies such as pulmonary rehabilitation, moderate exercise, and oxygen therapy can also help manage emphysema symptoms. In severe cases, surgical interventions like lung volume reduction surgery or lung transplantation may be considered.

Preventing Emphysema

The most effective way to prevent emphysema is to avoid smoking and exposure to secondhand smoke. Quitting smoking can also help slow the progression of the disease in those who already have emphysema. Additionally, taking steps to minimize exposure to air pollution, chemical fumes, and other lung irritants can help reduce the risk of developing emphysema.

Coping with Emphysema

Living with emphysema can be challenging, but there are ways to manage the condition and improve quality of life. In addition to following the treatment plan prescribed by your healthcare provider, you can also:

• Participate in pulmonary rehabilitation programs to improve your breathing and physical function
• Practice breathing exercises, such as diaphragmatic breathing, to strengthen your respiratory muscles
• Maintain a healthy lifestyle, including a balanced diet and regular exercise (as tolerated)
• Seek support from friends, family, and support groups to help cope with the emotional and psychological aspects of the disease

Emphysema is a chronic and progressive lung disease, but with proper management and a proactive approach to treatment, many individuals with emphysema can maintain a good quality of life and minimize the impact of the condition on their daily activities.

What Is It, Symptoms, Causes, and More

Emphysema is a disease of the lungs. It occurs most often in people who smoke, but it also occurs in people who regularly breathe in irritants.

Emphysema destroys alveoli, which are air sacs in the lungs. The air sacs weaken and eventually break, which reduces the surface area of the lungs and the amount of oxygen that can reach the bloodstream. This makes it harder to breathe, especially when exercising. Emphysema also causes the lungs to lose their elasticity.

Emphysema is one of the two most common conditions that fall under the umbrella term chronic obstructive pulmonary disease (COPD). The other major COPD condition is chronic bronchitis. Emphysema is an irreversible condition, so treatment aims to slow its progression and minimize symptoms.

Some people have emphysema for years without knowing it. Some of its first signs are shortness of breath and coughing, especially during exercise or physical exertion. This continues to get worse until breathing is difficult all the time, even when resting.

Other symptoms may include:

• exhaustion
• weight loss
• depression

Some people may develop bluish-gray lips or fingernails from lack of oxygen. If this happens, seek medical attention immediately.

According to the American Lung Association, 2 million adults (1.6 percent of people ages 18 years or older) had emphysema in 2018.

Rates were higher among males, non-Hispanic white people, and those over the age of 65. However, the rates among females have been increasing in recent decades, so the gap between the sexes has been decreasing.

Smoking tobacco is the main cause of emphysema. The more you smoke, the higher your risk of developing emphysema. This includes smoking cannabis.

Smoking leads to the death of more than 480,000 Americans a year, and 80 percent of those deaths are caused by COPD, including emphysema. Exposure to secondhand smoke also increases your risk of developing emphysema.

Other causes of, as well as potential risk factors for developing emphysema, may include:

• exposure to high pollution chemical fumes or lung irritants
• a genetic condition called alpha-1 deficiency can lead to a rare form of emphysema called alpha-1 deficiency-related emphysema.
• history of childhood respiratory infections
• a compromised immune system, especially as a result of HIV
• rare disorders such as Marfan syndrome.

Your doctor will begin by getting your background and medical history, asking in particular whether you smoke and whether you’re around hazardous fumes or pollutants at work or at home.

Various tests can detect emphysema, including:

• imaging tests, such as X-rays and CT scans, to look at your lungs
• blood tests, to determine how well your lungs are transferring oxygen
• pulse oximetry, to measure the oxygen content of your blood
• lung function tests, which measure how much air your lungs can breathe in and out and how well your lungs deliver oxygen into your bloodstream
• arterial blood gas tests, to measure the amount of blood and carbon dioxide in your blood
• electrocardiogram (ECG), to check heart function and rule out heart disease

When emphysema becomes severe or isn’t properly treated, serious complications may occur. These may include:

• pneumonia, which can bacterial or viral
• many respiratory tract infections
• cor pulmonale, which is failure of the right side of the heart
• pneumothorax, which is when air collects between the lungs and the chest cavity that can lead to lung collapse
• respiratory acidosis, which is when the lungs can’t obtain enough oxygen, leading to coma
• hypoxemia, which is when the lungs can’t adequately oxygenate the blood

There’s no cure for emphysema. Treatment aims to reduce symptoms and slow the progression of the disease with medications, therapies, or surgeries.

If you smoke, the first step in treating emphysema is to quit smoking. You may need medications to help you withdraw from nicotine. Consider discussing a cessation plan with your doctor.

Medications

Various medications can help treat the disease, including:

• bronchodilators, which help open air passages, making breathing easier and relieving coughing and shortness of breath
• steroids, which alleviate shortness of breath
• antibiotics, which fight infections that can make the condition worse

All of these medications can be taken orally or inhaled.

Therapies

Pulmonary rehabilitation or moderate exercise such as walking can strengthen breathing muscles and alleviate symptoms, making it easier to breathe and be physically active. Yoga, tai chi, and deep breathing exercises can also help relieve symptoms.

Oxygen therapy can help make breathing easier. People with severe emphysema may need oxygen 24 hours a day.

Surgery

Lung volume reduction surgery may be used to remove small parts of damaged lung, and a lung transplant can replace the entire lung. These are rare surgeries used only for people with severe emphysema.

Other treatments

Emphysema might cause you to become underweight. Eating foods rich in vitamins A, C, and E, like fruits and vegetables, is recommended to improve your overall health.

Getting vaccinated against certain infections, such as pneumonia, can help prevent you from getting an infection that could complicate emphysema. These infections include pneumonia, influenza, and COVID-19.

You may also experience anxiety and depression if you aren’t as active as you used to be. Joining a support group can help you connect with others who have the disease and share similar experiences. This can help you realize that you aren’t alone in fighting the disease.

Since emphysema is mainly caused by smoking tobacco, the best way to prevent it is to refrain from smoking. It’s also important to stay away from harmful chemicals and fumes as well as heavy pollution.

The outlook for people with emphysema varies based on its severity. There’s no cure for the disease, and it worsens with time, but you can slow its progression.

As a rule, smoking cigarettes speeds up the disease, so quitting is important.

Early detection of the disease is key, because people with emphysema can develop life threatening conditions when the lungs and heart become damaged over time.

It’s important to stay healthy by eating well and getting exercise. With the aid of medications and therapies, you can live a long, healthy life with emphysema.

THE ETIOLOGY OF EMPHYSEMA | JAMA Internal Medicine

THE ETIOLOGY OF EMPHYSEMA | JAMA Internal Medicine | JAMA Network










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Article

March 1930

L. M. LOEB, M.D.

Author Affiliations

CHICAGO

From the Physiology Laboratory of the University of Chicago and Cook County Hospital.

Arch Intern Med (Chic). 1930;45(3):464-472. doi:10.1001/archinte.1930.00140090147009

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Abstract

According to Fraenkel,¹ emphysema is found in more than 5 per cent of all autopsies. It is rarely found in children, but increases in frequency with each decade. It is often present in persons about 40 years of age, and frequently occurs during old age. Generally it is described as occurring in three types (excluding interstitial emphysema, which has no relation to the disease under discussion) namely: compensatory, atrophic and hypertrophic or vesicular emphysema.

TYPES OF EMPHYSEMA 

Compensatory. 
—Compensatory emphysema is a condition in which one portion of the lung increases in size and function, when another portion is destroyed or temporarily useless. It occurs, for instance, in association with pneumonias, pleural effusions and pneumothorax. Anatomically, there is found an enlargement of the normal lung; there are no variations from the normal structure; the unaffected lung, as a result of distention, has an increased vital capacity and is able to

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causes, symptoms and treatment in the article of the pulmonologist Karetnikov D.

V.

Above the article of the doctor

Karetnikov Dmitry Vladimirovich

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literary editor
Elizabeth Tsyganok,

scientific editor
Elena Lobova

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Publication date February 14, 2022Updated June 23, 2022

Disease definition. Causes of the disease

Emphysema (Emphysema) is a disease in which the amount of air in the lungs increases so much that their anatomy is disturbed: the alveoli become larger, and their walls gradually collapse ^{[1] [2]} .

Emphysema destroys the collagen fibers that are responsible for the elasticity of the lungs. Because of this, the alveoli can no longer contract and decompress and eventually overinflate. The overall density of the lung tissue decreases and becomes more “airy”. When the walls between the alveoli are destroyed, they merge with each other and form a bulla – an air cavity with clear, even and thin walls with a diameter of more than 1 cm. This emphysema is called bullous.

Emphysema occurs in 0.5–5.7% of people over 40 years of age. Most often it affects older men over 65 years old ^[3] .

Causes of pulmonary emphysema

Emphysema usually appears not as an independent disease, but as a concomitant syndrome of another disease.

The causes of emphysema can be both external and internal, sometimes they are combined. The most common cause of the development of the disease is tobacco smoking . Long-term smokers may develop chronic obstructive pulmonary disease (COPD), in which emphysema and chronic obstructive bronchitis coexist. However, emphysema can also be the initial stage in the development of COPD: it affects 52% of smokers without COPD ^[4] .

A more rare cause of the disease is work in a hazardous industry, where a person is exposed to fumes and aerosols without the necessary respiratory protection measures.

Emphysema can also occur in other non-smoking conditions, such as HIV infection, hypersensitivity (allergic) pneumonitis, or malformations of the lungs (impaired lung tissue formation or underdevelopment of a lung area) ^[5] .

Viruses can also be the cause: adenovirus, RS virus and pneumocystis. These agents reduce immunity, increase inflammation and affect tissue growth, reduce collagen synthesis, and thin the alveolar septa.

The main genetic disease that can lead to the development of emphysema is a deficiency of the alpha-1 antitrypsin enzyme. A person with a deficiency of this enzyme can develop emphysema even if he does not come into contact with smoke or aerosols, and with a combination of deficiency and harmful external factors, the disease appears before the age of 40–45 and proceeds more aggressively.

Consult your doctor if you experience similar symptoms. Do not self-medicate – it is dangerous for your health!

Symptoms of emphysema

Characteristic signs of emphysema are:

• Shortness of breath is the main symptom of emphysema. Most often, patients find it difficult to breathe: when breathing, they feel discomfort and lack of air. In sick people, shortness of breath appears even with such physical exertion, which they previously endured without much effort. However, this symptom can progress very slowly (from 1-2 to tens of years), so the patient may not notice the changes that have occurred until shortness of breath appears during usual activities.
• Expiratory lengthening – lasts longer than inhalation. This is due to the formation of an air “trap”: bronchioles open on inspiration and normally fill the lungs with air, but at the end of exhalation they close abruptly. In this case, the person tries to “keep” the bronchioles open, lengthening the exhalation. In severe cases, the patient begins to exhale through a closed mouth or lips folded into a tube, which increases pressure and expels air from the lungs.
• Cough is most often a chronic cough that has been lasting more than three months in total per year for the past two years. It can be either dry or wet. Sputum can also be different: it is usually scanty and mucous, but with the addition of an infection it becomes purulent. Sometimes the cough is accompanied by hemoptysis. In this case, it is necessary to undergo a comprehensive examination.
• Wheezing in the chest – due to the development of bronchitis (a companion of emphysema in COPD) and is often combined with a productive cough. As a rule, the patient can feel them independently without the help of a stethophonendoscope.
• Weight loss is a non-specific symptom that can also be associated with diseases of the gastrointestinal tract, oncology, hormonal disorders and eating disorders. However, the opposite situation is possible, when young patients develop emphysema after they have problems with weight gain ^[6] .

Pathogenesis of pulmonary emphysema

Poor blood supply to the lung tissue plays an important role in the development of emphysema. It stretches unnecessarily, becomes thinner and dies. Bronchial obstruction makes it difficult to exhale and increases alveolar pressure, which, together with inflammation, thins the alveoli.

The mechanism of bullae formation is not completely clear. Researchers suggest that the disease develops in stages: from solitary bullae to widespread emphysema.

In addition, animal research shows that there are several interrelated parallel processes, each of which leads to disease. However, scientists have not yet found out which of them prevails.

Concepts of pulmonary emphysema development

Concept of shift of protease-antiprotease balance and destruction of the extracellular matrix

All cells of our body produce various molecules, some of which are enzymes. Some of these enzymes, proteases destroy their own tissues for their subsequent restructuring. In emphysema, they destroy the elastic fibers of the lungs.

There are also enzymes in the body, antiproteases , which suppress excessive protease activity, if it occurs. The most studied of these molecules is alpha-1-antitrypsin .

A shift occurs when the balance between the activity of intrinsic proteases and antiproteases is disturbed. Protease activity is increased when tobacco or other smoke, aerosols, or bacterial infection damage lung tissue. Inflammation appears at the site of damage, where neutrophils penetrate to eliminate it. They break down elastin, and the remnants of elastin fibers increase the influx of new neutrophils and other cells containing proteases.

In addition to the shift in activity, alpha-1 antitrypsin deficiency plays an important role. This is a genetic disease, and quite common (on average, there is 1 patient per 5,000–10,000 people). With a deficiency of this enzyme, even weak damaging factors that do not affect a healthy person, such as dust or fumes, activate the protease system and lead to the development of emphysema.

In addition, alpha-1 antitrypsin deficiency often provokes cirrhosis of the liver, especially at a young age, so in this case, emphysema usually develops along with cirrhosis.

The concept of oxidative stress and damage to lung cells

Oxygen has the greatest effect on the lung, so lung tissues are well adapted to its high concentrations. However, smoking promotes the production of reactive oxygen species that damage surrounding cells. The destruction of intercellular partitions reduces the number of alveoli, exposing the “skeleton” of the lung tissue, which now becomes an easy target for proteases.

Autoimmune inflammation concept

Quite often, emphysema begins to progress after a person has stopped smoking. Therefore, the disease began to be associated with chronic self-destruction of cells and the inability of the body to stop this (inefficient phagocytosis). The combination of these factors disrupts cell metabolism and provokes the development of lung disease ^[8] .

In addition, a large number of T-lymphocytes, lymphocytic follicles and anti-elastin antibodies are found in the lesion and plasma of patients with emphysema, which also confirms the autoimmune nature of the disease ^[9] .

Classification and staging of emphysema

Doctors classify emphysema based on the location of the lesion. In this regard, they distinguish:

• Centriacinar (centrilobular) form – affects the center of the lung lobule around the bronchiole, which delivers air to the lobule for gas exchange. This type of emphysema develops under the influence of cigarette smoke, as the harmful components settle mainly near the bronchiole. Therefore, most often this form of the disease affects the upper sections of the lungs and smokers suffer from it (including those with COPD).
• Panacinar (panlobular/diffuse) form – destroys the entire lobule, usually without affecting the bronchiole. Changes occur either in the lower sections, or spread throughout the volume of the lungs. Most often, this type of emphysema is associated with alpha-1 antitrypsin deficiency, but it also occurs in smokers without enzyme deficiency.
• Paraseptal form – affects the entire lobule, while in most cases the lobules adjacent to the pleura are affected. This type of emphysema can occur in patients who smoke, as well as in patients whose cause is unknown. If the wall of the lobule ruptures, air enters the chest between the pleura.
• Distal form — alveolar ducts are usually involved in the pathological process.
• Irregular (irregular) form – manifested by various increase in lobules and their destruction, combined with the growth of scar tissue in the lung. Often accompanied by pneumoconiosis, tuberculosis and sarcoidosis.

Bullous emphysema can be the outcome of any form of the disease when the area of ​​destruction exceeds 1 cm ^[9] . Bullae can reach gigantic sizes, occupying the space of the whole lung, and press on healthy tissue ^[10] . Patients with this form of emphysema usually complain of severe shortness of breath that occurs with minimal daily physical activity, which is not a specific symptom.

Complications of pulmonary emphysema

The main complications of pulmonary emphysema are:

• chronic respiratory failure;
• spontaneous pneumothorax;
• weight loss;
• cor pulmonale.

Chronic respiratory failure becomes a major complication in the continuous progression of the disease. The degree of respiratory failure is determined by the doctor using pulse oximetry. If the patient’s blood oxygen saturation is less than 90% without an exacerbation of the disease, the doctor may prescribe home oxygen therapy. Usually, oxygen therapy is prescribed for life or it is canceled after surgery to eliminate respiratory failure. In this case, the patient, using a mask or nasal cannulas, must breathe an air mixture with a high oxygen content, which enters through a portable oxygen concentrator, for at least 13 hours a day ^[11] .

Spontaneous pneumothorax is a condition in which air enters the pleural cavity and the lung suddenly collapses. Spontaneous pneumothorax can occur, for example, when a bulla ruptures or when the wall of the alveolus and the adjacent pleura thin and rupture (most often with the paraseptal form of emphysema). This complication may also be the first manifestation of emphysema ^[11] .

Weight reduction . Due to the increased fatigue of the respiratory muscles, the patient develops severe shortness of breath, so he begins to play less sports. Without exercise, muscles atrophy and their mass decreases. This creates a vicious circle: the patient now suffocates with even less activity. In conditions of oxygen starvation, metabolism changes, due to which muscle mass and weight in general decrease.

Cor pulmonale — enlargement of the right side of the heart due to increased pressure in the pulmonary vessels. With the destruction of lung tissue, the number of blood vessels also decreases. However, the volume of blood passing through the lungs at a time remains the same, so the pressure and resistance to blood flow increase. Initially, cor pulmonale is the body’s way of compensating for damaged tissues, so it is asymptomatic (apart from other characteristic symptoms of emphysema). But further stagnation of blood in the systemic circulation leads to swelling of the legs and enlargement of the liver and spleen [16]. Formed later than in COPD.

Diagnosis of pulmonary emphysema

Important history items are smoking, work in rooms with polluted air, chronic or frequent acute lung disease and alpha-1-antitrypsin deficiency in the patient and his relatives.

Characteristic signs on physical examination indicating emphysema may include:

• barrel-shaped chest;
• horizontal arrangement of ribs and smoothness of intercostal spaces;
• bulging of the supraclavicular fossae due to enlargement of the apices of the lung;
• lack of weight.

An important sign of emphysema is also a sound above the lungs, resembling the sound of hitting a box or pillow, and an increase in the boundaries of the lungs ^[11] . Sometimes accompanied by weakened breathing.

Red blood cell count and peripheral blood saturation are checked to rule out respiratory failure. If the saturation is below 93%, it is necessary to conduct an analysis of arterial blood for gases contained in it in order to clarify the nature and degree of respiratory failure.

If a doctor suspects that a patient has a hereditary deficiency of alpha-1 antitrypsin, it is also necessary to donate blood to determine its activity. This is not the most common study, but many private laboratories perform it. The main indication for this test is having COPD before the age of 40 or when a COPD patient smokes at least one pack of cigarettes per day for 20 years ^[11] . If the activity of the enzyme is reduced, the genotype of the virus is determined by a geneticist using genotyping.

To check for an increase in the number of red blood cells and hemoglobin, a complete blood count is performed.

Instrumental diagnostics

The main diagnostic methods are:

• X-ray of the lungs in direct projection – prescribed to a patient with suspected emphysema to clarify the diagnosis ^[11] . With emphysema, it shows a decrease in the number of vessels and a “drip”, elongated heart.
• Computed tomography chest organs in high resolution – if the x-ray showed emphysema. With the help of CT, the doctor determines the structural nature of the disease and specifies the volume of involved lung tissue. CT also shows hyperairiness, the appearance of bullae, and a change in the ratio of blood flow and ventilation in different parts of the lungs. It also excludes other diseases with similar symptoms, such as interstitial pneumonia, pulmonitis, or idiopathic pulmonary fibrosis.
• Spirometry with drug test – estimates the volume of the lungs and the speed of breathing.

• Body Plethysmography and Lung Diffusivity Study – more accurately analyze lung function and determine dead space volume and individual giant bulla size. The doctor prescribes these studies before the planned operation for emphysema.

• Ultrasound of the heart – shows the pressure in the pulmonary artery, which appears several years after the onset of emphysema.

Treatment of emphysema

Emphysema, like COPD, is a chronic disease that people live with all their lives, so it cannot be cured, but it is possible to slow the progression, control symptoms, prevent and treat exacerbations ^[16] .

Patients with emphysema should stop smoking, and this applies to all patients, regardless of the type of emphysema and smoking history, since smoking cessation slows down the progression of the disease ^{[12] [13]} .

For emphysema, drugs that relieve spasm and swelling of the bronchi, and drugs that facilitate sputum discharge, such as ACC and Fluimucil, are also prescribed.

In case of exacerbations of chronic bronchitis, which is combined with emphysema, antibacterial drugs are added to the treatment.

Treatment of pulmonary emphysema with COPD

If emphysema accompanies COPD, the patient needs to take daily inhalations with bronchodilators. Therapy lasts a lifetime, with rare exceptions when the need arises to stop the medication.

To prevent exacerbation of COPD, it is important for patients to notice in time that the amount of sputum has increased, and its structure has changed from mucous to purulent. Each exacerbation of COPD activates the destruction of lung tissue and leads to an exacerbation of emphysema. It should be noted that the lung tissue is not restored.

Treatment of emphysema of the lungs of a genetic nature

A patient is prescribed intravenous alpha-1-antitrypsin replacement therapy if the patient has a complex of the following factors:

• alpha-1 antitrypsin deficiency with genotyping;
• symptoms of disease;
• decrease in spirometry parameters.

CT scans confirmed that this therapy slows down the progression of the disease ^[14] . This drug is registered in Russia.

Surgical treatment of emphysema

Thoracic surgeons perform operations to treat emphysema. Among them are:

• Bullectomy – bulla removal. After it, the compressed section of the lung straightens out and begins to participate in respiration and gas exchange, reducing respiratory failure.
• Lung volume reduction surgery – removal of the apex of the lung to improve ventilation of the lung tissue. It is carried out with the development of emphysema in the upper lobe of the lungs, when the patient is worried about severe shortness of breath.
• Endoscopic bronchial valve insertion – promotes ventilation of the lung in the affected area and provides for the removal of sputum and residual air when exhaling through the endobronchial valve. However, scientists are still studying the effectiveness of this treatment method.
• Lung transplant – recommended for severe emphysema with dyspnea at rest or with minimal exertion that persists despite medical and rehabilitation therapy.

To schedule an operation, you need to get advice from many specialists, including a pulmonologist, radiologist, general practitioner and otolaryngologist.

Rehabilitation for emphysema

Almost all patients with emphysema need rehabilitation. It includes several components:

• exercise;
• nutritional support;
• patient education;
• psychological help.

Regular exercise increases overall fitness. Patients with COPD are advised to exercise on a treadmill or bicycle ergometer and exercise with light dumbbells twice a week. In addition, you should walk daily as much as shortness of breath and general condition allows (average length is about 3–4 km). Such activities increase physical tone and reduce the degree of shortness of breath ^[11] .

Nutritional support is required for underweight patients with weak intercostal muscles. They are consulted by a nutritionist: he corrects the daily diet and adds the missing nutrients and vitamins to the daily diet.

During the training , the patient is told about the disease, possible prevention of exacerbations, and is taught the correct use of inhaled drugs.

Psychological assistance may be required for patients with severe symptoms, such as prolonged shortness of breath, since this condition can provoke depression.

The rehabilitation program is compiled individually for each patient.

Forecast. Prevention

The prognosis of life and its quality depends on the provoking factor that led to the development of emphysema. For example, in alpha-1 antitrypsin deficiency, the course of the disease and its outcome depend on the genotype of the protein and its level in the blood. The most unfavorable prognosis in patients with the phenotype ZZ, ZNull, NullNull ^{[11] [14]} .

Smoking cessation, stable course of COPD and timely prevention of its exacerbations are important factors for a favorable life prognosis in a patient with emphysema ^[14] .

Prevention of emphysema

For the prevention of emphysema you need:

1. Quit smoking.
2. Get vaccinated against respiratory infections (eg, COVID-19, influenza, and pneumococcal infections) as acute lung disease can lead to the progression of emphysema.
3. Avoid contact with harmful substances that irritate the respiratory tract, such as dust, fumes and smoke. If the patient works in a hazardous industry, it is recommended to change jobs ^[11] .

To evaluate the effectiveness of ongoing treatment and monitor the dynamics of the disease, you need to visit a doctor 2-4 times a year, even in the absence of symptoms. If persistent symptoms are pronounced, the doctor intensifies therapy. In addition, the patient should inform the doctor about all new symptoms and exacerbations that the patient was able to stop on their own. With constant monitoring, the doctor will be able to reduce the number of exacerbations, timely identify the complications of the disease and eliminate them ^[15] .

27. Pulmonary emphysema: definition of the concept, etiology, pathogenesis, manifestations.

Emphysema
lung is characterized
abnormal expansion of the air
spaces distal to terminal
bronchioles, which is accompanied
destructive changes in the alveolar
walls; one of the most common forms of chronic
nonspecific lung diseases.
There are primary (idiopathic)
emphysema of the lungs, developing without
previous bronchopulmonary
diseases, and secondary (obstructive)
emphysema is the most common complication
chronic obstructive bronchitis.
Depending on the prevalence
emphysema may be diffuse or
focal.

Etiology.
Pathogenesis .
There are two groups of reasons leading to
to the development of emphysema. the first
group of factors that affect
elasticity and strength of the lungs
structural elements: pathological
microcirculation, change in properties
surfactant, congenital deficiency
a,-antitrypsin, gaseous substances
(cadmium compounds, nitrogen oxides, etc.),
as well as tobacco smoke, dust particles
in inhaled air. These reasons may
lead to the development of primary, always
diffuse emphysema. Based on its pathogenesis
lies a pathological restructuring of everything
respiratory section of the lung. Weakening
elastic properties of the lung leads
to the fact that during exhalation and, therefore,
increased intrathoracic pressure
small bronchi that do not have their own cartilaginous
carcass and devoid of elastic traction
lung, passively subside, increasing
this bronchial resistance to
expiration and increased pressure in the alveoli.
Bronchial patency during inspiration
primary emphysema is not disturbed.

The factors of the second group contribute
increased pressure in the respiratory
lung and increase stretching
alveoli, alveolar ducts and respiratory
bronchioles. The highest value among
they have airway obstruction,
occurring in chronic obstructive
bronchitis. This disease becomes
the main reason for the development of secondary
or obstructive pulmonary emphysema
how exactly conditions are created under it
to form the valve mechanism
overstretching of the alveoli. Yes, downgrade
intrathoracic pressure during inspiration
causing passive stretching of the bronchial
lumen, reduces the degree of existing
bronchial obstruction; positive
intrathoracic pressure during exhalation
causes additional compression
bronchial branches and, aggravating already
existing bronchial obstruction,
contributes to the delay of inspired
air in the alveoli and their overstretching.
Distribution is important
inflammatory process with bronchioles
on adjacent alveoli with development
alveolitis and destruction of interalveolar
partitions. Causes of focal
(localized, irregular) emphysema
lung may have incomplete valvular
obstruction of the bronchus of an inflammatory or
tumor genesis; atelectasis or cirrhosis
area of ​​the lung; congenital pathology
(congenital lobar emphysema, congenital
unilateral emphysema).
Secondary
emphysema is characterized by
swelling of the respiratory bronchioles and
a change in the shape of mainly those
alveoli that lie close to them
(centroacinar emphysema). At
progression to pathological
the process can include the entire acinus
(slice). Alveoli are flattened
dilated, smooth muscle bundles
hypertrophic, then dystrophic.
Elastic fibers are straightened. Walls
respiratory bronchioles are thinned,
number of capillaries and cells
elements in them are reduced. In later
stages of emphysema, there is a violation
and complete disappearance of structural
respiratory elements of the lungs.
In primary emphysema, there is a uniform
defeat of all alveoli included in
composition of the acinus of the lung (panacinar
emphysema), atrophy of the interalveolar
partitions; reduction of capillary
channels. inflammatory changes in
bronchi, bronchioles are not expressed, and
their obstruction associated with inflammatory
edema does not occur.
Symptoms,
course of pulmonary emphysema .
Characterized by shortness of breath, barrel chest
cell, a decrease in its respiratory
excursions, expansion of intercostal
gaps, bulging of the supraclavicular
areas, boxed percussion sound,
weakened breathing, decreased area
relative dullness of the heart, low
diaphragm stop and decrease
mobility, increased transparency
lung fields on x-ray.
Primary emphysema in a much greater
degree than secondary, characteristic
severe shortness of breath, with which (without
previous cough) begins
disease; in patients already at rest
ventilation is extremely large, so their
exercise tolerance
very low. Known for the sick
primary emphysema symptom of “puffing”
(covering the oral fissure on exhalation with
swelling of the cheeks) is caused by the need
increase intrabronchial pressure
during exhalation and thereby reduce
expiratory collapse of the small bronchi,
preventing an increase in ventilation.