What is emphysema. How does emphysema affect the lungs. What are the main symptoms of emphysema. Who is at risk for developing emphysema. How is emphysema diagnosed. What are the treatment options for emphysema. Can emphysema be prevented.

What is Emphysema: A Comprehensive Overview

Emphysema is a chronic lung condition characterized by damage to the air sacs (alveoli) in the lungs. This damage causes the alveoli to lose their elasticity and trap air, making it difficult for the lungs to function properly. Emphysema is one of the main types of chronic obstructive pulmonary disease (COPD), along with chronic bronchitis.

The word “emphysema” comes from the Greek words “em,” meaning “in,” and “physan,” meaning “to blow.” This etymology reflects the condition’s primary characteristic: air becoming trapped within the lung tissue.

Key Features of Emphysema

• Progressive damage to lung tissue
• Reduced lung elasticity
• Difficulty exhaling completely
• Gradual decline in lung function

The Pathophysiology of Emphysema: How It Affects the Lungs

To understand emphysema, it’s crucial to grasp how it impacts the lungs at a cellular level. In healthy lungs, the alveoli are elastic and efficiently exchange oxygen and carbon dioxide. However, in emphysema, several changes occur:

1. Alveolar wall destruction: The walls between air sacs break down, creating larger, less efficient spaces.
2. Loss of elasticity: The remaining lung tissue becomes less elastic, making it harder to exhale completely.
3. Air trapping: Due to the loss of elasticity, air becomes trapped in the lungs, leading to hyperinflation.
4. Reduced gas exchange: The damaged alveoli are less effective at exchanging oxygen and carbon dioxide.

These changes result in the characteristic symptoms of emphysema and contribute to the progressive nature of the disease.

Recognizing the Symptoms: Early Signs and Progressive Manifestations

Emphysema typically develops slowly over many years, and symptoms may not be noticeable in the early stages. As the condition progresses, the following symptoms become more apparent:

• Shortness of breath, especially during physical activities
• Chronic cough, often with mucus production
• Wheezing or whistling sound when breathing
• Chest tightness or feeling of not getting enough air
• Frequent respiratory infections
• Fatigue and weakness
• Unintended weight loss (in advanced stages)
• Bluish tint to lips or fingernails (cyanosis) due to low oxygen levels

It’s important to note that symptoms may vary from person to person and can worsen over time if left untreated.

Risk Factors and Causes: Understanding Who’s at Risk

While anyone can develop emphysema, certain factors increase the risk. Understanding these risk factors is crucial for prevention and early intervention.

Primary Risk Factors

• Smoking: The leading cause of emphysema, responsible for about 80-90% of cases.
• Secondhand smoke exposure: Regular exposure to environmental tobacco smoke.
• Occupational exposure: Inhalation of chemical fumes, dust, and other irritants in the workplace.
• Air pollution: Long-term exposure to outdoor and indoor air pollutants.
• Age: Most people who develop emphysema are 40 years or older.
• Genetics: Alpha-1 antitrypsin deficiency, a rare genetic condition, can increase risk.

Understanding these risk factors can help individuals take proactive steps to reduce their chances of developing emphysema or slow its progression if already diagnosed.

Diagnosis and Assessment: Tools and Techniques for Identifying Emphysema

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

Diagnostic Tools and Procedures

1. Physical examination: Listening to lung sounds and assessing overall health.
2. Pulmonary function tests (PFTs): Measuring lung capacity and airflow.
3. Spirometry: A specific type of PFT that measures how much and how quickly air can be exhaled.
4. Chest X-ray: Identifying signs of emphysema and ruling out other conditions.
5. CT scan: Providing detailed images of lung tissue and identifying areas of damage.
6. Arterial blood gas analysis: Measuring oxygen and carbon dioxide levels in the blood.
7. Alpha-1 antitrypsin deficiency testing: Checking for the genetic condition that can cause emphysema.

These diagnostic tools help healthcare providers determine the presence and severity of emphysema, guiding treatment decisions and monitoring disease progression.

Treatment Approaches: Managing Emphysema and Improving Quality of Life

While emphysema is a progressive condition with no cure, various treatment options can help manage symptoms, slow disease progression, and improve quality of life.

Comprehensive Treatment Strategies

• Smoking cessation: The most important step in slowing disease progression.
• Bronchodilators: Medications that relax and open airways, improving breathing.
• Inhaled corticosteroids: Reducing airway inflammation and preventing exacerbations.
• Oxygen therapy: Supplemental oxygen to improve oxygen levels in the blood.
• Pulmonary rehabilitation: Exercise and education programs to improve lung function and overall health.
• Vaccinations: Preventing respiratory infections that can worsen emphysema.
• Nutrition counseling: Maintaining a healthy diet to support overall health and lung function.
• Surgery: In severe cases, procedures like lung volume reduction surgery or lung transplantation may be considered.

The choice of treatment depends on the severity of the condition, individual patient factors, and response to previous treatments. A multidisciplinary approach involving pulmonologists, respiratory therapists, and other specialists often provides the best outcomes.

Living with Emphysema: Strategies for Daily Management and Coping

Emphysema requires ongoing management to maintain the best possible quality of life. Individuals with emphysema can adopt several strategies to cope with their condition and minimize its impact on daily activities:

Practical Tips for Daily Living

1. Develop an action plan: Work with healthcare providers to create a plan for managing symptoms and exacerbations.
2. Practice breathing techniques: Learn pursed-lip breathing and diaphragmatic breathing to improve air exchange.
3. Conserve energy: Use energy-saving techniques for daily tasks to reduce breathlessness.
4. Maintain a healthy environment: Minimize exposure to irritants and pollutants at home and work.
5. Stay active: Engage in regular, moderate exercise as recommended by healthcare providers.
6. Join support groups: Connect with others who have emphysema for emotional support and practical advice.
7. Manage stress: Practice relaxation techniques and seek mental health support if needed.
8. Adhere to treatment plans: Take medications as prescribed and attend all follow-up appointments.

By incorporating these strategies into daily life, individuals with emphysema can better manage their symptoms and maintain a higher quality of life.

Prevention and Risk Reduction: Proactive Steps to Protect Lung Health

While not all cases of emphysema can be prevented, there are several steps individuals can take to reduce their risk or slow the progression of the disease:

Key Prevention Strategies

• Quit smoking: If you smoke, seek support to quit. It’s never too late to benefit from smoking cessation.
• Avoid secondhand smoke: Minimize exposure to environmental tobacco smoke.
• Protect yourself at work: Use appropriate protective equipment if exposed to workplace pollutants.
• Reduce air pollution exposure: Be aware of air quality and take precautions on high-pollution days.
• Get vaccinated: Stay up to date on flu and pneumonia vaccinations to prevent respiratory infections.
• Exercise regularly: Engage in aerobic activities to maintain lung function and overall health.
• Maintain a healthy diet: Eat a balanced diet rich in antioxidants to support lung health.
• Stay hydrated: Drink plenty of water to help keep airways clear of mucus.

By implementing these preventive measures, individuals can significantly reduce their risk of developing emphysema or slow its progression if already diagnosed.

Research and Future Directions: Advancements in Emphysema Treatment

The field of emphysema research is dynamic, with ongoing studies exploring new treatment options and potential ways to reverse lung damage. Some promising areas of research include:

Cutting-Edge Research Areas

1. Stem cell therapy: Investigating the potential of stem cells to regenerate damaged lung tissue.
2. Gene therapy: Exploring ways to correct genetic defects that contribute to emphysema.
3. Targeted drug delivery: Developing new methods to deliver medications directly to affected lung areas.
4. Bioengineered lung tissue: Creating artificial lung tissue for transplantation or repair.
5. Lung microbiome research: Studying the role of lung bacteria in emphysema development and progression.
6. Personalized medicine: Tailoring treatments based on individual genetic and molecular profiles.
7. Novel anti-inflammatory agents: Investigating new compounds to reduce lung inflammation.
8. Lung volume reduction techniques: Refining minimally invasive procedures to improve lung function.

These research directions offer hope for improved treatments and potentially even reversal of lung damage in the future. As studies progress, individuals with emphysema may have access to more effective and personalized treatment options.

In conclusion, emphysema is a complex and challenging lung condition that requires comprehensive management and ongoing care. By understanding the disease, recognizing symptoms early, adhering to treatment plans, and adopting preventive measures, individuals can better cope with emphysema and maintain a good quality of life. As research continues to advance, there is hope for more effective treatments and improved outcomes for those affected by this chronic lung disease.

Emphysema Definition & Meaning – Merriam-Webster

em·​phy·​se·​ma

ˌem(p)-fə-ˈzē-mə -ˈsē- 

: a condition characterized by air-filled expansions of body tissues

specifically

: a condition of the lung marked by abnormal enlargement of the alveoli with loss of pulmonary elasticity that is characterized especially by shortness of breath and may lead to impairment of heart action

emphysematous

ˌem(p)-fə-ˈze-mə-təs 

-ˈse-

-ˈzē-

-ˈsē-

adjective

emphysemic

ˌem(p)-fə-ˈzē-mik 

-ˈsē-

adjective

Example Sentences

Recent Examples on the Web

With growing distress, Sylvester had watched her mother, who had emphysema and peripheral artery disease, become increasingly frail and isolated.

—Judith Graham, CNN, 17 May 2023

Prolonged exposure to these carcinogens causes chronic bronchitis, emphysema and cancer in many parts of the body, but especially around airways just inside the entrance to the lungs.

—Arthur Dalley, Discover Magazine, 8 Mar. 2019

To figure out how to diagnose internal cancers that are frequently overlooked until too late from just a breath sample, scientists have been working with dogs to see if these smells can be reliably differentiated from, say, the smell of breakfast, that last cigarette, or emphysema.

—Veronique Greenwood, Discover Magazine, 22 Aug. 2011

Councilmember Dan O’Donnell, who said his 77-year-old father had just been diagnosed with Stage 1 emphysema after 65 years of smoking, questioned if the council could limit the number of tobacco shops allowed in the city.

—San Diego Union-Tribune, 3 Mar. 2023

Subcutaneous emphysema can occur in a variety of settings, including to trauma victims with chest injuries or among deep-sea divers who surface too fast.

—Douglas G. Adler, Discover Magazine, 14 Dec. 2021

But the hospital has been struggling to cope with the massive numbers of people seeking help for ailments, including asthma, upper respiratory infections, conjunctivitis and emphysema, a serious lung condition that causes shortness of breath.

—Kocha Olarn, CNN, 5 Apr. 2023

At that time doctors diagnosed my father, a heavy smoker, with emphysema.

—WIRED, 28 Mar. 2023

Albuterol is used to treat respiratory illnesses including asthma, bronchitis, RSV, emphysema, and chronic obstructive pulmonary disease (COPD), as well as symptoms of those with influenza and COVID-19.

—Mike Snider, USA TODAY, 9 Mar. 2023

See More

These examples are programmatically compiled from various online sources to illustrate current usage of the word ’emphysema.’ Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. Send us feedback about these examples.

Word History

Etymology

New Latin, from Greek emphysēma, from emphysan to inflate, from em- en- entry 2 + physan to blow, from physa breath — more at pustule

First Known Use

circa 1587, in the meaning defined above

Time Traveler

The first known use of emphysema was
circa 1587

See more words from the same year

Dictionary Entries Near

emphysema

emphatic state

emphysema

emphysematous anthrax

See More Nearby Entries 

Cite this Entry

Style

MLAChicagoAPAMerriam-Webster

“Emphysema. ” Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/emphysema. Accessed 21 Jun. 2023.

Copy Citation

Kids Definition

emphysema

noun

em·​phy·​se·​ma

ˌem(p)-fə-ˈzē-mə -ˈsē- 

: a condition marked by abnormal enlargement of the air spaces of the lungs, shortness of breath, and often by faulty heart action

Medical Definition

emphysema

noun

em·​phy·​se·​ma

ˌem(p)-fə-ˈzē-mə -ˈsē- 

: a condition characterized by air-filled expansions in interstitial or subcutaneous tissues

specifically

: a condition of the lung that is marked by distension and eventual rupture of the alveoli with progressive loss of pulmonary elasticity, that is accompanied by shortness of breath with or without cough, and that may lead to impairment of heart action

emphysematous

-ˈzem-ət-əs -ˈsem- -ˈzēm- -ˈsēm- 

adjective

emphysemic

-ˈzē-mik -ˈsē- 

adjective

More from Merriam-Webster on

emphysema

Britannica. com: Encyclopedia article about emphysema

Last Updated:
11 Jun 2023
– Updated example sentences

Subscribe to America’s largest dictionary and get thousands more definitions and advanced search—ad free!

Merriam-Webster unabridged

Emphysema Definition & Meaning | Dictionary.com

• Games
• Featured
• Pop culture
• Writing tips

Top DefinitionsExamplesBritishScientificCultural

[ em-fuh-see-muh, -zee- ]

See synonyms for: emphysematous on Thesaurus.com

nounPathology.

1. a chronic, irreversible disease of the lungs characterized by abnormal enlargement of air spaces in the lungs accompanied by destruction of the tissue lining the walls of the air spaces.

2. any abnormal distention of an organ, or part of the body, with air or other gas.

Origin of emphysema

¹

1655–65; <New Latin <Greek emphȳ́sēma inflation, equivalent to em-em-² + phȳsē- (variant stem of phȳsân to blow) + -ma noun suffix denoting result of action

Other words from emphysema

• em·phy·sem·a·tous [em-fuh-sem-uh-tuhs, -see-muh-, -zem-uh-, -zee-muh-], /ˌɛm fəˈsɛm ə təs, -ˈsi mə-, -ˈzɛm ə-, -ˈzi mə-/, adjective
• em·phy·se·mic, adjective

Words Nearby emphysema

• emphasis
• emphasize
• emphasized
• emphatic
• emphatically
• emphysema
• em pica
• empire
• empire builder
• empire building
• Empire Day

Dictionary.com Unabridged
Based on the Random House Unabridged Dictionary, © Random House, Inc. 2023

How to use emphysema in a sentence

• While pot smoke does contain cancer-causing chemicals, recent research has found that cannabis use is not associated with a higher risk of lung cancer or emphysema.

  More And More Americans Are Smoking Pot. What Does That Mean For Their Health? | Lester Black | November 30, 2021 | FiveThirtyEight

• And in her final years, when she was blinded by macular degeneration and suffocating with emphysema, vanity left her isolated.

  Understanding Diana Vreeland, ‘Empress of Fashion’ | Robin Givhan | November 28, 2012 | THE DAILY BEAST

• Suffering from severe emphysema, she clung to life through a ventilator, as Singer coordinated her care.

  The New Science of Reverse Aging | Danielle Friedman | November 7, 2010 | THE DAILY BEAST

• There may be some emphysema, but not enough to account for the respiratory difficulty.

  Psychotherapy | James J. Walsh

• Surgical emphysema signifies the effusion of air into the general connective tissues of the body.

  Encyclopaedia Britannica, 11th Edition, Volume 9, Slice 3 | Various

• Whooping-cough is well known as the exciting cause of emphysema in many persons.

  Encyclopaedia Britannica, 11th Edition, Volume 9, Slice 3 | Various

• Of pulmonary emphysema there are two forms, true vesicular and interstitial (or interlobular).

  Encyclopaedia Britannica, 11th Edition, Volume 9, Slice 3 | Various

• Madeira and the Canaries are useful when emphysema is present or where there is much irritability of constitution.

  Encyclopaedia Britannica, 11th Edition, Volume 6, Slice 5 | Various

British Dictionary definitions for emphysema

emphysema

/ (ˌɛmfɪˈsiːmə) /

nounpathol

1. Also called: pulmonary emphysema a condition in which the air sacs of the lungs are grossly enlarged, causing breathlessness and wheezing

2. the abnormal presence of air in a tissue or part

Origin of emphysema

¹

C17: from New Latin, from Greek emphusēma, a swelling up, from emphusan to inflate, from phusan to blow

Derived forms of emphysema

• emphysematous (ˌɛmfɪˈsɛmətəs, -ˈsiː-), adjective

Collins English Dictionary – Complete & Unabridged 2012 Digital Edition
© William Collins Sons & Co. Ltd. 1979, 1986 © HarperCollins
Publishers 1998, 2000, 2003, 2005, 2006, 2007, 2009, 2012

Scientific definitions for emphysema

emphysema

[ ĕm′fĭ-sē′mə ]

1. A chronic lung disease characterized by progressive, irreversible expansion of the alveoli with eventual destruction of alveolar tissue, causing obstruction to airflow. Patients with emphysema often have labored breathing, wheezing, chronic fatigue, and increased susceptibility to infection, and may require oxygen therapy. Long-term smoking is a common cause of emphysema.

The American Heritage® Science Dictionary
Copyright © 2011. Published by Houghton Mifflin Harcourt Publishing Company. All rights reserved.

Cultural definitions for emphysema

emphysema

[ (em-fuh-see-muh, em-fuh-zee-muh) ]

A chronic disease in which the tiny air sacs in the lungs become stretched and enlarged, so that they are less able to supply oxygen to the blood. Emphysema causes shortness of breath and painful coughing and can increase the likelihood of developing heart disease. Emphysema occurs most frequently in older men who have been heavy smokers.

The New Dictionary of Cultural Literacy, Third Edition
Copyright © 2005 by Houghton Mifflin Harcourt Publishing Company. Published by Houghton Mifflin Harcourt Publishing Company. All rights reserved.

Chronic obstructive pulmonary disease

“Each person must save his own body and soul. Those who hope that others will save them will be disappointed” Paracelsus

Prevalence of chronic obstructive pulmonary disease

Colak Y, et al. Am J Respir Crit Care Med. 2020;6:671–80.

DEFINITION

Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung disease characterized by chronic respiratory symptoms (shortness of breath, cough, sputum production, exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive obstruction to airflow (GOLD 2023).

Causes of death in patients with COPD

McGarvey L, et al. Thorax. 2007;62:411–5.

COPD RISK FACTORS

• Tobacco smoking.

• Inhalation of toxic particles and gases.

• Recurrent lung infections.

• Anomalies of the lungs.

• Genetic anomalies: SERPINA1 gene mutation leading to alpha ₁ -antitrypsin deficiency.

PATHOGENESIS

Global Initiative for Chronic Obstructive Lung Disease (GOLD).

COPD CLINIC

Respiratory

• Shortness of breath: persistent, progressive.

• Wheezing.

• Chronic cough ± sputum.

• Chronic bronchitis: cough and sputum ≥3 months per year for ≥2 years in a row, with no other conditions explaining the symptoms (27–35% of COPD).

• Recurrent infections of the lower respiratory tract.

Non-respiratory
• Slimming.

• Muscle wasting.

• Erythrocytosis: Hb ≥170 g/l (m), ≥150 g/l (w) (6–10% COPD).

• Normochromic anemia.

• Sleep disorders.

• Depression, anxiety.

COPD exacerbation predictors

Bellou V, et al. BMJ. 2019;367:l5358.

COPD DIAGNOSIS

• GOLD ABE, ADO scales.

• Spirometry: FEV ₁ /FVC <70% after bronchodilator (less accurate but simpler than lower limit), FEV ₁ <80%.
• Pulse oximetry: hypoxemia SaO ₂ <92%, severe <80%.
• C-reactive protein: indications for antibiotics (PACE).

• 6-minute walk test, STS test (sit-stop).

• Chest x-ray: exclusion of other diseases, emphysema, cor pulmonale.

• Computed tomography: exclusion of other diseases, emphysema, lung cancer screening (yearly in smokers).

• Echocardiography: cor pulmonale.

• α ₁ -antitrypsin: COPD <50 years, predominantly basal emphysema, family history of emphysema at <50 years of age.
• Screening for COPD in asymptomatic patients does not improve quality of life, morbidity or mortality (USPSTF) .

Respiratory contribution to resistance

CLASSIFICATION OF SEVERITY OF BRONCHIAL OBSTRUCTION

In patients with FEV ₁ /FVC <70% 15 minutes after 400 mcg salbutamol:
GOLD 1 (light) : FEV ₁ ≥80%.

GOLD 2 (moderate) : FEV ₁ 50-79%.

GOLD 3 (severe) : FEV ₁ 30-49%.

GOLD 4 (very severe) : FEV ₁ <30%.

FEV ₁ and age

ERS/ATS technical standard. Eur Respir J. 2022;60:2101499.

RISK CLASSIFICATION GOLD ABE

Group A: rare exacerbations (≤1 per year without hospitalization), mild symptoms (CAT <10, mMRC <2).
Group B: rare exacerbations, severe symptoms (CAT ≥10, mMRC ≥2).

Group E: frequent exacerbations (≥2 or ≥1 hospital admissions per year).

Chronic bronchial obstruction in COPD patients

Ramirez-Venegas A, RH et al. Am J Resp Crit Care Med. 2014;190:996–1002.

COPD COMPLICATIONS

• Emphysema of the lungs.

• Bronchiectasis.

• Respiratory failure.

• Pulmonary heart.

• Pulmonary embolism.

• Cardiac arrhythmias: polymorphic atrial tachycardia, atrial fibrillation.

COPD and comorbidity

GERD – gastroesophageal reflux disease. Barr R, et al. Am J Med 2009;122:348–55.

FORMULATION OF THE DIAGNOSIS

□ COPD, severe exacerbation. [J44.1]

□ COPD (smoking, stove smoke), GOLD E. Respiratory failure (SpO ₂ 54%). Chronic cor pulmonale, decompensation, persistent atrial fibrillation. [J44.1]

□ COPD (cement dust), GOLD B. Chronic cor pulmonale, CHF II FC. [J44.8]

□ Asthma-COPD syndrome, exacerbation. Tobacco abuse (8 pack-years). [J44.8]

Chest x-ray for emphysema

CLASSIFICATION OF SEVERITY OF COPD EXACTIONS (GOLD 2023)

Light

• Shortness of breath (visual analog scale <5).

• Respiratory rate <24/min.
• Heart rate <95 minutes.
• SaO ₂ ≥92% and change ≤3%.

• Treatment: short-acting bronchodilators.

Moderate

• Shortness of breath (visual analog scale ≥5).

• Respiratory rate ≥24/min.

• Heart rate ≥95/min.

• SaO ₂ <92% and/or >3% change.

• Hypoxemia (PaO ₂ ≤60 mmHg) and/or hypercapnia (PaCO ₂ >45 mmHg) without acidosis.

• Treatment: short-acting bronchodilators + antibiotics and/or corticosteroids.

Heavy

• Shortness of breath, respiratory rate, heart rate, SaO ₂ similar to moderate.

• Hypercapnia (PaCO ₂ >45 mmHg) and acidosis (pH <7.35).
• Treatment: hospitalization.

Computed tomography for bullous emphysema

COPD AGAINST TREATMENT (GOLD 2023)

• Oxygen, non-invasive ventilation.

• Short-acting bronchodilators (beta ₂ -agonist, anticholinergic): inhaler/nebulizer, dose escalation, frequency, combination.

• Corticosteroids: prednisolone 30–40 mg, methylprednisolone for 5–7 days.

• Antibiotics (purulent, copious sputum, mechanical ventilation): amoxicillin + clavulanate, macrolides for 5-7 days.

• Water balance monitoring.

• Prevention of venous thromboembolism: unfractionated low molecular weight heparin subcutaneously.

Beta-blockers in COPD patients without coronary disease

Rutten F, et al. Arch Intern Med. 2010;170:880–7.

INITIAL THERAPY (GOLD ABE)

Group A: anticholinergic or beta ₂ agonist.

Group B: long acting anticholinergic + long acting beta ₂ agonist.

Group E: long-acting anticholinergic + long-acting beta ₂ agonist ± corticosteroid (eosinophilia ≥300/µl). Roflumilast (FEV ₁ <50%), macrolide (smoker).

Cholinolytics and cardiovascular risk

ASCENT COPD. JAMA. 2019;321:1693–701.

COPD MAINTENANCE TREATMENT (GOLD 2023)

• Smoking cessation: psychotherapy, nicotine relievers (nasal spray, oral inhaler, chewing gum, lozenge), controllers (nicotine patch, bupropion, varenicline).

• Long-acting bronchodilators: anticholinergics (preferred), beta ₂ -agonists, theophylline (slight bronchodilation, improvement of symptoms, teopek 200-350 mg 1-2 times after meals).

• Inhaled corticosteroids (not monotherapy): Reduce exacerbations in FEV ₁ <50%, no effect on progression or mortality.
• Roflumilast (500 mcg once): an anti-inflammatory drug reduces the frequency of exacerbations with combination therapy.

• Mucolytics: may reduce the frequency of exacerbations in some patients.

• Macrolides: azithromycin 250 mg/day or 500 mg 3 times a week.

• Long-term low-flow oxygen therapy >15 h/day.

• Alpha ₁ -antitrypsin in deficiency.

• Rehabilitation (at FEV ₁ <50%): cough control, respiratory muscle training, exercise, psychotherapy, antidepressants, rollators.
• Influenza vaccination.

• Pneumococcal vaccination: PPSV23 for patients ≥65 years of age or PCV13 for FEV ₁ <40% and severe comorbidity in patients <65 years of age.

• Regular exercise.

Triple or dual inhalation therapy for COPD

IMPACT. N Engl J Med. 2018;18:1671–80.

INHALATION THERAPY

Long-acting beta ₂ -agonist + anticholinergic

• Vilanterol + umeclidinium [anoro, DPI] 25/55 mcg once.

• Indacaterol/glycopyrronium [ultibro, DPI] 110/50 mcg once.

• Olodaterol/tiotropium [spiolto, MDI] 5/5 mcg once.

• Formoterol/aclidinium [dualclear, DPI] 12/400 mcg twice.

• Formoterol/glycopyrronium [bevespi, MDI] 5/7 mcg twice.

Corticosteroid + beta ₂ -agonist + anticholinergic

• Beclomethasone + formoterol + glycopyrronium [trimbow, MDI] 200/12/20 mcg twice.

• Budesonide + formoterol + glycopyrronium [breztri, MDI] 160/5/7 mcg twice.

• Mometasone + indacaterol + glycopyrronium [enerzeir, DPI] 80–160/150/50 mcg once.

• Fluticasone furoate + vilanterol + umeclidinium [Treledge, DPI] 92-184/22/55 mcg once.

Inhaled corticosteroids and blood eosinophilia

Suissa S, Ernst P. Chest. 2017;152:227–31.

INHALATED CORTICOSTEROIDS

Readings

• Hospitalizations with exacerbations of COPD.

• ≥2 moderate exacerbations per year.

• >300 eosinophils per µl of blood.

• Concomitant asthma.

Contraindications

• Repeated pneumonia.

• <100 eosinophils per µl of blood.
• History of mycobacterial infection

Continuous oxygen therapy devices

Oxygen concentrators, compressed and liquid oxygen cylinders.

LONG-TERM OXYGEN THERAPY (GOLD, TSANZ, BTS)

Readings

• PaO ₂ ≤55 mmHg Art. or SaO ₂ ≤88% twice in 3 weeks

• PaO ₂ 55-60 mmHg Art. or SaO ₂ ~88% in the presence of pulmonary hypertension, peripheral edema, or erythrocytosis (Ht >55%).

Method

• Duration: night, >15 h/day.

• Speed: 2-5 l/min.

• Target: SpO ₂ ≥90 (92-98%, at risk of hypercapnia 88-92%).

• Check every 60-90 days

Oxygen Therapy Effectiveness (LOTT)

SpO ₂ 89–93%. New Engl J Med. 2016;375:1617–27.

INTERVENTIONAL TREATMENT

• Bronchoscopy therapy: [Zephyr] valves, nitinol coils, thermal ablation.

• Bullectomy, resection of 20-35% of the lungs.

• Lung transplantation.

Zephyr Endobronchial Valves for Heterogeneous Emphysema (TRANSFORM)

Kemp S, et al. AJRCCM. 2017;196:1535-43.

05/21/2023. © Belyalov F.I., 2004–2023.

Diagnosis in Traumatology – PROSMP

Go back

Severe CTBI. Coma. Subcutaneous hematoma of the forehead.

At the ambulance stage, TBI is classified according to severity only (which is determined by
based on the Glasgow coma scale). The terms “concussion / bruise of the brain” should not be used.

mild CTBI. Multiple superficial head injuries.

If there are many superficial wounds on the head, the term “multiple” is used.

Combined injury. ZChMT average degree. Closed fracture of the left femur in the lower third.

Combined injury – damage to two or more anatomical and functional systems (fractures + craniocerebral
trauma, fractures + liver damage). There are 7 such areas: head, neck, chest, abdomen, pelvis,
spine, upper and lower limbs.

By analogy, the diagnosis “Polytrauma” is written. Polytrauma is a severe or extremely severe combined or
multiple trauma (2 or more injuries in one system), accompanied by the development of acute disorders
vital functions.

The terms “Concomitant injury” and “Polytrauma” are always placed first in the diagnosis.

TBI of moderate severity. Fracture of the base of the skull.

Determination of severity based on the Glasgow Coma Scale. Signs of TBI:

– damage to the skin and aponeurosis

– fractures of the bones of the cranial vault (frontal, parietal)

– fractures of the bones of the base of the skull (occipital, temporal, sphenoid, ethmoid)

– symptom of glasses (“raccoon eyes”)

9 0003- anosmia (loss of smell) and hyposmia (impairment of smell)

– leakage of CSF/blood from the nose or ears

– hypacusia (decrease in hearing acuity)

– paraorbital emphysema

AF severe MT. Intracranial hemorrhage?

Intracranial hemorrhage questionable can be diagnosed if there is rapid deterioration
conditions (depression of consciousness, the appearance of convulsions), persistent arterial hypertension, hyperthermia, “floating”
eyeballs and other symptoms.

Three bruised wounds of the parietotemporal part of the head on the right.

Such a diagnosis is enough to take him to the emergency room. No need to invent TBI where it does not exist.

Thermal burn with hot liquid of the anterior surface of the right thigh II degree 1% of the body surface.

The diagnosis indicates what caused the burn – a flame, a hot liquid, steam, an object (for example, an iron),
degree of burn, and area. Both in adults and in children over 15 years of age, the rule of the palm is widely used when
the surface of the burnt palm is taken as 1% of the total body area. This method is used for local
scattered, mosaic lesions or in addition to the rule of nines. In children under 15 years of age – the area of ​​burns
determined by the Landa table and
Browder.

Burn shock develops with a thermal burn that affects more than 15% of the body surface, and in persons over 60 years of age
– with less extensive lesions (S-10% or less).

Thermal burn of the back II-III stage. S-10%. Smoke toxic inhalation.

Burn shock.

The term “Toxic smoke inhalation” may be used instead of “Combustion products poisoning”. At
combined with
inhalation burn (inhalation lesion of the DP), the term “Thermoinhalation injury” is used or
“Thermoinhalation defeat”.

Closed injury of the chest: contusion of the ribs and soft tissues. Heart injury.

Often occurs in an accident – when hitting the steering wheel, when hitting passengers if they are not wearing seat belts, when
collision at high speed. Also, do not forget about terms such as “Lung injury” and “Bruise
heart”. When the lungs are bruised, there are pains at the site of injury, shortness of breath, cough, hemoptysis. Heart contusion
manifested by tachycardia, low blood pressure, deafness of tones during auscultation, rhythm disturbance.

Stab-cut wound of the anterior surface of the chest on the right. Open pneumothorax.

Remember that in addition to the front surface of the chest, there is also the back. With open pneumothorax
the condition will be severe, the affected lung will turn off from the act of breathing. See Help
with chest trauma.

Penetrating injury to the heart

Probable signs of injury to the heart can be: bleeding chest wound in the region of the heart; heavy
condition with small wounds of the chest wall; dyspnea; decrease in blood pressure; acceleration and weak filling
pulse; pallor of the skin; anxiety or semi-conscious state; muffled unheard tones
hearts.

Two stab wounds to the abdomen. Traumatic shock 2 degrees.

In most cases, due to irritation of the peritoneum, the patient will experience severe pain in the abdomen, so
developing shock is classified as traumatic, not hypovolemic. With traumatic shock of the 2nd degree, the patient
will be lethargic, the skin will be pale, blood pressure is reduced, tachycardia up to 140 beats, breathing will be quickened.

Closed abdominal injury with damage to internal organs

History of trauma, clinical picture of acute abdomen (symptoms of peritoneal irritation) + clinical picture of internal bleeding
(symptom of Vanka-vstanka)

Traumatic eventration. Traumatic shock 3 degrees.

It is possible not to indicate “open abdominal injury” in the diagnosis. The very term eventration already suggests that you see
bowel loops with my own eyes, and the word “traumatic” indicates that it happened as a result of
injury. In traumatic shock of the 3rd degree, the patient will be inhibited, the pulse will be thready, the skin will be pale, with
earthy tone, blood pressure near zero. See Help for Abdominal Injuries.

Two incised wounds in the lower third of the left forearm.

If there are several wounds in the same area, you can indicate their number in the diagnosis. If this number is large or
there is difficulty in counting the exact number, use the word “plural”.

Open fracture of the bones of the left leg in the lower third.

Open means that the skin is damaged and the deformed bone is visible. If a fracture is visible, then
indicate – “fracture” (and not “damage”).

Fracture of the distal part of the right radius

Synonym – “fracture of the radius in a typical place”. Remember that not only the beam can break.

Dislocation of the shoulder joint.

If the patient is clearly dislocated, write “dislocation” (not “injury”). Even if there is a fracture-dislocation, it is not
there will be a discrepancy in diagnoses, tk. assistance is provided in exactly the same way (anesthesia and immobilization).

Gunshot wound of the right forearm. Blind shot wound to the abdomen

Bullets damage not only soft tissues, but also bones, nerves and blood vessels. The peculiarity of a shot wound is that
that there are a lot of pellets, the hollow and parechymatous organs of the abdominal cavity are damaged and an extensive
bleeding.