What are the key symptoms of emphysema. How is emphysema diagnosed. What are the main causes and risk factors for developing emphysema. What treatment options are available for managing emphysema symptoms. How can lifestyle changes help slow the progression of emphysema. What are the potential complications of untreated emphysema. How does emphysema differ from other lung diseases.

What is Emphysema and How Does it Affect the Lungs?

Emphysema is a progressive lung disease that falls under the umbrella of chronic obstructive pulmonary disease (COPD). It is characterized by damage to the air sacs (alveoli) in the lungs, which causes them to lose their elasticity and trap air. This leads to difficulty breathing and other respiratory symptoms.

In emphysema, the walls between the air sacs break down, creating larger air spaces instead of many small ones. This reduces the surface area available for gas exchange, making it harder for oxygen to enter the bloodstream and carbon dioxide to be expelled. As the disease progresses, it becomes increasingly difficult to breathe, especially during physical activity.

How does emphysema differ from other lung diseases?

While emphysema shares some similarities with other respiratory conditions, it has distinct characteristics:

• Emphysema primarily affects the alveoli, whereas chronic bronchitis mainly impacts the bronchial tubes.
• Unlike asthma, which causes reversible airway constriction, emphysema leads to permanent lung damage.
• Emphysema is a progressive disease, meaning it worsens over time, unlike some acute respiratory infections.

Recognizing the Symptoms of Emphysema

Emphysema often develops slowly, with symptoms gradually worsening over time. Early detection is crucial for effective management and slowing disease progression. Common symptoms include:

• Shortness of breath, especially during physical activity
• Persistent cough, often with mucus production
• Wheezing or whistling sound when breathing
• Chest tightness
• Frequent respiratory infections
• Fatigue and weakness
• Unintended weight loss in later stages

As the disease progresses, symptoms may become more severe and impact daily activities. Some individuals may develop a barrel-shaped chest due to lung hyperinflation.

When should you seek medical attention for emphysema symptoms?

It’s important to consult a healthcare provider if you experience:

• Persistent shortness of breath that worsens over time
• Inability to perform daily activities due to breathing difficulties
• Lips or fingernails turning blue or gray (cyanosis)
• Rapid heartbeat
• Confusion or disorientation

Understanding the Causes and Risk Factors of Emphysema

Emphysema develops due to long-term exposure to irritants that damage lung tissue. While smoking is the primary cause, other factors can contribute to its development:

What are the main causes of emphysema?

1. Smoking: Tobacco smoke is the leading cause of emphysema, responsible for about 80-90% of cases.
2. Secondhand smoke: Regular exposure to environmental tobacco smoke can also increase risk.
3. Air pollution: Long-term exposure to industrial pollutants, vehicle emissions, and other airborne irritants.
4. Occupational exposure: Certain jobs involving exposure to chemical fumes, dust, or vapors can contribute to emphysema development.
5. Alpha-1 antitrypsin deficiency: A rare genetic condition that can lead to emphysema, even in non-smokers.

Understanding these risk factors is crucial for prevention and early intervention. While some causes, like genetic factors, cannot be controlled, many others can be mitigated through lifestyle changes and occupational safety measures.

Diagnosing Emphysema: Tests and Procedures

Accurate diagnosis of emphysema is essential for proper treatment and management. Healthcare providers use a combination of methods to assess lung function and confirm the presence of emphysema:

How is emphysema diagnosed?

• Physical examination: The doctor will listen to your lungs and assess your overall health.
• Pulmonary function tests: These measure how well your lungs work, including spirometry to assess airflow.
• Chest X-ray: This can show signs of emphysema, such as enlarged lungs or air pockets.
• CT scan: Provides detailed images of the lungs, helping to identify emphysema and assess its severity.
• Arterial blood gas analysis: Measures oxygen and carbon dioxide levels in the blood.
• Alpha-1 antitrypsin test: Checks for the genetic condition that can cause emphysema.

Early diagnosis allows for timely intervention, which can significantly slow disease progression and improve quality of life. Regular check-ups and screenings are particularly important for individuals at high risk, such as long-term smokers.

Treatment Options for Managing Emphysema

While emphysema cannot be cured, various treatment options can help manage symptoms, improve quality of life, and slow disease progression. Treatment plans are typically tailored to each individual’s needs and the severity of their condition.

What are the main treatment approaches for emphysema?

1. Smoking cessation: The most crucial step in slowing emphysema progression.
2. Bronchodilators: Medications that help relax and open airways, improving airflow.
3. Inhaled corticosteroids: Reduce airway inflammation and may be used in combination with bronchodilators.
4. Oxygen therapy: Supplemental oxygen can help improve breathing and overall quality of life.
5. Pulmonary rehabilitation: A program combining exercise, education, and support to improve lung function and overall health.
6. Vaccinations: Regular flu and pneumonia vaccines to prevent respiratory infections.
7. Surgery: In severe cases, procedures like lung volume reduction surgery or lung transplantation may be considered.

Emerging treatments, such as endobronchial valve placement and lung volume reduction coils, offer new hope for some patients with advanced emphysema. These minimally invasive procedures aim to improve lung function by reducing hyperinflation.

Lifestyle Changes and Self-Management Strategies for Emphysema

In addition to medical treatments, lifestyle modifications play a crucial role in managing emphysema and improving overall health. Patients can take an active role in their care through various self-management strategies:

How can lifestyle changes help manage emphysema symptoms?

• Quit smoking and avoid secondhand smoke
• Engage in regular, gentle exercise as recommended by your healthcare provider
• Practice breathing techniques, such as pursed-lip breathing and diaphragmatic breathing
• Maintain a healthy diet to support overall health and immune function
• Avoid air pollution and protect yourself when exposure is unavoidable
• Use energy conservation techniques to manage daily activities without excessive fatigue
• Join support groups to connect with others facing similar challenges

Adopting these lifestyle changes can significantly improve quality of life and help prevent exacerbations. It’s important to work closely with your healthcare team to develop a personalized self-management plan that addresses your specific needs and goals.

Complications and Prognosis of Emphysema

Emphysema can lead to various complications if left untreated or poorly managed. Understanding these potential issues is crucial for patients and caregivers to ensure prompt intervention and appropriate care.

What are the potential complications of untreated emphysema?

• Pneumothorax: A collapsed lung due to air leaking into the space between the lung and chest wall
• Respiratory failure: Severe breathing difficulties requiring mechanical ventilation
• Cor pulmonale: Right-sided heart failure due to increased pressure in the pulmonary arteries
• Pulmonary hypertension: High blood pressure in the arteries that supply the lungs
• Increased risk of respiratory infections
• Depression and anxiety related to chronic breathing difficulties

The prognosis for emphysema varies depending on factors such as the severity of the disease, age, overall health, and adherence to treatment. Early diagnosis and proper management can significantly improve outcomes and quality of life. While emphysema is a progressive disease, many patients can maintain a good quality of life for years with appropriate care and lifestyle modifications.

Prevention Strategies and Public Health Initiatives for Emphysema

Preventing emphysema is crucial for reducing the burden of this chronic disease on individuals and healthcare systems. Public health initiatives and personal prevention strategies play a vital role in addressing this issue.

How can emphysema be prevented at individual and societal levels?

Individual prevention strategies include:

• Never starting to smoke or quitting if you already do
• Avoiding secondhand smoke exposure
• Using protective equipment in occupations with exposure to harmful fumes or dust
• Maintaining good overall health through diet and exercise
• Getting regular check-ups, especially if you’re at high risk

Public health initiatives focus on:

• Implementing and enforcing smoke-free policies in public spaces
• Providing accessible smoking cessation programs and resources
• Educating the public about the dangers of smoking and air pollution
• Improving air quality through environmental regulations
• Promoting occupational safety standards to reduce workplace exposure to harmful substances

These preventive measures can significantly reduce the incidence of emphysema and other respiratory diseases, leading to better health outcomes for populations worldwide.

Research and Future Directions in Emphysema Treatment

The field of emphysema research is dynamic, with ongoing efforts to develop new treatments and improve existing ones. Understanding current research trends can provide hope and insight into future management options for patients with emphysema.

What are the promising areas of research in emphysema treatment?

• Stem cell therapy: Investigating the potential of stem cells to regenerate damaged lung tissue
• Gene therapy: Exploring ways to correct genetic defects that contribute to emphysema
• Novel drug delivery systems: Developing more efficient methods to deliver medications directly to the lungs
• Biomarkers: Identifying biological markers for early detection and personalized treatment
• Lung regeneration techniques: Researching methods to stimulate the growth of new, healthy lung tissue
• Improved minimally invasive procedures: Refining and expanding bronchoscopic lung volume reduction techniques

These research directions offer hope for more effective treatments and potentially even ways to reverse lung damage in the future. While many of these approaches are still in early stages, they represent the ongoing commitment of the medical community to improving outcomes for emphysema patients.

As research progresses, it’s crucial for patients to stay informed about new developments and discuss potential new treatment options with their healthcare providers. Participating in clinical trials, when appropriate, can also contribute to the advancement of emphysema treatment and provide access to cutting-edge therapies.

Emphysema and Disorders of the Pleural Cavity

• Edward W. Humphrey
• Deanne Lawrence McKeown

Part of the
Comprehensive Manuals of Surgical Specialties
book series (CMSS)

Abstract

Bullous emphysema is a disorder in which the lungs contain bullae that are not associated with an intrinsic disease of the airways or with pulmonary scarring from a disease such as tuberculosis. For surgical purposes, a bulla is defined as an emphysematous space, not lined by epithelium, with a roof formed by visceral pleura. Most single bullae that occupy less than one-third of a thoracic cavity and that are situated in otherwise normal lungs do not cause symptoms. A large bulla, however, can compress and compromise the function of the rest of the lung. In addition, a bulla can cause a relaxation of the adjacent lung, thereby decreasing the radial tension on airways and causing an increased resistance to airflow. A bulla can become infected; the lung can bleed into a bulla, occasionally causing life-threatening hemoptysis; and a bulla can rupture, producing a pneumothorax.

Keywords

Pleural Fluid Pleural Cavity Spontaneous Pneumothorax Parietal Pleura Visceral Pleura 

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag New York Inc. 1982

Authors and Affiliations

• Edward W. Humphrey
• Deanne Lawrence McKeown

1. 1.University of MinnesotaUSA
2. 2.Minneapolis Veterans Administration Medical CenterMinneapolisUSA
3. 3.SedonaUSA

Emphysema: Background, Pathophysiology, Etiology

Emphysema – Physiopedia

Pulmonary emphysema, a progressive lung disease, is a form of chronic obstructive pulmonary disease (COPD).  Emphysema is primarily a pathological diagnosis that affects the air spaces distal to the terminal bronchiole. It is characterized by abnormal permanent enlargement of lung air spaces with the destruction of their walls without any fibrosis and destruction of lung parenchyma with loss of elasticity.^[1]

There are three types of emphysema; centriacinar, panacinar, paraseptal. See image 1.

1. Centriacinar emphysema affects the alveoli and airways in the central acinus, destroying the alveoli in the walls of the respiratory bronchioles and alveolar ducts ^[2] .
2. Panacinar emphysema affects the whole acinus ^[2] .
3. Paraseptal emphysema is believed to be the basic lesion of pulmonary bullous disease ^[2].

Emphysema, as a part of COPD, is an illness that affects a large number of people worldwide. In 2016, the Global Burden of Disease Study reported a prevalence of 251 million cases of COPD globally. Around 90% of COPD deaths occur in low and middle-income countries  .

The prevalence of emphysema:

• In United States is approximately 14 million, which includes 14% white male smokers and 3% white male nonsmokers.

It is slowly increasing in incidence primarily due to the increase in cigarette smoking and environmental pollution. Another contributing factor is decreasing mortality from other causes such as cardiovascular and infectious diseases. Genetic factors also play a significant role in determining the possibility of airflow limitation in patients.

Emphysema severity is significantly higher in the coal worker pneumoconiosis, and this is independent of smoking status.^[1]

The exact cause of Emphysema is still yet to be distinguished, however research is suggesting the prevalence is strongly related to smoking, air pollutions and in some cases, occupation ^[3]. Another common association is the deficiency of the enzyme alpha₁-antitrypsin, which is the protein protecting the alveoli ^[4].

The prevalence of Emphysema within the smoking population is believed to increase as smoking is a major risk factor associated. It is thought to have a higher incidence in those with a lower socioeconomic background, therefore affecting lifestyle and environment, resulting in the likelihood of respiratory infection ^[5].

The alveoli and the small distal airways are primarily affected by the disease, followed by effects in the larger airways ^[4]. Elastic recoil is usually responsible for splinting the bronchioles open. However, with emphysema, the bronchioles lose their stabilizing function and therefore causing a collapse in the airways resulting in gas to be trapped distally^[4].

There is an erosion in the alveolar septa causing there to be an enlargement of the available air space in the alveoli ^[4]. There is sometimes a formation of bullae with their thin walls of diminished lung tissue.

Smoking contributes to the development of the condition initially by activating the inflammatory process ^[3]. The inhaled irritants cause inflammatory cells to be released from polymorphonuclear leukocytes and alveolar macrophages to move into the lungs ^[3]. Inflammatory cells are known as proteolytic enzymes, which the lungs are usually protected against due to the action of antiproteases such as the alpha1-antitrypsin ^[3]. However, the irritants from smoking will have an effect on the alpha1-antitrypsin, reducing its activity. Therefore emphysema develops in this situation when the production and activity of antiprotease are not sufficient to counter the harmful effects of excess protease production ^[3]. A result of this is the destruction of the alveolar walls and the breakdown of elastic tissue and collagen. The loss of alveolar tissue leads to a reduction in the surface area for gas exchange, which increases the rate of blood flow through the pulmonary capillary system ^[3].

CT scan is a common method used to diagnosis emphysema. The observations mainly seen to identify emphysema are a decrease in lung attenuation and a decrease in the number and diameter of pulmonary vessels in the affected area ^[6].

Patients diagnosed with emphysema may complain of difficult/laboured breathing and reduced exercise capacity as their predominating symptoms ^[7]. The loss of the elastic recoil in the lungs leads to irreversible bronchial obstruction and lung hyperinflation, which increases the volume over normal tidal breathing and functional residual capacity ^[7].

The main aims of treating patients with Emphysema are to relieve symptoms and to improve quality of life ^[8][9]. To measure patients’ quality of life, the St George’s Respiratory Questionnaire (SGRQ) and the Guyatt’s Chronic Respiratory Questionnaire (CRQ) are often completed in order to measure the effectiveness of a treatment intervention ^[8].

Other outcome measures relevant include:

6 minute walk test

Grip strength

Borg RPE

30 second sit to stand

Generally, the diagnosis for Emphysema can be based on clinical, functional and radiographic findings ^[10]. However, it is thought that mild Emphysema is not well detected on conventional chest radiography, therefore the use of pulmonary function tests (PFT) are often used to try and diagnose the condition ^[11].

In order to accurately diagnose Emphysema, the history of the patient’s condition needs to be fully understood ^[12] . The use of high-resolution CT scans is part of the standard procedure when trying to detect this condition as it is non-invasive and is found to be sensitive in detecting pathological changes related to Emphysema ^[12].

Physiotherapy and Other Management[edit | edit source]

Physiotherapy management for Emphysema is commonly associated with similar management of COPD. The use of a pulmonary rehabilitation programme consisting of exercise and education can be designed by the physiotherapist along with other members of the multi-disciplinary team (MDT) in order to maximise the patients exercise capacity, mobility and also self-confidence ^[4]. The other MDT members can consist of a respiratory nurse and dietitians, as well as the physiotherapist in the hope to treat each patient like an individual and meet their specific needs by tailoring a programme to suit them ^[4].

Pulmonary rehabilitation for patients with severe symptoms and multiple exacerbations reduces dyspnea and hospitalizations. ^[1]

As COPD is the umbrella term used for diseases like Emphysema, the prevention strategies are very similar. The most common suggestion for preventing emphysema, and such, is to stop smoking, and to avoid breathing in any harmful pollutants ^[13].

1. ↑ ^1.01.11.2 Pahal P, Avula A, Sharma S. Emphysema. [Updated 2021 Feb 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.Available: https://www.ncbi.nlm.nih.gov/books/NBK482217/#!po=74.0000(accessed 24.5.2021p
2. ↑ ^2.02.12.2 Hochhegger B, Dixon S, Screaton N, Cardinal V, Marchiori S, Binukrishnan S, Holemans J, Gosney J, McCann C, Emphysema and smoking related lung diseases. The British Institute of Radiology 2014; 20 (4).
3. ↑ ^{3.03.13.23.33.43.5} Mattison S, Christensen M. The pathophysiology of emphysema: Considerations for critical care nursing practice. Intensive and Critical Care Nursing 2006; 22: 329-337.
4. ↑ ^{4.04.14.24.34.44.5} Hough A. Physiotherapy in respiratory and cardiac care. Hampshire: Cengage Learning EMEA, 2014
5. ↑ Haas F, Haas SS. The Chronic Bronchitis and Emphysema Handbook. Chichester: John Wiley and Sons, Inc; 2000.
6. ↑ Newell, J. CT of Emphysema. Radiologic Clinics of North America 2002; 40 (1): 31-42.
7. ↑ ^7.07.1 Visca D, Aiello M, Chetta A. Cardiovascular function in pulmonary emphysema. BioMed Research International 2013.
8. ↑ ^8.08.1 Harper R, Brazierm JE, Waterhouse JC, Walters SJ, Jones NMB, Howard P.Comparison of outcome measures for patients with chronic obstructive pulmonary disease (COPD) in an outpatient setting. Thorax 1997; 52: 879-887.
9. ↑ Naunheim KS, Wood DE, Mohsenifar Z, Sternberg AL, Criner GJ, DeCamp MM, Deschamps CC, Martinez FJ, Sciurba FC, Tonascia J, Fishman AP. Long-term follow-up of patients receiving lung-volume-reduction surgery versus medical therapy for severe emphysema by the national emphysema treatment trial research group. The Annals of Thoracic Surgery 2006; 82 (2): 421-443.
10. ↑ Klein JS, Gamsu G, Webb WR, Golden JA, Muller NL. High-resolution CT diagnosis of emphysema in symptomatic patients with normal chest radiographs and isolated low diffusing capacity. Radiology 1992; 182: 817-821.
11. ↑ Sanders C, Nath PH, Bailey WC. Detection of Emphysema with computed tomography correlation with pulmonary function tests and chest radiography. Investigative Radiology 1988; 23: 262-266.
12. ↑ ^12.012.1 Zaporozhan J, Ley S, Eberhardt R, Weinheimer O, Svitlana I, Herth F, Kauczor H-U. Paired inspiratory/expiratory volumetric thin-slice CT scan for emphysema analysis: comparison of different quantitative evaluations and pulmonary function test. American College of Chest Physicians 2005; 128 (5): 3212-3220.
13. ↑ National Health Service. NHS Choices. http://www.nhs.uk/Conditions/Chronic-obstructive-pulmonary-disease/Pages/Introduction.aspx (accessed 02 June 2015)

Pulmonary Interstitial Emphysema | Cedars-Sinai

Not what you’re looking for?

What is pulmonary interstitial emphysema?

Pulmonary interstitial emphysema (PIE) is when air gets trapped in the tissue outside of tiny air sacs (alveoli) in the lungs. It affects newborn babies. PIE is fairly common in neonatal intensive care units (NICUs).

When you breathe, air
travels in through your mouth and nose to your lungs. The air goes into the
alveoli. This is where gases get exchanged. Here, the lungs send oxygen to
the blood. And they release carbon dioxide, a waste product. The oxygen then
travels through the blood to all the organs of your body.

Normally, air in the lungs stays in the alveoli. But in some cases, air can escape into the nearby tissue around the tiny sacs. This tissue is called the interstitium. This can happen if the wall of an air sac breaks open. If enough air leaks out, this can cause problems with breathing and blood flow.

PIE usually affects
low-weight infants who need a device (ventilator) that helps with breathing.
These infants often have a lung problem that is caused by preterm birth. PIE
often affects infants in the first few days of life. It may affect one or
both lungs.

PIE is classified by how long it lasts. Acute PIE lasts for less than a week. If it lasts longer, it is called persistent PIE. PIE may also be called diffuse or localized. Diffuse means it occurs in multiple places in the lungs. Localized means it occurs in a single spot.

What causes pulmonary interstitial emphysema?

PIE most often happens in preterm
infants. It occurs when their lungs don’t make enough of a substance called
surfactant. Surfactant allows alveoli to be more flexible and less likely to break
open.

Being on a ventilator may cause PIE. During artificial ventilation, a ventilator applies air pressure to the air sacs of your child’s lungs. This helps your child breathe by opening closed-off lung sacs. But in some cases, this extra pressure can create a leak in an air sac.

Who is at risk for pulmonary interstitial emphysema?

Babies with a greater risk of PIE are those with the following conditions:

• Preterm birth, which often leads to respiratory disease
• The lungs don’t develop correctly
  (pulmonary hypoplasia)
• Breathing in the first intestinal discharge (meconium) at birth
• A lung infection (pneumonia)
• Very fast breathing right after birth (transient tachypnea of the newborn)

What are the symptoms of pulmonary interstitial
emphysema?

Signs of PIE often appear within 4
days of birth. Mild PIE may have no signs. More severe PIE may cause signs of breathing
trouble, such as:

• Grunting or other signs of trouble breathing
• Fast breathing
• Pale appearance
• Parts of the body tinted blue (cyanosis) due to low oxygen in the blood

How is pulmonary interstitial emphysema diagnosed?

You may be asked about you and your
child’s health history. This may include information before, during, and after birth.
Your child will have a physical exam. His or her heart and lungs may be checked. Blood
tests may be done to look for signs of low levels of oxygen and high levels of carbon
dioxide.

Your child may likely have an
imaging test, such as a chest X-ray or a chest CT scan. Leaked air will often appear on
both of these imaging tests.

How is pulmonary interstitial emphysema treated?

PIE is a serious condition. It can
cause death if not correctly treated. For this reason, treatment is done inside a
neonatal intensive care unit (NICU).

Treatment is done to make sure your
child gets enough oxygen. It also aims to prevent more air leaks. Treatment may
include:

• Lying your baby on the side with the
  air leak, which helps move more air into the lung that is working well
• Lowering ventilator pressure if possible, to help prevent more air leaks
• Using high-frequency oscillatory ventilation, which may lower pressure in the air sacs
• Giving extra oxygen

Your child’s vital signs and levels of oxygen in the blood are checked during the treatment. Your child may also need X-rays to check on the status of the air leaks as they heal.

In most cases, PIE gets better with these treatments, and the leaked air goes away.

If your child has a severe
localized case of PIE, the healthcare team may collapse the lung with the air leak for a
short time. This is so the air sac can heal. This is done by placing a breathing tube
into the lung without the air leak. Or air flow may be blocked for a short time to the
lung with the air leak. Your child might need a breathing tube and ventilator support
during this time.

In rare cases, a child might need to have part of a lung removed to treat PIE that does not go away.

Your child may also need treatment for other lung problems that may be causing the PIE.

What are possible complications of pulmonary interstitial
emphysema?

PIE can sometimes cause pneumothorax. This is air in the space between the outer lungs and the chest wall. This can make breathing problems worse. Your child may need ventilator support or a chest tube for a large pneumothorax.

How can I prevent pulmonary interstitial emphysema?

Preventing preterm birth may help prevent PIE. You can decrease the chance of preterm birth by:

• Not smoking during pregnancy
• Not using alcohol or drugs during
  pregnancy
• Getting early and regular prenatal
  care throughout your pregnancy
• Seeking medical attention at the first signs of preterm labor

Key points about pulmonary interstitial emphysema

• Pulmonary interstitial emphysema (PIE)
  is when air gets trapped in the tissue outside air sacs in the lungs.
• It affects some newborn babies who
  are placed on ventilators, or breathing machines. PIE is fairly common in neonatal
  intensive care units (NICUs).
• Lung disease caused by preterm birth
  increases a child’s risk of PIE.
• PIE can cause trouble breathing and
  low oxygen levels in the blood.
• In most cases of PIE, the air leaks go
  away on their own with supportive care.
• In rare cases, your child might need a
  lung deflated for a short time to help treat PIE. Surgery may be needed in rare
  cases.

Next steps

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

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

Not what you’re looking for?

Chronic Obstructive Pulmonary Disease: Diagnostic Considerations

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Homa DM,
Akinbami LJ,
Ford ES,
Redd SC.
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3. Petty TL,
Weinmann GG.
Building a national strategy for the prevention and management of and research in chronic obstructive pulmonary disease. National Heart, Lung, and Blood Institute Workshop Summary. Bethesda, Maryland, August 29–31, 1995. JAMA.
1997;277:246–53.

4. Petty TL.
COPD in perspective. Chest.
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Emphysema – an overview | ScienceDirect Topics

Animal Models of COPD

Several excellent reviews of animal models of COPD recognize the challenge to simultaneously generate relevant anatomic and functional lesions of the lung, such as chronic bronchitis, airway remodeling, emphysema, PH, and spontaneous exacerbations, all within a useful experimental timeframe. While no model has achieved these goals, there has been important progress in the field, only made possible by animal modeling of such a complex disease. Most models produce only mild to moderate disease, with the exception of the intratracheal elastase instillation, which induces a rapid and dose-dependent degree of airspace enlargement. Moreover, most rodent models that exhibit pulmonary COPD-like lesions are usually partially reversible upon cessation of the inciting exposure and lack the occurrence of spontaneous exacerbation. These models offer the opportunity to study mechanisms of and develop therapies against the development rather than the progression of COPD-like disease. Nevertheless, even if no animal model recapitulates all aspects of human disease, they do offer the opportunity to identify pathogenic or reparative pathways, which, as stated previously, can then be probed in a translational manner to studies of human samples.

In addition to cigarette smoke exposure by inhalation, which is the most widely accepted animal model of COPD, other models have been developed, each emphasizing a pathogenic mechanism of COPD development, or a certain phenotype (Table 3). Many of these models have been criticized for their nonphysiological nature, the nonrealistic short timespan that some require to induce lesions which are COPD-like, or their transient nature. However, if interpreted in the appropriate context, they each contributed significant knowledge and advanced our understanding of this complex disease. The cigarette smoking inhalation model itself is not an ideal model, although it has several important advantages in that it utilizes the most common risk factor for COPD development, induces several anatomical lesions that best recapitulate ‘human COPD,’ and can be used in a variety of animal species, including well-characterized inbred strains and transgenic mice. In addition to the long duration of time required to induce a robust phenotype, the main disadvantages of the inhaled cigarette smoke model are related to the development of very subtle lesions of chronic bronchitis or mucus hypersecretion, probably linked to a high intrinsic ratio between bronchial epithelial and goblet cells and low number of submucosal glands seen in rodents. In addition, the methods utilized to generate cigarette smoke exposure are not very well standardized; therefore, the degree of COPD disease, with a relatively mild phenotype of emphysema, small airway remodeling, and PH, varies among laboratories and seldom induces the irreversible disease and/or the severe changes seen in human COPD GOLD stage III/IV. These exposure methods include a variety of commercial smoking machines that will deliver either nose-only exposure or whole-body exposure, both occurring intermittently, 3–5 h per day, once or twice a day, at various dosages (expressed as main- and sidestream percentages, ppm of carbon monoxide, cigarettes per minute per day), and for various durations ranging from acute exposures, measured in hours and days, to chronic exposures, lasting from weeks to months. The serum cotinine levels achieved are fairly similar and do not exceed the levels seen in humans with history of moderate cigarette smoking. Acute cigarette smoke exposures typically provoke measurable innate immune responses and antioxidant, stress, and metabolic responses, while chronic cigarette smoke exposures are required to generate significant adaptive immune host defense responses and changes in morphological and functional parameters. There are several notable differences in species and gender susceptibility to cigarette smoke, rats being relatively more resistant, whereas female mice being more susceptible to its effects. Among mouse strains, the NZWLac/J mice are relatively resistant; the C57BL6/J, A/J, DBA2, and SJ/L are mild to moderately susceptible; and AKR/J being most susceptible to cigarette smoke-induced lung COPD-like injury. There is also strain-specific predilection for COPD phenotypes, for example, lungs exposed to cigarette smoke exhibit predominantly emphysema in the pallid mouse (a strain with low levels of A1AT), more prominent airway inflammation and oxidative stress in C57BL6/J, while displaying more prominent apoptosis in the DBA2/J mouse. In other species, such as rabbit, guinea pig, or hamsters, cigarette smoke models have been mainly used to study small airway remodeling or PH, because their airways have more mucus glands, and extensive pulmonary function and hemodynamic measurements can be easily performed in larger animals. In addition, in ferrets, cigarette smoke can cause airway squamous metaplasia and initiate carcinogenesis, allowing the study of smoking-induced lung cancer.

Table 3. Select animal models of COPD that target specific pathogenic mechanisms

The typical endpoints of COPD modeling include airway and airspace morphology and morphometry, lung function testing, as well as systemic manifestations of weight loss and decreased functional performance (exercise studies). In addition, a combination of corroborative biochemical and cellular changes indicative of inflammation, oxidative stress, matrix proteolysis, cellular stress, including apoptosis, autophagy, and senescence, are typically presented to refine the lung injury phenotype. These measurements are performed on fixed, inflated lungs, using standardized inflation pressures, on laser capture microdissected lung structures, on bronchoalveolar lavage fluid samples, lung tissue homogenates, primary cells isolated from lung tissues, plasma, cardiovascular structures, bone marrow, etc. An area of ongoing work has been to unify and standardize lung morphometry (e.g., airway remodeling, airspace enlargement, alveolar wall destruction) performed in animal models of COPD. Airspace size, surface to volume ratio, and mean linear intercept have largely been used to define emphysema. In addition to integrating morphometry results with pulmonary function measurements of lung static compliance and lung volumes, the use of stereoscopic analyses of histological sections, micro-CT, or micro-PET imaging will further improve the accuracy of these methods. Recent advances in these methodologies are very exciting and will provide not only accurate descriptive parameters but also mechanistic insight into the disease. To this end, intravital microscopic techniques have been developed to allow real-time assessment of inflammation and injury of the alveolar structures in intact animals.

The risk of surgical emphysema post VATS pleural biopsy and IPC

Abstract

Introduction: Video Assisted Thoracoscopic Surgical (VATS) pleural biopsies are part of the algorithm to investigate unilateral pleural effusions. Visceral pleural thickening can cause trapped lung, and indwelling pleural catheter (IPC) placement is standard management. The risk of developing surgical emphysema is unknown.

Aim: To establish the incidence, severity, impact and risk factors for surgical emphysema post VATS pleural biopsy and IPC placement (VATS-IPC).

Method: We retrospectively analysed consecutive patients undergoing VATS-IPC. Chest radiographs and electronic discharge summaries were reviewed. Surgical emphysema was radiographically graded as: 1 localised to IPC site; 2 ipsilateral chest wall; 3 involvement of neck; 4 involvement of contralateral chest wall.

Results: Between 2000 and 2018, 176 cases were identified. The median age was 70 [interquartile (IQR) range 64-76] years and 126/176 (72%) were male. Surgical emphysema was identified in 97/176 (55%) cases with grade 4 present in 16/176 (9%).

In patients with grade ≥2 a malignant diagnosis was more likely (97% versus 83%; p=0.01; OR 5.28(95%CI 1-26). No difference in age or gender was identified across the grades (p=0.47 & p=0.35 respectively). Length of stay (LOS) increased across the grades of severity (p<0.01). In those with Grade 4 disease, the LOS was 12.9[8-18.25]days versus 4[3-7] days in those without surgical emphysema (p<0.01). Grading remained significantly associated with LOS when adjusted for diagnosis, age and gender (p=0.03).

Conclusion: Severe emphysema occurred in nearly 1 in 10 patients. Severity was associated with a malignant diagnosis and with a significant increase in LOS. Further investigation is warranted to identify other risk factors.

Footnotes

Cite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA1079.

This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).

• Copyright ©the authors 2019

B.3 Main CT symptoms of lung pathology in viral lung lesions

Thoracic surgery

About the branch

The department offers the population in Israel and abroad not only the most modern medical equipment, but also the services of a professional and experienced staff.The operations of the chest and chest cavity organs are performed using the most innovative technologies that are selected individually, taking into account the needs of each patient.

Who can benefit from our services?

Services offered by the Department of Chest and Thoracic Surgery are intended for the surgical treatment of lung cancer and / or other lung tumors, malignant or benign, primary or secondary, for the treatment of tumors in the mediastinum and thoracic cavity, esophageal cancer and / or benign tumors esophagus, congenital chest deformities or deformities due to trauma, hyperhidrosis, severe pulmonary emphysema, various lung infections and / or chest infections, etc.

Operations

About 80% of operations in the Department of Chest and Thoracic Surgery are performed using minimally invasive methods (thoracoscopy). This method is more effective and safer than the traditional surgical method with opening the chest and spreading the ribs. In the process of thoracoscopic operations, 2-3 incisions are made between the ribs – one for a video camera and two for the introduction of surgical instruments. However, in more complex cases that do not allow for a minimally invasive procedure, a traditional operation with opening the chest is performed.

Advantages of minimally invasive method:

• lower level of pain after surgery
• Shorter hospital stay with faster return to daily activities
• method allows to operate on elderly people
• allows you to operate on severe patients suffering from other concomitant diseases
• preservation of respiratory function after surgery
• only small scars remain on the body
• Significant reduction in postoperative complications
• higher chances of recovery and better quality of life.

Treatment methods and procedures

• Lobectomy (removal of a lobe) of the lung in patients with lung cancer and / or other lung tumors.
• Pneumonectomy (complete removal of the lung) for patients with lung cancer.
• Removal of mediastinal tumors.
• Removal of the esophagus in patients with esophageal cancer.
• Reduction of lung tissue volume in patients with severe pulmonary emphysema.
• Removal of blisters from the lung in patients with primary pneumothorax or with pulmonary bullae.
• Adhesion of the pleura in patients with malignant pleural effusion.
• Correction of congenital chest deformities.
• Removal of the affected sections of the chest wall in patients with tumors.
• Partial removal of the heart lining in patients with pericardial effusion.
• Implantation of a pacemaker in the left ventricle in patients with severe heart failure.
• Bilateral cauterization of the sympathetic nerve in patients with hyperhidrosis.
• Biopsies of the pleura, lymph nodes of the mediastinum, pericardium, diaphragm.
• Diaphragm fixation in patients with diaphragm paralysis.

Medical staff

In the thoracic department of the Shamir Medical Center – “Assaf ha-Rofe” at your service – a staff of surgeons with extensive experience in the field of minimally invasive operations on the lungs, esophagus and other organs of the chest. The department of surgery of the chest and organs of the chest cavity works in close cooperation with other departments and units in the medical center, including the pulmonary department, departments of radiology, oncology, gastroenterology, pathology and others.
The department is headed by Dr. Mikhail Papiashvili, one of the leading thoracic surgeons in Israel, specializing in minimally invasive chest surgery.

About the medical center “Assaf ha-Rofe”

Shamir Medical Center – Assaf HaRofeh is a public university hospital, the fourth largest in Israel, and the central hospital for the Shfela district.

The work of outpatient clinics, emergency rooms, inpatient departments and maternity wards is carried out with the participation of clinics and laboratories of various medical specializations.3,400 doctors, researchers, paramedical personnel, nurses and administration personnel provide personalized treatment and state-of-the-art medical care to every patient, whether Israelis or coming from abroad for treatment.

In Noginsk, doctors rescued a patient with COVID-19 who had 7 cardiac arrest

A 67-year-old man with confirmed coronavirus infection was admitted to the Noginsk central district hospital.His condition was rapidly deteriorating, so the doctors made an urgent decision to transfer the patient to intensive care.

“The patient was admitted to us in a serious condition, with respiratory failure of the second degree and lung damage of about 75%. His condition required a connection to a ventilator. The situation was aggravated by the man’s serious concomitant disease – bullous lung disease, ”says Roman Uteshev, anesthesiologist-resuscitator of the infectious diseases hospital at the Noginsk hospital.

Bullous lung disease, or as it is also called emphysema, is a formidable disease manifested by the appearance in the lungs of areas of pathologically stretched lung tissue filled with air.These air bubbles are called bullae. At first, these bullae are small in size and do not cause inconvenience to the patient. But over time, they grow and can reach 15 centimeters in diameter.

“Emphysema is a serious disease in itself, and then viral pneumonia was added. Already when the patient was on mechanical ventilation, he began to have spontaneous rupture of bullae. After the large bulla burst, the left lung was practically completely collapsed. Against this background, cardiac arrest occurred, ”says the resuscitator.

The patient was resuscitated within almost 15 minutes. The doctors then performed an emergency drainage of the left pleural cavity to release air from the lung and expand it. Already during the operation, 6 more cardiac arrests occurred, but the doctors did not give up.

“It was a very difficult battle. Thanks to the well-coordinated work of our entire team, we managed to stabilize the patient, ”explains the doctor.

In total, the man spent 4 months in the hospital, including a month on mechanical ventilation.This affected the muscles: atrophy began. Doctors attached the expander to the bed, and the man began to develop muscles, learn to sit down, get up on his feet. At the moment, the man has already been discharged home and continues to recover.

Thoracic surgery in Germany, cost, treatment

Thoracic surgery is a surgery of the chest cavity organs. Surgery of the heart and great vessels, as a rule, is a separate area, however, in many large and university hospitals in Germany and around the world there are large departments of cardiothoracic surgery.

Such a combination is easily explained, because the heart and respiratory organs are not only in anatomical proximity, but also in a complex functional relationship with each other, as well as with other organs of the mediastinum. In the diagnosis and treatment of laryngeal pathology, thoracic surgeons work closely with ENT specialists.

Departments of thoracic surgery in Germany are equipped with the latest equipment, which makes it possible to diagnose and treat the entire spectrum of diseases of the chest wall, lungs, mediastinum.

The competence of thoracic surgeons includes:

• Pathology of the respiratory tract (larynx, trachea and bronchi): stenosis (narrowing), congenital malformations, neoplasms, tracheo-esophageal fistulas
• Pathology of the chest wall: developmental disorders (keeled and funnel chest), trauma and post-traumatic deformities of the ribs and sternum, disrupting the skeleton of the chest and causing cosmetic defects, tumors
• Pleural pathology: neoplasms, including pleural mesothelioma, pleural effusion of various etiology? Bullous lung disease and pneumothorax of various etiology
• Diseases and lesions of lung tissue, for the diagnosis and treatment of which surgical and minimally invasive methods are used
• Pathology of the cervical and thoracic esophagus: developmental anomalies, cicatricial narrowing, neoplasms
• Primary and secondary tumors of the chest cavity organs.

For a complete diagnosis, thoracic surgeons have access to all modern examination methods. After examination with auscultation of the lungs, screening X-ray examination and spirography, according to the indications, various types of tomography are prescribed, allowing you to study in detail and carry out 3D-reconstruction of the intrathoracic organs, find out their spatial relationships and plan the necessary interventions.

Fibrooptic and video bronchoscopy represent not only the most valuable diagnostic method (examination, taking sputum for analysis and biopsy of mucous membranes and formations), but also ample opportunities for minimally invasive treatment.During bronchoscopy, it is possible to install stents that restore patency and stabilize the trachea and large bronchi, occluders – special devices that temporarily close the bronchus, which is the source of bleeding. Also, by means of a bronchoscope, bougienage (dilation) of cicatricial stenosis of the trachea, laser surgery of small benign neoplasms and granulations are performed. In infectious diseases, lung abscesses, pleural empyema, lingering pneumonia and bronchitis, cystic fibrosis, bacteriological diagnosis is of great importance.

A laboratory study of any material taken during research, with the determination of the sensitivity of the isolated pathogens to antibacterial drugs, provides an effective prescription and correction of treatment. The multidisciplinary pulmonary treatment teams in Germany include bacteriologists and clinical pharmacologists, which are proven to provide the best results. Videothoracoscopy is a minimally invasive surgical procedure that can perform diagnostic and therapeutic functions.Through several point punctures of the chest wall under general anesthesia, special manipulators are introduced into the pleural cavity, with the help of which you can carefully examine the lung, pleura and some mediastinal organs, take a biopsy, coagulate bullae with bullous emphysema, eliminate the pathological contents of the pleural cavity. In clinics of thoracic surgery in Germany, through a thoracoscopic approach (without a traditional surgical incision), resections of metastases in the lungs, removal of a part of the lung in case of focal lesions, reduction operations for pulmonary emphysema, operations on the thoracic esophagus and many other complex interventions are performed.

Comprehensive oncological treatment is provided for patients with tumors of the thoracic cavity in institutions such as the Interdisciplinary Thoracic Tumor Center, whose specialists work closely with the Cancer Center at the University Hospital in Freiburg. Timely surgical intervention based on the principles of radicality and minimal trauma, supplemented, if necessary, with chemotherapy, radiation therapy, immunotherapy, followed by comprehensive rehabilitation, provides the highest percentage of radical treatment, the best indicators of the duration and quality of life of patients with tumor diseases.The high level of technology, full-fledged equipment and qualifications of doctors put thoracic surgery in Germany in one of the leading positions in the world. In addition, a stay in German clinics is always comfortable and conducive to recovery. Of course, the treatment of lung and mediastinal diseases in Germany is a reliable choice.

Pulmonology and thoracic surgery | Treatment | Treatment

EFFECTIVE AND RELIABLE SURGICAL APPROACHES THANKS TO PERFECT OPPORTUNITIES OF MODERN MEDICINE …

The Department of Chest Surgery at the Medipol University Hospital provides effective treatment of patients through the introduction of modern medical technologies and a high academic level of training of specialists.

SPECTRUM OF RENDERED SERVICES

• Lung cancer
• Cancer of the pleura (mesothelioma)
• Tumors of the trachea
• Stenosis (narrowing) of the trachea
• Thymus tumor
• Progressive emphysema of the lungs
• Rupture of the pleural membrane of the lungs (pneumothorax)
• Accumulation of fluid in the pleural cavity
• Inflammation of the pleura (empyema)
• Chest deformity (depressed or convex chest)
• Compression syndrome of the upper aperture of the chest
• Injuries to the chest (fractures, bleeding or organ damage due to stab and gunshot wounds, car accident or fall)
• Protrusion of adjacent organs of the diaphragm
• Excessive sweating of the palms (hyperhidrosis)

Excessive sweating of the palms (hyperhidrosis)

THE HIGHEST LEVEL OF DIAGNOSTICS AND TREATMENT OF ANY LUNG DISEASES FROM ASTHMA TO SLEEP DISORDERS …

The Department of Pulmonology of the Clinical Hospital of Medipol University provides qualified medical care by experienced specialists of high academic background.

The Pulmonology Department offers medical services in the following areas:

• Diagnostics and treatment of lung cancer,
• Diagnosis and treatment of chronic obstructive pulmonary disease,
• Asthma Diagnosis and Treatment,
• Performing an injection skin test for patients with complaints of allergies (itching in the nose, sneezing, shortness of breath),
• Conducting immunotherapy (antiallergic vaccine therapy) in patients with indications
• Test-study of the state of pulmonary functions,
• Hospitalization of patients requiring advanced diagnostics,
• Providing assistance in smoking cessation.

appointments, ratings and reviews on DocDoc.ru

Pulmonologists of St. Petersburg – latest reviews

The reception went well. Irina Viktorovna listened attentively to my problems, studied the test results, explained and told everything clearly.I was satisfied. I would recommend this specialist to my friends, if necessary.

Marseilles,

02 November 2021

Yuri Viktorovich is a good and thorough doctor.He listened to me, consulted for a long time, paid a lot of attention and did not rush me. The doctor seemed competent. I am completely satisfied. If necessary, I will apply again.

Bogdan,

01 November 2021

I have known this specialist for a long time.I like it very much. I think she is one of the best doctors I have ever seen. Nice, friendly, sweet, attentive doctor. He spends enough time for an appointment, asks everything in detail, conducts a thorough examination, gives recommendations and explains everything clearly. I recommend a doctor!

Anna,

October 29, 2021

The quality of the reception was fine.The doctor listened to the patient, told the diagnosis and prescribed treatment. We’ll turn back later. Elena Sergeevna is a good doctor. The meeting lasted about forty minutes and this time was quite enough.

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October 18, 2021

I liked the welcome.Vladimir Nikolaevich looked at the results of the checks and all the materials that I had, examined me. It instills a feeling of confidence, calmness, it is comfortable, calm and safe with it. Before that, I had a bunch of different studies, some incomprehensible information. He summarized it all and gave the confidence that everything is super. As a result, I got an understanding of what is coming, peace of mind, what to do next, what would be even better. I realized that there was no problem. I recommend this specialist.

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07 October 2021

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September 27, 2021

An attentive doctor.She examined me thoroughly, explained everything clearly and made a preliminary diagnosis. The doctor also ordered another examination for me. I was satisfied and now I know what to start from.

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September 20, 2021

I am happy with the first appointment.The doctor conducted an examination, collected an anamnesis of diseases and prescribed tests. The attitude of the person is very good towards the patient. A cultured and polite girl. A friendly and attentive doctor. I have no complaints against Vasilisa Lvovna.

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09 September 2021

The doctor is attentive, explains everything clearly and easily.I cannot characterize him from a professional point of view, since I am not a doctor, but I will definitely say that a doctor is a good one. I can recommend it to everyone!

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July 29, 2021

An attentive and friendly doctor.She asked everything and wrote that I need to get tested. I was satisfied!

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