What are the symptoms of paraseptal emphysema. How is paraseptal emphysema diagnosed. What treatment options are available for paraseptal emphysema. Can paraseptal emphysema be prevented.

What is Paraseptal Emphysema?

Paraseptal emphysema (PSE) is a specific type of pulmonary emphysema that affects the outermost parts of the lungs. In this condition, the alveoli, which are tiny air sacs responsible for gas exchange, become damaged and inflamed, leading to the formation of enlarged air spaces. This structural change reduces the lungs’ efficiency in exchanging oxygen and carbon dioxide during breathing.

PSE is one of three main types of pulmonary emphysema, alongside centrilobular and panlobular emphysema. Each type affects different regions of the lungs, with PSE specifically targeting the peripheral areas. Understanding the unique characteristics of PSE is crucial for proper diagnosis and management of the condition.

Mild vs. Severe Paraseptal Emphysema

PSE can be classified into two main categories based on severity:

• Mild PSE: Characterized by rows of small lucencies (areas of lower-density lung tissue) along the outermost parts of the lungs, each no larger than 1 centimeter in diameter.
• Severe or substantial PSE: Involves lucencies present in other parts of the lungs, with diameters exceeding 1 centimeter.

The distinction between mild and severe PSE is important for determining the appropriate treatment approach and predicting the potential progression of the disease.

What Causes Paraseptal Emphysema?

The development of PSE, like other forms of emphysema, is primarily attributed to chronic inflammation of the alveoli. While the exact mechanisms are not fully understood, several factors have been identified as potential causes or contributors to the condition:

1. Cigarette smoke inhalation (both active smoking and secondhand exposure)
2. Exposure to air pollutants
3. Respiratory infections
4. Alpha-1 antitrypsin deficiency (a rare genetic condition affecting lung function)

Among these factors, cigarette smoking remains the most significant and well-established cause of emphysema, including PSE. The harmful chemicals in tobacco smoke can trigger chronic inflammation and oxidative stress in the lungs, leading to the destruction of alveolar walls and the formation of enlarged air spaces characteristic of emphysema.

Is paraseptal emphysema preventable?

While not all cases of PSE can be prevented, certain lifestyle choices and precautions can significantly reduce the risk of developing the condition:

• Avoiding tobacco smoke: This includes quitting smoking and minimizing exposure to secondhand smoke.
• Protecting against air pollution: Using air purifiers indoors and avoiding heavily polluted areas when possible.
• Maintaining good respiratory health: Regular exercise, a balanced diet, and proper management of existing respiratory conditions can help maintain lung function.
• Genetic counseling: For individuals with a family history of alpha-1 antitrypsin deficiency, genetic counseling and early screening can help identify and manage the risk.

Recognizing the Symptoms of Paraseptal Emphysema

The symptoms of PSE are similar to those of other types of pulmonary emphysema. Patients with PSE may experience:

• Chronic cough
• Shortness of breath, especially during physical activity
• Wheezing
• Chest tightness
• Fatigue

It’s important to note that these symptoms typically develop gradually over time and may worsen as the disease progresses. Many individuals with early-stage PSE may not experience noticeable symptoms, which underscores the importance of regular check-ups and lung function tests for those at risk.

When should you seek medical attention for suspected PSE?

If you experience persistent respiratory symptoms, especially if you have a history of smoking or exposure to lung irritants, it’s crucial to consult a healthcare provider. Early detection and management of PSE can significantly improve outcomes and quality of life. Seek immediate medical attention if you experience severe shortness of breath, chest pain, or coughing up blood, as these may indicate more serious complications.

Diagnosing Paraseptal Emphysema

Accurate diagnosis of PSE is essential for appropriate management and treatment. Healthcare providers typically use a combination of methods to diagnose and assess the severity of the condition:

1. Lung function tests: These tests, including spirometry, measure how well the lungs are working and can help identify airflow limitations characteristic of emphysema.
2. Chest X-rays: While not always definitive for early-stage PSE, X-rays can reveal some of the structural changes associated with emphysema.
3. Computed tomography (CT) scans: High-resolution CT scans provide detailed images of the lungs, allowing doctors to identify the characteristic lucencies and air spaces of PSE.
4. Blood tests: These can help rule out other conditions and, in some cases, identify genetic factors like alpha-1 antitrypsin deficiency.

During the diagnostic process, healthcare providers must differentiate PSE from other types of emphysema, such as centrilobular and panlobular emphysema, as well as other respiratory conditions that may present with similar symptoms.

How is paraseptal emphysema distinguished from other types of emphysema?

The key distinguishing factor of PSE is its location within the lungs. While centrilobular emphysema affects the central regions of the lungs and panlobular emphysema affects all areas, PSE specifically targets the outer regions or periphery of the lungs. High-resolution CT scans are particularly useful in identifying these location-specific changes and differentiating between the various types of emphysema.

Treatment Options for Paraseptal Emphysema

Although there is currently no cure for PSE or other forms of emphysema, various treatment options are available to manage symptoms, slow disease progression, and improve quality of life. Treatment plans are typically tailored to the individual patient’s needs and may include:

• Smoking cessation programs: For patients who smoke, quitting is the most important step in slowing the progression of PSE.
• Bronchodilator medications: These drugs help open up the airways, making breathing easier.
• Anti-inflammatory drugs: Corticosteroids and other anti-inflammatory medications can help reduce airway inflammation.
• Oxygen therapy: Supplemental oxygen may be prescribed for patients with low blood oxygen levels.
• Pulmonary rehabilitation: This comprehensive program combines exercise, education, and support to improve lung function and overall well-being.
• Vaccinations: Annual flu shots and pneumococcal vaccines can help prevent respiratory infections that could exacerbate PSE.

In severe cases or when large bullae (air pockets larger than 1 cm in diameter) develop, surgical interventions may be considered. These may include lung volume reduction surgery or, in extreme cases, lung transplantation.

What role does lifestyle modification play in managing PSE?

Lifestyle changes can significantly impact the management of PSE and improve overall quality of life. Key modifications include:

• Maintaining a healthy diet rich in antioxidants and anti-inflammatory foods
• Engaging in regular, moderate exercise as tolerated and recommended by healthcare providers
• Avoiding exposure to air pollutants and other lung irritants
• Practicing stress-reduction techniques, as stress can exacerbate breathing difficulties
• Ensuring adequate sleep and rest

Complications and Long-term Outlook for Paraseptal Emphysema

While PSE is a chronic condition, its progression and long-term outlook can vary significantly between individuals. Factors influencing the prognosis include:

• The person’s age and overall health
• The severity of the emphysema at diagnosis
• How well the condition responds to treatment
• Whether the individual continues to smoke or is exposed to other lung irritants
• The presence of other medical conditions

Potential complications of PSE and other forms of emphysema include:

1. Respiratory insufficiency or failure
2. Increased risk of respiratory tract infections and pneumonia
3. Development of depression and anxiety
4. Increased risk of lung cancer, particularly in those with coexisting chronic obstructive pulmonary disease (COPD)
5. Pneumothorax (collapsed lung), which is a particular risk in PSE due to the peripheral location of the affected lung tissue

Can the progression of paraseptal emphysema be slowed or halted?

While the damage caused by PSE is generally irreversible, the progression of the disease can often be slowed through a combination of medical interventions and lifestyle changes. Key strategies include:

• Immediate smoking cessation
• Strict adherence to prescribed medications and therapies
• Regular follow-ups with healthcare providers to monitor lung function and adjust treatment as needed
• Participation in pulmonary rehabilitation programs
• Maintaining overall health through diet, exercise, and stress management

Living with Paraseptal Emphysema: Coping Strategies and Support

Living with PSE can be challenging, but many individuals lead fulfilling lives with proper management and support. Coping strategies and resources that can help include:

• Patient education programs to better understand and manage the condition
• Support groups, both in-person and online, for sharing experiences and coping strategies
• Psychological counseling to address the emotional impact of living with a chronic condition
• Occupational therapy to learn energy-conserving techniques for daily activities
• Home modifications to create a lung-friendly environment

It’s important for individuals with PSE to work closely with their healthcare team to develop a comprehensive management plan that addresses both the physical and emotional aspects of living with the condition.

How can family members support loved ones with paraseptal emphysema?

Family members and caregivers play a crucial role in supporting individuals with PSE. They can help by:

• Encouraging adherence to treatment plans and medication schedules
• Assisting with household tasks to reduce physical strain
• Creating a smoke-free and low-pollutant home environment
• Providing emotional support and understanding
• Accompanying the patient to medical appointments and helping to communicate concerns to healthcare providers
• Learning about PSE to better understand the challenges their loved one faces

Emerging Research and Future Directions in Paraseptal Emphysema Treatment

While current treatments for PSE focus on symptom management and slowing disease progression, ongoing research aims to develop more targeted and effective therapies. Some promising areas of investigation include:

• Stem cell therapy: Exploring the potential of stem cells to regenerate damaged lung tissue
• Gene therapy: Targeting genetic factors that may contribute to emphysema development
• Novel anti-inflammatory agents: Developing medications that can more effectively reduce lung inflammation
• Lung volume reduction techniques: Improving minimally invasive procedures to remove damaged lung tissue
• Biomarker research: Identifying biological markers that could lead to earlier diagnosis and more personalized treatment approaches

These areas of research offer hope for improved outcomes and potentially curative treatments for PSE and other forms of emphysema in the future.

What role might artificial intelligence play in the future of PSE management?

Artificial intelligence (AI) is increasingly being explored in various aspects of respiratory medicine, including the management of emphysema. Potential applications of AI in PSE include:

• Improved image analysis for more accurate and early diagnosis
• Predictive modeling to identify patients at high risk of developing complications
• Personalized treatment planning based on individual patient data and disease characteristics
• Remote monitoring of lung function and symptoms through wearable devices and smart home technology

As research in this field progresses, AI may become an integral part of PSE management, enhancing diagnostic accuracy, treatment efficacy, and patient outcomes.

Paraseptal emphysema: Symptoms, outlook, and more

Paraseptal emphysema (PSE) is a type of pulmonary emphysema. In PSE, the outermost parts of the lungs fill with enlarged air spaces. This can cause breathing difficulties and other respiratory symptoms.

Currently, there is no cure for PSE or other forms of pulmonary emphysema. However, treatments are available to help slow the progression of the disease, alleviate symptoms, and improve quality of life.

This article describes PSE, including its causes, symptoms, diagnosis, and treatment. We also define mild versus severe PSE and provide information on a person’s outlook.

There are three types of pulmonary emphysema, which differ depending on which part of the lungs it affects. Paraseptal emphysema (PSE) is a type of emphysema, along with centrilobular and panlobular emphysema.

The lungs contain tiny air sacs called alveoli, responsible for exchanging oxygen and carbon dioxide when a person breathes in and out. In emphysema, the alveoli become inflamed and rupture, creating air pockets within the lungs. These air pockets decrease the surface area of the lungs, making the lungs less efficient at exchanging gases.

Different kinds of emphysema affect different parts of the lungs. People with PSE have damage to the alveoli in the outermost parts of their lungs.

There are two main forms of PSE: mild PSE and severe or substantial PSE. Both types involve lucencies, which are areas of lower-density lung tissue.

Scientists define mild PSE as when a person has rows of small lucencies along the outermost parts of their lungs, and each lucency is no larger than 1 centimeter (cm) in diameter. Severe PSE is when lucencies are present in other parts of the lungs, and the lucencies are larger than 1 cm in diameter.

Emphysema occurs when a chronic trigger, such as smoking, causes inflammation in the alveoli within the lungs. The most common cause of emphysema is inhaling cigarette smoke, which could be from smoking or inhaling second-hand smoke.

Other factors that may play a role in the development of emphysema include:

• inhaling air pollutants
• respiratory infections
• alpha-1 antitrypsin deficiency, which is a rare genetic condition that can affect lung function

The symptoms of PSE are the same as those for other types of pulmonary emphysema and may include:

• chronic cough
• shortness of breath
• wheezing

These symptoms may worsen as the disease progresses.

The outlook for people with pulmonary emphysema depends on several factors, including:

• the person’s age and overall health
• how well the condition responds to medical intervention
• whether the person experiences complications as a result of the condition

According to a 2021 review, some possible complications of emphysema include:

• respiratory insufficiency
• respiratory failure
• respiratory tract infections
• pneumonia
• depression
• anxiety

People with PSE are also at increased risk of developing a collapsed lung. Moreover, evidence also indicates a relationship between cancer and emphysema. Individuals with both PSE and chronic obstructive pulmonary disease (COPD) may be at increased risk of developing certain forms of lung cancer.

As a 2021 review explains, doctors may diagnose PSE using lung function tests and chest X-rays.

A doctor may need to differentiate between the three main types of pulmonary emphysema:

• Centrilobular (proximal acinar): Affects the more central regions of the lungs.
• Paraseptal (distal acinar): Affects the outer regions of the lungs.
• Panlobular (panacinar): Affects all areas of the lungs.

Any of the above types of emphysema have the potential to develop into bullous emphysema (BE). The development of bullae characterizes this type of emphysema, which are air pockets greater than 1 cm in diameter. Large bullae typically cause more severe respiratory symptoms and may require surgical treatment.

Currently, there is no cure for pulmonary emphysema. However, treatments are available to slow the progression of the disease, alleviate symptoms, and improve quality of life. This may involve multiple therapies, such as:

• anti-inflammatory drugs to reduce airway inflammation
• bronchodilator medications to help open up the airways
• supplemental oxygen therapy to ensure that a person with breathing difficulties has sufficient oxygen in their blood
• opioids to help with pain management
• psychological therapies to help with depression and anxiety

Paraseptal emphysema (PSE) is a type of pulmonary emphysema. There are three main types of pulmonary emphysema. They involve damage to the tiny air sacs or alveoli within the lungs, but each type differs according to the parts of the lungs they affect. Paraseptal emphysema affects alveoli in the outer regions of the lungs.

As with other types of pulmonary emphysema, PSE can cause respiratory issues, such as breathing difficulties, coughing, and wheezing.

Although there is no cure for pulmonary emphysema, treatments can help to slow the progression of the disease and alleviate symptoms. Treatment options include anti-inflammatory medications to reduce airway inflammation, bronchodilators to ease breathing, and opioids to help with pain management. A person can consult their doctor about their individual treatment options and outlook.

Advanced Emphysema – UChicago Medicine

Today on At the Forefront, we’re going to discuss COPD and advanced emphysema and the toll it takes on your lungs. We’ll discuss some of the exciting treatments that are increasing lifespans and quality of life for people who are suffering. That’s coming up right now on At the Forefront.

[MUSIC PLAYING]

And we want to remind our guests that today’s program is not designed to take the place of a visit with your physician. We’re going to start off with having each one of you introduce yourselves and tell us a little bit about what you do here at UChicago Medicine. You both have been on– you’re both veterans of the program. In fact, we were talking before the show, Dr. Hogarth you were actually on the very first program. So I appreciate you being back. Tell us a little bit about your role here at UChicago Medicine.

Sure. My name is Kyle Hogarth. I’m a Professor of Medicine and I’m a Pulmonologist. And I help run our Interventional Pulmonary Program. So I, with my colleagues, we do procedures inside people’s lungs to either help them breathe better or to diagnose whatever might be wrong on the inside, whether that’s lymph nodes or lung nodules.

And Ajay, we’re going to go over to the corner with you. We’re still doing our social distancing. So you’re a little ways away from us. Tell us a little bit about your role here.

Sure. My name is Ajay Wagh. I’m an Interventional Pulmonologist. I’ve been here at the University of Chicago now coming up on three years working with Dr. Hogarth and Dr. Murgu. And we offer minimally invasive strategies to help people breathe and diagnose and treat lung conditions. And I’m excited to be part of the team.

Great. And you guys have had some– you do a lot of different procedures to folk’s lungs and a lot of exciting things. And one of the things we’re going to talk about today are our valves. But before we get into that, I want to know if you can just tell us a little bit about why you do those procedures and what kind of a patient are you you’re looking at there. And Dr. Hogarth, let’s start with you if we can.

Yeah, sure. So look, there are a lot of people with bad COPD and emphysema. And majority of it an inhaler that your doctor is prescribed is typically enough to minimize the symptoms and give you back less symptoms when you want to go walk places or do things. But there are a significant amount of people whose lung disease is severe enough, that their emphysema is bad enough, that even though they’ve done everything their doctors ask them to do, and they’re taking the inhalers, et cetera.

When you ask them to do any amount of walking or any amount of activities, they run into problems. And sometimes it’s even the simple things like getting around your home or being able to run errands or the simple, hey, I want to go to the corner store. It doesn’t matter. They’re limited. And so they have to slow down their lifestyle. They have to adjust their lifestyle.

And when they talk to their doctor about it, unfortunately, there’s no other inhalers to try. There no other drugs to try. So that’s where procedures come in to offer up a chance– that we’ll talk later about the workup for this– but to specifically help these patients breathe better.

And Dr. Wagh, exactly happens to your lungs when you are experiencing advanced emphysema or COPD? There’s quite a bit of damage that’s been done at that point. Is that correct?

Yes, sir. So there’s definitely damage. There can be damage to the lung tissue itself. There can be damage to the airways. When we think about advanced emphysema, we really think about damage to the lung tissue. And COPD is obstructive lung disease, chronic obstructive pulmonary disease. And it’s really hard for that tissue to get the air out. We call that air trapping. And that’s the main problem that we focus on with our special procedure.

And so let’s talk a little bit about that procedure. And first of all, if you can tell us when a patient comes to you and they’re experiencing these difficulties, I imagine there’s a whole slew of things you probably look at and try. Walk us through that if you will.

So on the assumption that you’ve already been on the correct medications, quit smoking, and done something called pulmonary rehab to get your reconditioning– because those are the core things that everyone should be doing– be on the appropriate, guideline based medications that you’re taking daily. Finish pulmonary rehabilitation so that you can maximize your exercise. And obviously quit smoking and not be around secondhand smoke.

So then if you’re still symptomatic and still limited, that’s when we initiate the workup to see if you’re a candidate for these valves. We’ll need breathing tests to quantify and measure just how bad your lungs are, to quantify how bad that gas trapping that Dr. Wagh just talked about, how hyper inflated you are. And then a specialized CT scan of the lungs to quantify and measure the degree of emphysema, so that we just how bad it is. Because these valves we’ve got to know where to place them. And so the scan we do helps to pinpoint the correct spot to place these devices so we maximize the benefit.

And when you’re talking about these valves, I imagine they’ve got to be tiny.

They are quite tiny.

Where do they go and what do they look like? How do you place something like this?

So we place it through a bronchoscope. So that’s why Dr. Wagh and I are involved. It’s done under anesthesia. So you are asleep for it. We go through your mouth. There is no cutting. This is the beautiful thing about it. So we go down into the airways that are the ones that we said from CAT scan is where the bad part of the lung is. And think of these things as a one way valve or a cork with an exit.

So in other words, we’re going to plug up the sick part of the lung. We’re going to let the air out of that part of the lung. And what’s pretty unique about the University of Chicago– so there’s actually two different valve manufacturers in the market that make these devices. And they’re similar and yet different, and they have their pros and cons to each of them. And we are one of the only hospitals in the country that stock both and have the ability to use both.

In some very unique scenarios, we even have patients who have both inside them. So it wasn’t a pick one procedure. What matters is that you need to be able to get these valves in the correct airways. And I can’t be limited based on some nuance to your anatomy or a nuance to these valves. And so I think that’s, again, one of the unique things about an institution like ours is that they afford us the ability to ensure that we can take care of anyone who’s remotely a candidate for this procedure.

That’s an amazing fact and I think if we can touch on that just a little bit more. So when you’re working with a patient, is that something before you do the procedure that they’re going to need these? Or is it once you get in there–

No, it’s a great question. I know Ajay will agree with me. It’s the unpleasant surprise that the valves that– if you have only one company’s valves on the shelf and you sit there and go, I’m not sure how this is going to work. And I can’t think of anything worse than saying, I’m going to wake you up. You got to go home and you got to come back because we ordered the other one we needed.

And it’s quite literally an on the fly measurement. Because we’re taking active measurements on the inside. And that’s how we figure this out. And it’s not a common occurrence. But if it’s more than one in a million, it’s common enough.

Yeah, exactly. And if you’re the patient that’s going through the procedure, you want that variety available.

Yeah, and you’d like to be only knocked out once, not multiple times.

Dr. Wagh, I’m kind of curious, let’s bring you into the conversation. What is that process like when you’re doing the work and you see, OK, I need this and this, and you start to work through the process with the patient. It’s got to be gratifying, first of all, that you can offer that. And what’s the– then I think if we can, let’s talk a little bit about the rehab for the patient afterwards.

Absolutely. So as part of the workup, we would generally get a referral from a lung specialist of the patient who would like for us to evaluate the patient for this procedure. And as Dr. Hogarth mentioned, we look at the breathing tests. We look at the patient’s ability to walk and their functional capacity.

We want to ensure that the patient has quit smoking for about four months. And we also look at their CAT scan and send that for a special report so that we can assess certain criteria on the CAT scan. And we want to do all of this stuff before we bring the patient back for the actual procedure to ensure that they’re a good candidate for the procedure.

And how long does a procedure like this take, generally?

The actual procedure is quite short, less than an hour on most occasions.

Yeah, it usually ends up averaging about 30 minutes.

Wow. OK, I would have anticipated much more significant than that.

Yeah, no it’s pretty incredible.

What is it the impact to the patient? Is it immediate and how do they feel afterwards?

I’ll let Ajay address that one.

So it depends, just like most things medically or many things medically. I think some patients definitely see some benefit quite early on, but it could take actually several weeks to see a full benefit. And at that point in time, around six weeks or so, we ask the patient to come back for a new breathing test and a new scan to really assess objectively whether or not they’ve benefited.

And I would imagine that if that portion of the lung, your lungs, you’re taking that pressure off and taking the air out. Do the rest of the lungs then have to kind of build and grow?

Well, in fact, that’s the whole reason these things work. You’ve got the sick part of your lung, not only does it not work well it’s gotten very enlarged, and it’s actually squishing the healthy parts. That’s the easiest way to think about it. And it’s shoving your diaphragm down. So when I ask you to take a deep breath, you already are at rest.

So you’re breathless because you can’t go deeper. So if we deflate you, then the healthier part to your lungs are able to expand and do more work. And it’s not the same but it’s similar to cutting off the branch of a tree that’s dead. And you cut the dead branch off, and then the rest of the tree expands in. A couple of weeks later the tree looks beautiful again, and you can’t even tell it had a dead branch. Very similar.

So just I would imagine a tremendous–

But without cutting.

Yeah, we’re not cutting any branches off. But I would imagine it’s a tremendous quality of life change for these patients.

When you can’t breathe nothing else matters, right? And to restore even a little bit of lung function for people to have the freedom to be able to go grocery shopping again. One of my patients was very frustrated. She’s an older lady. The younger tennis players were beating her on the tennis court. She was in great shape but still had limits. And now she’s back to beating the younger tennis players.

Well, that’s exciting news. Let’s talk a little bit about smoking, too, because I know that’s central to the issue that happens here, or oftentimes it is. Is that primarily what you see in your patients or can it be a whole slew of different reasons that they get to this stage?

Well, typically we see patients who have this problem as a result of smoking. So we want to encourage– or we continue to encourage patients to quit smoking. And it is something that we look for prior to proceeding with such a procedure.

I’ve always been kind of curious if somebody is a smoker and has been a smoker for a while, they’ve obviously done some damage to their lungs. If they stop while they’re still in a somewhat healthy stage, do the lungs regenerate at all or have you pretty much have done the damage?

No the lungs don’t regenerate. So I tell people the reason to quit smoking or never to start is your lungs are the bank account that you only draw money from and you never add to. The medications make the lungs work more efficiently. This treatment, these valves help to make the lungs work more efficiently. But the damage, unfortunately, is damage done. And the only way to keep that from getting worse is to quit smoking.

That’s just a great reminder to people that may be watching.

And vaping, too. And by the way, all smoke. So with legalized marijuana, smoke is smoke. Your lungs don’t care. Smoke is smoke. Everything damages your lungs when you put it in there. So, don’t.

You know, I’m glad you brought that up because that’s another huge issue currently. I mean particularly here in Illinois, we see the legalization. And we see so many people vaping. And I think a lot of people are under the misperception that vaping isn’t bad for you.

Right, that it’s somehow safer.

Yeah.

I think this is a moving target. I think Ajay would agree with me. And you’ll hear people say, well, it’s got to be safer. Yeah, I mean I guess it’s safer to get hit by a car than it is to get hit by a bus. I’m going to just not get hit by either vehicle is really the analogy I would use. Both sound like a really bad idea. I don’t know, Ajay would agree?

Absolutely, we just want to breathe in clean air. So I mean that’s what our recommendation would be to focus on breathing clean air and focus on our environment and emphasize clean air in our environment as well. So yeah, I mean, we don’t want to encourage anybody to put anything in their lungs other than clean air.

And that’s what our lungs are built for. They’re not built to inhale smoke and other garbage.

Correct.

Great. So there is some hope out there for folks with COPD or significant emphysema. So that’s positive. If the valves don’t work, there are other options as well that you all offer.

Well there are. So I think this is where it’s unique. So Ajay and I– so Dr. Wagh and I are very involved in several different clinical trials that are also looking at ways to help people with emphysema. So that will be ways to make the valves work more effectively in some people where they aren’t possible. And there are multiple other medical devices under varying levels of investigation.

So they’re not available yet, but this is why large teaching hospitals and research hospitals like ours exist. Precisely because at one point valves were experimental. And yet we were doing them as part of the trial. And when they became FDA approved, we were one of the first sites– and we’re the first site in Illinois– to offer this procedure. It should be noted, probably not surprising, Dr. Wagh and I have done more of these procedures than anyone in about a couple hundred miles– maybe it’s about 400 mile radius around Chicago.

So we have the largest experience, the largest ability to care for these patients, and how to better expedite the workup. And then you’re right, if somebody you’re not a candidate for these device or any of the other ones coming down the pipeline, certain patients are candidates for a surgical approach to this. And then obviously, we always have transplant as some level of availability.

They have their own rules and workup, obviously. But and I always tell all my patients, don’t let your doctor assume that you’re a transplant candidate or not, wait till a transplant doctor says you’re not a candidate. Because the rules in transplant are changing as well. And so you may be. At least worth finding out if you have no other options.

Yeah, one of the– and these are actually multiple benefits of an institution like UChicago Medicine, academic Medical Center, Research Hospital, you guys do clinical trials. All of this exciting things that don’t happen necessarily at other institutions. Dr. Wagh?

I would like to add one more thing that the valves are not prohibitive for surgical or transplant evaluation, as well. So you can still undergo valves and still undergo those other evaluations as well.

So one of the other things that I think is pretty unique about the University of Chicago is– look, people get CT scans of their chest for many different reasons. And the scan will get read and evaluated by the doctors and thankfully it doesn’t have a lung nodule, or maybe that’s why they did it. But there’s a whole lot of other wealth of information hidden inside that CAT scan if only we were asking the specific questions.

So you keep hearing in the news about things like artificial intelligence and various things being auto-read and algorithms, et cetera. So we utilize a very unique software made by a company called inBio. And what it does is in the background it’s reading every single CT scan done here to look for the degree of emphysema you have, and flag whether you may be a candidate for these valves.

So the flip side of it is maybe you haven’t even talked to your doctor about being short of breath or having limits. But we’re going to flag and say, you know what? You’re potentially a candidate for this. And look, you may not need them. You may be breathing just fine. But we are going to try to capture more people who would potentially benefit and could breathe better.

I literally saw a gentleman this morning who was not doing great with his breathing but just kind of thought that’s how life was. And he had a CT for another reason. We found it. And now we saw him. And he’s going to get this procedure in two weeks.

Wow, that’s fantastic. So, Ajay, you’ve been leading this project. You can talk more about it.

Yeah, absolutely Dr. Hogarth. I mean I think it’s wonderful to be able to offer a specialized care for patients who may or may not even be aware of the possibility. And we’re actively communicating with other physicians, ensuring that they’re aware of this, and should a patient’s scan get flagged, we’re in conversations with those other physicians to see if potentially those patients may be a candidate.

And that they could potentially have that conversation with their doctor, or even have a visit with us. And we would certainly be happy to have that conversation with the patient as well. So we’ve begun to identify several patients that may be good candidates. And we’re out actually now discussing with those doctors who were the ordering providers.

All right. We’re going to take a quick break. When we come back, we’ll have a couple of other physicians join us to talk about some of the surgical options. Stay with us. We’ll be back in just a moment.

And welcome back. We have two different doctors with us for this portion of the program. Dr. Renea Jablonski and Dr. Lucia Madariaga join us to talk a little bit more about COPD and advanced emphysema. And what all of that can do to a person. And some things that you can do if you have that condition.

And I want to start off and talk a little bit more about COPD and advanced emphysema. We discussed it in the first portion of the program. But the question I have now I guess is, what is the difference between the two and how do they interact?

So I’m Renea Jablonski. I’m one of the pulmonologists. And I work with the lung transplant program here. So COPD is a condition that has– it’s an umbrella term to cover two different diseases. Emphysema, which is a term to describe a process where there’s destruction of the lung tissue. And chronic bronchitis, which is a condition that’s mostly involving more inflammation in the air tubes in the lungs causing a chronic cough. So we’re here today to talk about procedures that can be done for that subset of patients who have that emphysema subset of COPD.

And they’re both pretty significant issues though for patients and very serious, particularly from a quality of life standpoint. But even longevity, would that be accurate?

That’s correct. And we know that the more advanced your lung function decline is with COPD, the likely shorter your life expectancy might be. When we meet patients with COPD, we’ll also often look for other things like evidence that your lungs are putting more stress on your heart or that your lungs are not doing an adequate job, either getting oxygen into your body or CO2 out of your body. As those can also be markers that your risk of death might be higher with this condition.

Dr. Madariaga, I’m sorry, I didn’t give you an opportunity to introduce yourself. I went right over that portion of it, and I apologize for that. So tell us a little bit about what you do here at UChicago Medicine.

Yes, my name is Lucia Madariaga. And I’m a General Thoracic Surgeon and Lung Transplant Surgeon here at UChicago. I take care of many patients with advanced emphysema.

So let’s talk a little bit about lung volume reduction surgery. We talked about valves in the first part of the program, but lung volume reduction surgery is the, I guess, the next step in this treatment. Or next treatment option, I guess you could say. What exactly is that and what does that entail and Dr. Madariaga, I’m sorry, let’s go to you on that one.

Sure. So lung volume reduction surgery, the point of the operation is to remove the unhealthy upper part of the lung, so that the lower part of the lung, which is more normal, can do its work of breathing and helping the patient feel better. And the way we do the surgery here is we do it through a minimally invasive technique, meaning we use three small incisions about 1 inch in size. And we do both sides at the same time. And after the operation, the patient stays in the hospital for a bit and is able to go home.

When you say minimally invasive, is that kind of a robotic type thing or is there another way that you do that?

We have different techniques. So we use thorascopic techniques, which is with the camera. But it can also be done robotically as well.

And when a patient– so describe that to me. When you work on the lungs for the patient, what exactly are you doing? And what is the patient experiencing at that point that needs the– why do they need the LVRS?

Yeah, so in advance emphysema that qualifies for lung volume reduction surgery, most of the destroyed part of the lung is in the upper part of the lung. And so the theory behind this operation is if we remove that part of the lung, the upper part, which is destroyed, then the more normal part of the lung, which is the lower part of the lung, can fill up the space and work better for the patient.

And is this something that a patient has a pretty quick reaction to afterwards?

Yes. So most patients we go through a very rigorous selection process to make sure that the patients we offer this procedure on will actually get some quality of life and breathing benefit. So that after the surgery, they can notice that their breathing feels better. Of course, there’s a recovery period from surgery because we do make an incision. And after the patient works through that, keeps up with exercise, perhaps going to pulmonary rehab, I think most patients feel like they can breathe better and have better quality of life.

Dr. Jablonski, how do patients– when it comes to you, how do they know that they’re at that level that they need the help? I’m assuming they’re referred to you probably by another– maybe their primary care physician or someone else. But how do they know that they’re that far along that they need this level of help?

Some patients ask their physicians or their care providers for a referral. And then you’re right, some patients are also referred to us, often by their primary lung doctor or pulmonologist, less frequently by their primary care doctor. And usually they’re coming to us to ask for more help because they’re so limited by their lungs and their difficulty breathing that they can’t do and enjoy the quality of life that they would like to be enjoying.

When you talk about how limited they are, are these folks that can’t walk up a flight of stairs usually or?

Frequently, yes, yes. Have trouble walking up a flight of stairs, have trouble even doing things like cooking a meal or getting dressed because it’s so difficult for them to breathe.

And I would imagine if you’re to that stage that has to have an impact on your heart, as well, doesn’t it? I mean, isn’t your heart working harder to try to pump blood at that point too?

It can. And we see in some patients with advanced lung disease that it can put more stress on the heart. As part of the evaluation for any of these procedures that we’re talking about today, we do ensure that the patient’s heart is healthy enough to undergo whatever procedure we think might be right for their emphysema.

Is there a point where people think about a lung transplant maybe to take care of this problem? Or is that completely out of the norm?

Yes, sometimes we do think about a lung transplant for patients with advanced emphysema. We know that with either the valve procedure or with the lung volume reduction surgery that there are a subset of patients whose lungs are just too sick to qualify for one of these procedures. Or some patients in whom we do see that extra stress that’s put on the heart by the lung disease, and those are patients with whom we start to have those difficult talks about whether transplant might be the right option for them.

And I know we have a new machine. I’ve seen this and this is totally off topic, but I’m just fascinated by this, for lung transplants that helps keep the lungs active and alive longer. So we actually have increased our transplant I guess halo for lungs, which is pretty good news for patients. That’s pretty exciting. So how does somebody get referred to the program?

So we have a streamlined process now with our advanced emphysema program where patients can, with one referral, come and see all three of our groups to decide which procedure might be best for them. And we have a website link to the University of Chicago website that has information about who to call so that you can get an appointment with us.

Dr. Madariaga, I know you alluded to this a moment ago, but how much better does a patient feel once they have one of these procedures? And how quickly do they feel better? I just I love hearing about this.

Yeah, so in general, I would say that patients feel about 30% to 40% better in terms of their breathing. But I think it’s important to qualify not in terms of numbers but in terms of what they actually want to accomplish after surgery. For example, one of my patients he wanted to garden and cut roses for his wife and take out the trash. And then with his recovery after surgery, he was able to exercise and recover to the point where he is able to do those sort of things. So for each patient we need to decide what makes up your quality of life. And what would you like to do afterwards that we can help you with.

After you have the operation, you basically stay in the hospital for about 5 to 7 days. These patients tend to be on the sicker side. So we just want to be very careful before sending you home that you’re fully recovered from that standpoint. And we do do an operation, so it takes maybe one to two weeks to feel a little bit recovered from your incisions. But we expect you to be able to walk as soon as surgery is over. And walking every single day and getting back to a normal exercise routine really accelerates your recovery.

And I would imagine when people get that quality of life back, I mean that’s just such a huge thing. And you probably hear from a lot of happy patients and happy families. And it’s got to be very rewarding.

Yes, it’s very nice to see the trajectory of patients feeling much better after surgery that they’re able to do the things that they want to do.

That’s great. And we said it in the first segment of the program, and I just can’t hammer this home enough, don’t smoke. If you are a smoker, stop smoking. That’s just that’s so critical. And I would imagine most of the patients you will see are probably former smokers. And it just has to resonate so much with you.

Yes. And we’re here to help you quit smoking if that’s something that you’re interested in doing.

That’s great. All right, we are out of time. We really appreciate the two of you being on the program today. That was great information. Special thanks to all of our guests for being with us today. And a big thank you to those of you who watch the program.

To make an appointment, you can go online to use your uchicagomedicine.org. You can also check out our website and find just all kinds of great information on this program and others. Or give us a call at 888-824-0200. Thanks again for being with us today. And I hope everyone has a great week.

Bullous emphysema in dogs diagnosis and treatment

Bullous disease

Bullous emphysema is an abnormal air cavity in the interstitium of the lung that occurs when air penetrates from the destroyed alveoli into the interlobular connective tissue of the lungs with a tendency to increase the body and the development of respiratory failure .

Other terms exist for this pathology: interstitial emphysema, emphysematous bullae, bullous lung, bulla, bullous disease, etc.

The lungs are a paired respiratory organ in which gas exchange between the inhaled air and blood takes place.

Causes of bullous disease

The cause of bullous emphysema is the rupture of the walls of the alveoli and bronchioles, which can occur with a strong cough, vomiting, a sharp fall, trauma to the chest, prolonged barking, damage to the lung tissue by parasites and foreign bodies.

A rupture is observed in areas of the lung where nutrition is disturbed and dystrophic changes in the lung tissue have occurred. Air enters through defects in the interstitium of the lungs. At the same time, the lung tissue retains its elasticity, a pathological air cavity (bulla) is formed and gradually it increases in size. Part of the air released into the interalveolar tissue moves along the bronchi, then through the trachea enters the subcutaneous tissue of the neck, breast, and trunk.

All these processes lead to an increase in the volume of the lung against the background of a decrease in the breathing area. The indicators of physiological ventilation with perfusion are sharply reduced in the animal, and oxygen starvation develops.

Symptoms and signs of the disease

Clinical signs of the disease are expressed in sudden onset and progressive shortness of breath. There are signs of respiratory failure. The chest increases in size, cyanosis of the mucous membranes is observed, a cough occurs. There may be asymmetry of respiratory movements.

Diagnosis and treatment of bullous emphysema

Diagnosis is established on the basis of anamnesis data, a combination of clinical signs and the results of special studies.

Lateral radiographs show the presence of free air in the chest cavity (Figure 1). In a direct projection, one can determine the mediastinal displacement and the integrity of the opposite lung (photo 2).

Thoracoscopy is a highly informative and proven method for diagnosing bullous disease in dogs.

The main treatment is surgical, an operation is performed. With the development of severe respiratory failure against the background of bulla rupture, it is urgently necessary to conduct active drainage of the chest cavity and perform an operation to remove the affected lung in a short time.

Partial or complete lung lobectomy is performed (photo 3a,b). With diffuse bullous emphysema, mechanical or chemical pleurodesis is performed, but the effectiveness of this method of treatment in animals is discussed.

Predictions

Recurrence of the disease is possible after surgical treatment of a lung bulla in dogs.

Treatment of bullous disease in the veterinary center of Dr. Vorontsov

If your pet has any signs of illness, please contact our veterinary center of Dr. Vorontsov. We are located near the intersection of the Moscow Ring Road and the Kashirskoye Highway, the exact address is Sovkhoz im. Lenina, house 3a (location map), Domodedovskaya, Orekhovo, Zyablikovo, Krasnogvardeyskaya metro stations.

To make an appointment call:

+7(495) 740-48-59
+7(936) 001-03-04.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE ᐉ Symptoms • Treatment • Causes • Signs • Drugs in the Low Price Pharmacy (ANC)

Chronic obstructive pulmonary disease (COPD) is a pathology in which bronchial patency is impaired, structural changes occur in the tissues of the lungs, which leads to disruption of normal ventilation of the lungs. The disease is characterized by such manifestations as cough with sputum, shortness of breath and discoloration of the skin.

COPD is dangerous because it is irreversible and progressive. More often, the disease affects men after forty years of age, can lead to disability and even death.

Causes of chronic obstructive pulmonary disease

Among the causes of chronic obstructive pulmonary disease:

• Smoking. It is the most common cause of the development of the disease (from 90 to 95% of cases),
• Working conditions. If the work is associated with the inhalation of polluted air, then this can lead to COPD. Among the harmful professions that can lead to the development of this pathology, it is necessary to indicate builders, railway workers, workers in pulp and paper mills, etc.
• Lower respiratory infections.
• Genetic predisposition that causes deficiency of alpha1-antitrypsin, which protects the lungs from damage.

Symptoms of chronic obstructive pulmonary disease

Under the influence of adverse factors, the inner lining of the bronchi becomes inflamed, more bronchial mucus begins to be produced. The patency of the bronchi decreases, deformation of the bronchial walls or emphysematous changes in the lung tissue occur. This leads to a decrease in oxygen levels and an increase in carbon dioxide levels in the blood.

The first stages of COPD are almost asymptomatic. The first symptom of the disease is a cough. At first it may occur intermittently, but gradually becomes a daily occurrence. Breathing becomes hard, wheezing is heard.

Also rather early symptoms are mucous sputum, which usually appears in the morning, shortness of breath (first during physical exertion, and then at rest). If an infection joins, then the sputum becomes purulent and is excreted more abundantly. There may be cyanosis of the skin.

With the active development of the disease, a number of complications may occur: respiratory failure, pneumonia, heart failure, cor pulmonale. COPD can significantly impair quality of life and even lead to death.

Diagnosis of chronic obstructive pulmonary disease

Diagnosis and treatment of COPD is performed by a pulmonologist. If this pathology is suspected, a series of examinations is prescribed. Usually, spirometry is prescribed to diagnose chronic obstructive pulmonary disease. This study shows how the lungs function.

A cytological examination of sputum is done, it can be used to determine the degree of inflammation of the bronchi.