What are the stages of emphysema. How is emphysema diagnosed. What complications can arise from untreated emphysema. What treatment options are available for emphysema patients. How does smoking affect the development of emphysema. Can emphysema be reversed. What is the outlook for people with emphysema.

Understanding Emphysema: A Progressive Lung Condition

Emphysema is a serious lung condition that falls under the umbrella of Chronic Obstructive Pulmonary Disease (COPD). It primarily affects the air sacs (alveoli) in the lungs, causing them to weaken and lose their ability to contract after expanding. This condition develops gradually, often due to long-term exposure to harmful substances, with smoking being the leading cause.

What Causes Emphysema?

While smoking cigarettes is responsible for 80% of emphysema cases, other factors can contribute to its development:

• Secondhand smoke exposure
• Marijuana smoking
• Air pollution
• Chemical fumes
• Alpha-1 antitrypsin deficiency (a genetic condition)

People over 40 years old and those with a history of prolonged smoking are at higher risk for developing emphysema.

Recognizing the Symptoms of Emphysema

Emphysema symptoms often develop slowly and may not become noticeable until significant lung damage has occurred. Early signs typically include:

• Shortness of breath, especially during physical activity
• Persistent fatigue

As the condition progresses, additional symptoms may emerge:

• Chronic coughing
• Chest tightness
• Wheezing
• Increased mucus production
• Difficulty breathing, even at rest
• Poor appetite and weight loss

Diagnosing Emphysema: Tests and Procedures

Diagnosing emphysema involves a combination of physical examinations, medical history review, and specific tests. Healthcare providers may use the following methods to assess lung function and determine the presence and severity of emphysema:

Spirometry and Pulmonary Function Tests (PFT)

These tests measure airflow during inhalation and exhalation, providing crucial information about lung capacity and function. Results are compared to normal values for individuals of similar age, height, weight, and ethnic background.

Additional Diagnostic Tools

• Chest percussion (tapping) to detect trapped air
• Blood tests to evaluate oxygen and carbon dioxide levels
• Electrocardiogram (ECG) to assess heart function
• Chest X-rays or CT scans to visualize lung structure

Emphysema Stages: Understanding Disease Progression

Emphysema typically progresses through several stages, with symptoms worsening over time. Doctors use a combination of symptom assessment and breathing test results to determine the stage of the disease.

How are emphysema stages determined?

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has established a staging system based on the forced expiratory volume in one second (FEV1) percentage. This system categorizes emphysema into four stages:

1. Stage 1 (Mild): FEV1 ≥ 80% predicted
2. Stage 2 (Moderate): 50% ≤ FEV1 < 80% predicted
3. Stage 3 (Severe): 30% ≤ FEV1 < 50% predicted
4. Stage 4 (Very Severe): FEV1 < 30% predicted

It’s important to note that symptoms may not correlate directly with these stages, and individual experiences can vary.

Complications of Untreated Emphysema

If left untreated, emphysema can lead to serious complications that significantly impact quality of life and overall health. Some potential complications include:

Giant Bullae (Holes in Lungs)

These large air pockets can impair lung expansion and increase the risk of infection. In severe cases, they may lead to a collapsed lung.

Pneumothorax (Collapsed Lung)

This life-threatening condition is particularly dangerous for emphysema patients due to their already compromised lung function.

Heart Problems

Emphysema can increase pressure in the arteries connecting the lungs to the heart, potentially leading to heart enlargement and weakening.

Treatment Options for Emphysema Patients

While emphysema cannot be cured, various treatment options can help slow disease progression, manage symptoms, and improve quality of life. The choice of treatment depends on the severity and stage of the condition.

Smoking Cessation

The most crucial step in managing emphysema is to stop smoking. This can significantly slow disease progression and improve overall lung health.

Medications

Several types of medications may be prescribed to manage emphysema symptoms:

• Bronchodilators: These medications help open airways, improving breathing and reducing coughing.
• Corticosteroids: These anti-inflammatory drugs can help reduce airway inflammation and improve lung function.
• Antibiotics: Used to treat respiratory infections that can exacerbate emphysema symptoms.

Oxygen Therapy

For patients with severe emphysema and low blood oxygen levels, supplemental oxygen can improve quality of life and reduce strain on the heart.

Pulmonary Rehabilitation

This comprehensive program combines exercise, education, and support to help patients manage their condition and improve overall well-being.

Surgical Interventions

In some cases, surgical procedures may be recommended for severe emphysema:

• Lung volume reduction surgery: Removes damaged lung tissue to improve breathing.
• Lung transplantation: Reserved for end-stage emphysema when other treatments have failed.

Living with Emphysema: Lifestyle Modifications and Self-Care

Managing emphysema effectively requires a combination of medical treatment and lifestyle changes. Patients can take several steps to improve their quality of life and slow disease progression:

Avoiding Triggers

Identify and avoid environmental factors that can worsen symptoms, such as air pollution, strong odors, and extreme temperatures.

Regular Exercise

Engage in gentle, regular physical activity to maintain lung function and overall health. Consult with a healthcare provider to develop a safe exercise plan.

Nutrition

Maintain a healthy diet rich in fruits, vegetables, and lean proteins to support overall health and immune function.

Stress Management

Practice stress-reduction techniques such as meditation, deep breathing exercises, or yoga to help manage anxiety and breathlessness.

Vaccinations

Stay up-to-date with recommended vaccinations, including flu and pneumonia shots, to reduce the risk of respiratory infections.

Prognosis and Outlook for Emphysema Patients

The outlook for people with emphysema varies depending on several factors, including the severity of the condition, adherence to treatment, and lifestyle choices. While emphysema is a progressive disease, proper management can significantly improve quality of life and slow its advancement.

Factors Affecting Prognosis

• Stage of the disease at diagnosis
• Smoking status and exposure to other lung irritants
• Adherence to treatment plans
• Presence of comorbidities
• Age and overall health

Life expectancy in emphysema is often correlated with symptoms and pulmonary function test results, particularly the forced expiratory volume in one second (FEV1). Healthcare providers may use specialized calculators to estimate survival rates based on these factors.

It’s important to note that individuals who quit smoking and take proactive steps to protect their lungs generally have a better prognosis. Regular follow-ups with healthcare providers and adherence to treatment plans are crucial for managing the condition effectively.

Emerging Research and Future Directions in Emphysema Treatment

As our understanding of emphysema continues to evolve, researchers are exploring new avenues for treatment and management. Some promising areas of investigation include:

Stem Cell Therapy

Scientists are studying the potential of stem cells to regenerate damaged lung tissue and improve lung function in emphysema patients.

Gene Therapy

Research is ongoing to develop gene-based treatments that could help prevent or slow the progression of emphysema, particularly in cases related to genetic factors like alpha-1 antitrypsin deficiency.

Novel Drug Therapies

Pharmaceutical companies are working on developing new medications that target specific pathways involved in emphysema progression, potentially offering more effective treatment options.

Improved Diagnostic Tools

Advanced imaging techniques and biomarker research may lead to earlier and more accurate diagnosis of emphysema, allowing for more timely intervention.

While these areas of research show promise, it’s important to remember that developing new treatments takes time and rigorous testing. Patients should continue to work closely with their healthcare providers to manage their condition using currently available evidence-based treatments.

Emphysema Prevention: Strategies for Lung Health

While not all cases of emphysema can be prevented, there are several steps individuals can take to reduce their risk of developing this condition:

Smoking Cessation and Avoidance

Given that smoking is the primary cause of emphysema, quitting smoking or never starting is the most effective prevention strategy. This includes avoiding exposure to secondhand smoke as well.

Workplace Safety

If you work in an environment with airborne irritants or chemicals, always use proper protective equipment and follow safety guidelines to minimize lung exposure.

Air Quality Awareness

Stay informed about air quality in your area and take precautions on days when pollution levels are high, such as staying indoors or using air purifiers.

Regular Exercise

Engaging in regular physical activity can help maintain lung function and overall health, potentially reducing the risk of developing emphysema.

Healthy Diet

A balanced diet rich in antioxidants and anti-inflammatory foods may help protect lung tissue from damage.

Regular Check-ups

Schedule regular health check-ups, especially if you have risk factors for emphysema. Early detection can lead to more effective management and better outcomes.

By implementing these preventive measures, individuals can significantly reduce their risk of developing emphysema and maintain better overall lung health throughout their lives.

Emphysema Stages: Symptoms, Complications, and Treatment

Emphysema typically occurs slowly in stages, usually due to years of smoking cigarettes or other types of tobacco. Your doctor will use your symptoms and breathing test results to decide your stage.

Smoking is the most common cause of a serious lung condition called emphysema. With emphysema, the air sacs (alveoli) weaken and lose their ability to contract after expanding. Air can also get trapped in these sacs, causing some to break. This can make breathing difficult and ultimately decrease the amount of oxygen you get into your bloodstream.

Smoking cigarettes causes 80 percent of all emphysema. Other causes include:

• secondhand smoke
• marijuana smoke
• air pollution
• chemical fumes
• alpha-1 antitrypsin deficiency, a genetic condition that affects the lungs

People over 40 years old, or people who smoked for long periods, are at higher risk for this condition. Once developed, emphysema can’t be reversed.

If you have emphysema, your doctor will likely diagnose the condition as chronic obstructive pulmonary disease (COPD). This is an umbrella term for lung diseases that get worse over time. They tend to cause increased breathlessness due to the combination of chronic bronchitis, emphysema, and obstructed lung airways. While COPD isn’t exactly the same, people who have emphysema are also more likely to have other lung diseases such as bronchitis, asthma, and lung cancer.

It’s common for most people to not feel the symptoms of emphysema until there’s 50 percent or more damage to the lung tissue. Early symptoms may appear gradually as shortness of breath and on-going fatigue. Sometimes they may only affect your body when you’re physically active.

But as the condition progresses, you may see an increase in:

• coughing
• chest tightness
• shortness of breath
• wheezing
• more mucus production

Eventually the feeling that you aren’t getting enough air may will also occur when you’re resting. Other symptoms that may also appear due to strained breathing include a poor appetite and weight loss.

Your doctor will determine your stage by looking at your symptoms and the results of your breathing tests.

Read more: How long can you live with stage 4 COPD? »

The spirometry and pulmonary function test (PFT) measures your airflow as you inhale and exhale. The PFT will show how much air your lungs can carry. Your doctor will then compare these results to normal results of people with a similar age, height, weight, and ethnic background.

Other tests your doctor may perform include:

• tapping your chest to listen for a hollow sound, which means there’s air trapped in your lungs
• blood tests to see how well your lungs transfer oxygen to your bloodstream and remove carbon dioxide
• electrocardiogram (ECG) to check heart function and rule out heart conditions
• a chest X-ray or a chest CT scan to look for small pockets of air in your lungs, but these aren’t helpful for detecting early stages

If left untreated, emphysema can develop into serious complications, such as:

Holes in lungs (giant bullae): These large holes make it difficult for your lung to expand. They can also get infected and may lead to a collapsed lung.

Collapsed lung: This is a life-threatening conditionfor people with emphysema because their lungs are already damaged.

Heart problems: Emphysema often increases pressure in the arteries connecting your lungs to your heart. This can cause an area of your heart to expand and then weaken.

The outlook for people with emphysema depends on the severity of the condition and how early they start treatment. The earlier you start your treatment, the better your outcome. Lung damage from emphysema is irreversible. But you can slow the progression and improve your quality of life.

The prediction of life expectancy in COPD is correlated with your symptoms and the results of one of the PFT parameters, the FEV1. This is also known as your forced expiratory volume of air within the first second of forcefully breathing out (performed right after breathing in as much air in as possible). You can also use this calculator to get an estimate of your survival rates.

People who stop smoking and take steps to protect their lungs from further damage usually have a longer life expectancy. Talk to your doctor about your outlook. Everyone’s outlook depends on the severity of their stage, treatment, and what steps they take to manage their condition.

There’s no cure for emphysema. Current treatments aim to slow the progression of the disease and reduce symptoms. Your doctor will recommend a treatment based on the severity and stage of your condition. The first line of treatment is to stop smoking, if you haven’t yet.

Medications

Your doctor may prescribe medication, such as:

• Bronchodilators: This helps open up airways to improve symptoms like breathing difficulty and coughing.
• Corticosteroids: These medications can improve breathing by removing inflammation in the lung. But long-term use increases the risk of high blood pressure, diabetes, or cataracts.
• Antibiotics: Your doctor may prescribe antibiotics if you develop infections such as bacterial pneumonia or bronchitis.

Your doctor may also recommend therapies to improve breathing and relieve symptoms. These include pulmonary rehabilitation where you’ll learn various breathing exercises. For people who need extra oxygen, your doctor may prescribe oxygen therapy. You will use a nasal cannula device or wear a facemask to breathe oxygen through a machine.

Therapies

You may also need nutrition therapy if you have other conditions such as obesity that interferes with your health and contribute to breathlessness. For more severe cases that affect younger adults without additional complications, your doctor may recommend surgery to remove damaged lung tissue or a lung transplant.

Read more: Understanding emphysema treatments »

Clinical trials

Researchers who are studying emphysema are actively looking for participants. These trials range from evaluating current treatments to new management options for people with severe emphysema. If you’re interested in participating in a clinical trial, visit CenterWatch.com.

Make a doctor’s appointment if you have shortness of breath that lasts for several months and doesn’t improve. Especially if breathlessness interferes with your daily activities. See a doctor even if your symptoms worsen, even if you already received a diagnosis.

The Mayo Clinic recommends seeking medical attention if you experience:

• difficulty talking because you are so short of breath
• a bluish or grayish tinge to your lips or fingernails
• lack of mental alertness
• a fast heartbeat

Over 11 million people in the United States have COPD, according to the American Lung Association. Of those people, three million people have emphysema, according to the Cleveland Clinic. Once you’ve developed emphysema, the damage is irreversible. The first step you can take to manage your health is to stop smoking, if you smoke. You can also wear a mask to avoid secondhand smoking or inhaling dust and chemical fumes.

Following these steps can help prevent emphysema complications from occurring.

You can also talk to your family, friends, or a counselor to relieve stress that may come with this condition. You may want to consider joining a support group for people with emphysema or lung diseases. This can be a good way to express your feelings, find out about new treatments, and coping strategies. Contact your local chapter of the American Lung Association to find a support group near you.

Read more: What happens when you quit smoking? »

Emphysema Stages: Symptoms, Complications, and Treatment

Emphysema typically occurs slowly in stages, usually due to years of smoking cigarettes or other types of tobacco. Your doctor will use your symptoms and breathing test results to decide your stage.

Smoking is the most common cause of a serious lung condition called emphysema. With emphysema, the air sacs (alveoli) weaken and lose their ability to contract after expanding. Air can also get trapped in these sacs, causing some to break. This can make breathing difficult and ultimately decrease the amount of oxygen you get into your bloodstream.

Smoking cigarettes causes 80 percent of all emphysema. Other causes include:

• secondhand smoke
• marijuana smoke
• air pollution
• chemical fumes
• alpha-1 antitrypsin deficiency, a genetic condition that affects the lungs

People over 40 years old, or people who smoked for long periods, are at higher risk for this condition. Once developed, emphysema can’t be reversed.

If you have emphysema, your doctor will likely diagnose the condition as chronic obstructive pulmonary disease (COPD). This is an umbrella term for lung diseases that get worse over time. They tend to cause increased breathlessness due to the combination of chronic bronchitis, emphysema, and obstructed lung airways. While COPD isn’t exactly the same, people who have emphysema are also more likely to have other lung diseases such as bronchitis, asthma, and lung cancer.

It’s common for most people to not feel the symptoms of emphysema until there’s 50 percent or more damage to the lung tissue. Early symptoms may appear gradually as shortness of breath and on-going fatigue. Sometimes they may only affect your body when you’re physically active.

But as the condition progresses, you may see an increase in:

• coughing
• chest tightness
• shortness of breath
• wheezing
• more mucus production

Eventually the feeling that you aren’t getting enough air may will also occur when you’re resting. Other symptoms that may also appear due to strained breathing include a poor appetite and weight loss.

Your doctor will determine your stage by looking at your symptoms and the results of your breathing tests.

Read more: How long can you live with stage 4 COPD? »

The spirometry and pulmonary function test (PFT) measures your airflow as you inhale and exhale. The PFT will show how much air your lungs can carry. Your doctor will then compare these results to normal results of people with a similar age, height, weight, and ethnic background.

Other tests your doctor may perform include:

• tapping your chest to listen for a hollow sound, which means there’s air trapped in your lungs
• blood tests to see how well your lungs transfer oxygen to your bloodstream and remove carbon dioxide
• electrocardiogram (ECG) to check heart function and rule out heart conditions
• a chest X-ray or a chest CT scan to look for small pockets of air in your lungs, but these aren’t helpful for detecting early stages

If left untreated, emphysema can develop into serious complications, such as:

Holes in lungs (giant bullae): These large holes make it difficult for your lung to expand. They can also get infected and may lead to a collapsed lung.

Collapsed lung: This is a life-threatening conditionfor people with emphysema because their lungs are already damaged.

Heart problems: Emphysema often increases pressure in the arteries connecting your lungs to your heart. This can cause an area of your heart to expand and then weaken.

The outlook for people with emphysema depends on the severity of the condition and how early they start treatment. The earlier you start your treatment, the better your outcome. Lung damage from emphysema is irreversible. But you can slow the progression and improve your quality of life.

The prediction of life expectancy in COPD is correlated with your symptoms and the results of one of the PFT parameters, the FEV1. This is also known as your forced expiratory volume of air within the first second of forcefully breathing out (performed right after breathing in as much air in as possible). You can also use this calculator to get an estimate of your survival rates.

People who stop smoking and take steps to protect their lungs from further damage usually have a longer life expectancy. Talk to your doctor about your outlook. Everyone’s outlook depends on the severity of their stage, treatment, and what steps they take to manage their condition.

There’s no cure for emphysema. Current treatments aim to slow the progression of the disease and reduce symptoms. Your doctor will recommend a treatment based on the severity and stage of your condition. The first line of treatment is to stop smoking, if you haven’t yet.

Medications

Your doctor may prescribe medication, such as:

• Bronchodilators: This helps open up airways to improve symptoms like breathing difficulty and coughing.
• Corticosteroids: These medications can improve breathing by removing inflammation in the lung. But long-term use increases the risk of high blood pressure, diabetes, or cataracts.
• Antibiotics: Your doctor may prescribe antibiotics if you develop infections such as bacterial pneumonia or bronchitis.

Your doctor may also recommend therapies to improve breathing and relieve symptoms. These include pulmonary rehabilitation where you’ll learn various breathing exercises. For people who need extra oxygen, your doctor may prescribe oxygen therapy. You will use a nasal cannula device or wear a facemask to breathe oxygen through a machine.

Therapies

You may also need nutrition therapy if you have other conditions such as obesity that interferes with your health and contribute to breathlessness. For more severe cases that affect younger adults without additional complications, your doctor may recommend surgery to remove damaged lung tissue or a lung transplant.

Read more: Understanding emphysema treatments »

Clinical trials

Researchers who are studying emphysema are actively looking for participants. These trials range from evaluating current treatments to new management options for people with severe emphysema. If you’re interested in participating in a clinical trial, visit CenterWatch.com.

Make a doctor’s appointment if you have shortness of breath that lasts for several months and doesn’t improve. Especially if breathlessness interferes with your daily activities. See a doctor even if your symptoms worsen, even if you already received a diagnosis.

The Mayo Clinic recommends seeking medical attention if you experience:

• difficulty talking because you are so short of breath
• a bluish or grayish tinge to your lips or fingernails
• lack of mental alertness
• a fast heartbeat

Over 11 million people in the United States have COPD, according to the American Lung Association. Of those people, three million people have emphysema, according to the Cleveland Clinic. Once you’ve developed emphysema, the damage is irreversible. The first step you can take to manage your health is to stop smoking, if you smoke. You can also wear a mask to avoid secondhand smoking or inhaling dust and chemical fumes.

Following these steps can help prevent emphysema complications from occurring.

You can also talk to your family, friends, or a counselor to relieve stress that may come with this condition. You may want to consider joining a support group for people with emphysema or lung diseases. This can be a good way to express your feelings, find out about new treatments, and coping strategies. Contact your local chapter of the American Lung Association to find a support group near you.

Read more: What happens when you quit smoking? »

Pulmonary tuberculosis – causes, how it is transmitted, forms, stages, symptoms, signs, diagnosis, treatment

Causes

Classification

Symptoms

Complications

Diagnosis

Treatment

900 02 Prevention

Pulmonary tuberculosis (ICD A15-A16) is an infectious disease caused by microorganisms from the genus Mycobacterium, transmitted by aspiration. The disease has been known since ancient times, but so far it has not been possible to defeat it. According to the WHO, the incidence has increased in recent years due to the spread of the coronavirus. In 2020 alone, 1.5 million people died. In the 21st century, the struggle is complicated by the appearance of hidden variants of the course and the resistance of the pathogen to drugs.

Causes of pulmonary tuberculosis

The causative agent of pulmonary tuberculosis can be several types of mycobacteria (most often Mycobacterium tuberculosis). Mycobacterium differs from other microorganisms in the presence of a dense outer shell, which allows it to survive in various adverse conditions.

The bacterium remains active and viable under the following conditions:

• at temperatures up to +90 °C and -260 °C;
• with drying and high humidity;
• under the influence of various physical influences and chemicals.

In addition, they are able to freeze, turning into L-forms that remain viable for decades, and also undergo genetic mutation, developing drug resistance, which they can pass on to new generations.

Predisposing moments for infection are:

• low social level of the population, therefore the highest incidence in developing countries;
• chronic intoxication, alcohol abuse, smoking, drug use;
• HIV infection.

How is pulmonary tuberculosis transmitted? Infection occurs through the respiratory tract. Mycobacteria spread as follows:

• by airborne droplets, when a microbe released during coughing or sneezing by a sick person enters the mucous membrane of the respiratory tract of a healthy person;
• air-dust, if bacteria accumulate in dust and then, together with dust particles, move to the respiratory system.

Classification of pulmonary tuberculosis

Based on different parameters, forms of pulmonary tuberculosis are determined.

Where possible spread:

• open, when the mycobacterium is shed by coughing and breathing into the environment;
• closed if not allocated.

Downstream:

• primary, when diagnosed for the first time;
• secondary, if infection occurs repeatedly;
• chronic pulmonary tuberculosis, when activation occurs many years after infection, is usually diagnosed in older people.

By the nature of the inflammatory process:

1. Focal pulmonary tuberculosis, in which inflammatory foci up to 1 cm in size are determined.
2. Infiltrative pulmonary tuberculosis, when areas of inflammation larger than 1 cm, can merge with each other, leading to destruction.
3. Cavernous pulmonary tuberculosis, if cavities are formed, that is, cavities filled with secret.
4. Fibrous pulmonary tuberculosis with the formation of fibrotic changes that occur at the site of inflammation.
5. Fibrous-cavernous pulmonary tuberculosis with a combination of cavities and fibrous seals.
6. Tuberculoma is a focus of necrosis surrounded by a fibrous capsule.
7. Cirrhotic, in which the proliferation of connective tissue around the cavity predominates.
8. Caseous is characterized by a severe course, the presence of necrosis within one lung lobe.

By predominant localization:

• lung tissue;
• intrathoracic lymph nodes;
• pleura;
• bronchi, trachea;
• miliary with multiple small foci on both sides;
• disseminated with spread through the lymph or blood throughout the body.

The disease proceeds for a long time. The following stages of pulmonary tuberculosis are distinguished:

1. Primary infection, in which a focus occurs at the site of the pathogen with a reaction of nearby lymph nodes.
2. Latent, or hidden, period when accumulation and distribution throughout the body occurs.
3. Active inflammation with the formation of a typical clinical picture, the formation of decay sites and the release of mycobacteria into the external environment.
4. Residual manifestations, changes in the form of fibrous bands, pneumosclerosis, emphysema, cirrhosis.
5. Outcomes, which can be both resorption of the focus, and the formation of seals at the sites of inflammation. The formation of calcifications.

Symptoms of pulmonary tuberculosis

Tuberculosis of the lungs can develop in adults and children.

The symptoms of the disease develop gradually, but in some cases a rather acute violent onset is possible, as in pneumococcal pneumonia.

During the spread of the coronavirus, the tuberculosis clinic was masked by the symptoms of a new infection that occurs with respiratory failure and damage to the respiratory organs.

Pulmonary tuberculosis is characterized by the presence of two types of clinical manifestations or signs:

• intoxication;
• respiratory syndrome.

The severity of intoxication depends on the reactivity of the organism, the activity of the pathogen, the spread of the inflammatory process.

Symptoms of intoxication:

• fever;
• profuse night sweats;
• weakness;
• unmotivated fatigue;
• loss of appetite, weight loss;
• nervousness, excessive irritability.

Respiratory syndrome has the following manifestations:

• cough of varying intensity, which can be dry or wet;
• shortness of breath at first during physical exertion, then at rest;
• discomfort, congestion, chest pain;
• labored breathing;
• hemoptysis, the presence of streaks or blood clots in the sputum, rusty sputum.

Complications of pulmonary tuberculosis

Complications can develop at different stages of the pathological process.

In the acute stage, the following are possible:

• pulmonary hemorrhage requiring urgent medical attention;
• spontaneous pneumothorax with the accumulation of air in the pleural cavity, as a result of which the work of the lungs and heart is disrupted;
• accession of secondary purulent inflammation;
• generalization of the process, the spread of pathogens throughout the body and the formation of distant foci.

In the later stages of the disease:

• pulmonary heart failure;
• chronic respiratory failure.

Diagnosis of pulmonary tuberculosis

Tuberculosis infection can be suspected with a long course of pneumonia, the absence of the effect of the therapy. An important role in early diagnosis belongs to additional studies. First of all, X-ray helps to identify pulmonary tuberculosis.

In addition to conventional images, it is possible to determine the prevalence of the process by the results of MRI and CT of the chest.

Confirm the diagnosis by the presence of the pathogen. To do this, carry out:

• sputum examination for mycobacteria;
• skin tests Mantoux or Diaskintest;
• blood test for T-POS, specific immunological test.

Treatment of pulmonary tuberculosis

Treatment is carried out in accordance with clinical guidelines for pulmonary tuberculosis. Antimicrobial and antibacterial drugs, symptomatic agents are used. The course of admission is long: therapy lasts for months and even years. Treatment is carried out under the supervision of doctors, with mandatory monitoring of liver function, since the drugs cause drug-induced hepatitis.

In some cases, an operation is indicated for pulmonary tuberculosis, aimed at removing the tuberculoma or cavern.

Prevention of pulmonary tuberculosis

Prevention starts at the hospital. The first vaccine a newborn receives is BCG. Further throughout life, revaccination is carried out and the amount of anti-tuberculosis antibodies and the intensity of immunity are determined.

When a patient is identified, the following is required:

• isolation of the patient;
• disinfection in the apartment after his hospitalization;
• surveillance of all contacts.

Such measures allow us to identify possible infected as early as possible and begin effective treatment.

Tuberculosis has been and remains one of the problems of modern medicine. Moreover, such more modern infections as HIV and COVID-19 contribute to its spread.

Article author:

Ivanova Natalya Vladimirovna

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Altitude sickness

Altitude (mountain) sickness is a disease that occurs as a result of a significant and rapid decrease in pressure in the surrounding gaseous medium.

The main etiological factor of mountain sickness is a decrease in the partial pressure of oxygen in the inhaled air as one rises to a height.

Altitude sickness develops when flying at altitudes of 3-4 km or more when breathing air or at altitudes above 12 km when breathing oxygen.

Altitude sickness develops:

• Predominantly in pilots in high-altitude flights
• When astronauts enter space
• In climbers when ascending to altitude
• In persons working in high-mountainous areas
• During ascents in pressure chambers

Pathogenesis of altitude sickness other organs.

With the ineffectiveness of the adaptive mechanisms to compensate for the hypoxic factor, there is a pronounced decrease in oxygen tension in the vital organs – in the tissues of the heart and brain. The phase of exhaustion and decompensation begins:

• the transport function of the cardiorespiratory system is impaired,
• bradycardia is observed, blood pressure decreases,
• the tone of regional vessels decreases due to the vasodilating effect of underoxidized products –
• structural damage to cells and tissues occurs

9 0033 Symptoms, severity of course, degree of disability and the outcome of altitude sickness depend on:

• Altitude and rate of ascent
• Duration and repetition of exposure
• Initial state of the organism
• Individual resistance
• Nature and intensity of work performed

In the development of the disease, 4 stages of hypoxic state are distinguished:

• Hidden
• Adaptive reactions (compensation)
• Severe disorders (decompensation)
• Terminal (critical)

Latent stage is detected at altitudes up to 3 km when breathing air or at 10. 5-11.5 km when breathing oxygen only when doing physical work.

The stage of adaptive reactions (compensation ) develops during a long stay (1 hour or more) at altitudes of 3-5 km or in the first 3-5 minutes of exposure at a height of 6-7 km when breathing air or at equivalent altitudes when breathing oxygen : there is an increase in the activity of transport systems – the respiratory and SS, as well as an increase in the tone of the nerve centers that regulate these systems.

Clinic stage of compensation:

• Face pink, eyes shining
• Euphoria, excessive gesticulation, laughter
• Violation of fine coordination, decreased visual acuity
• Inadequate attitude to the environment, the situation of the flight and to one’s own condition
• Productivity work increases, but its quality decreases

The stage of decompensation develops under conditions of prolonged stay at altitudes of 6-7 km when breathing air or at altitudes of 13-13. 8 km when breathing oxygen:

• Dizziness, feeling of heaviness in the head,
• Lethargy, sluggish and slow movements, intermittent and unintelligible speech
• Cold clammy sweat, severe visual impairment
• possible development of clonic convulsions, especially working muscles

900 27 Mental and physical work requires strong-willed effort, productivity and quality are reduced by 30-50%

The critical (terminal) stage can occur at altitudes of 6-7 km with an exposure of more than 30 minutes and 8-11 km – 10 minutes with air breathing (14 km or more – within a few seconds when breathing oxygen):

• Cardiac decompensation
• General tonic convulsions
• Severe visual disturbances (black veil)
• Loss of consciousness
• Respiratory and cardiac arrest

Clinical picture of mountain sickness has the most vivid symptoms by the 5th day of stay at altitude, in the future, adaptation may occur and the symptoms weaken.
Clinic:

• Asthenic syndrome with psychopathological manifestations: decreased memory, attention, emotional instability,
• Tactile and pain sensitivity is disturbed
• Visual acuity decreases
• Hearing and smell deteriorate

glands

• Polycythemia

Altitude the disease in pilots is acute and has 2 forms:

• collaptoid (at altitudes of 5-7 km when breathing air or 12.5-13.5 km when breathing oxygen when staying for a long time – minutes, hours), accompanied by a sharp deterioration in condition, heart weakness and loss of consciousness – complete impairment of working capacity
• fainting (with more pronounced and acute oxygen deficiency): sudden loss of consciousness with convulsive twitching of individual muscle groups oxygen tension is limited to a period of a few minutes. The period from the onset of hypoxia to a sharp deterioration in performance is the time of active consciousness or reserve time. It is inversely related to altitude (7-8 km – minutes, 11-12 km – seconds). The period from the onset of hypoxia exposure to the expiration of the period of possible spontaneous (without resuscitation procedures) recovery of suppressed functions is the “survival time” or “total rescue time”. “Survival time” in humans is estimated to be 120-150 seconds.

  With prolonged exposure to acute hypoxia, the subsequent normalization of the oxygen regime may be ineffective: cerebral edema can lead to death or the development of severe complications – decortication, posthypoxic encephalopathy.

  Treatment of altitude sickness
  Re-oxygenation:

  • Descending
  • Supply for breathing oxygen, oxygen-air mixture, carbogen

  9 0021 In severe cases – drug therapy:

  • For relief of cerebral edema: mannitol, furosemide, diacarb
  • IV glucose
  • Hyperbaric oxygen therapy

  Prevention and protection 9 0346
  Use of technical means (three-stage protection systems):

  • Pressurized cabins
  • Sets of oxygen-breathing equipment and wearable high-altitude equipment
  • Parachute oxygen devices and oxygen supply units for ejection seats

  Creation of automatic alarm systems for the development of hypoxic conditions.
  Preliminary high-altitude adaptation (performing ascents in a pressure chamber) with the formation of skills to recognize high-altitude hypoxia in an emergency in flight and take adequate measures to eliminate it.

  The developed high-altitude life support system eliminated the possibility of developing altitude sickness under normal conditions.
  Detection of reduced tolerance to hypoxia in a pilot is more often associated with transient causes or with the presence of diseases that reduce the tolerance of oxygen starvation. In this case, repeated expert pressure chamber ascents are recommended (pressure ascent to a height of 5 km for 20 minutes with a break of 7 days), and then a complete clinical and instrumental examination.

  Contraindications to climbing to heights are any disorders of the central nervous and cardiovascular systems, pituitary-endocrine disorders, pathology of the sense organs and digestive glands.
  Preliminary and regular medical examinations of flight personnel are of great importance.

  Altitude disorders of decompression genesis – disorders in the body that occur at altitude under the influence of changes in external pressure, including normal oxygen supply.

  Barocavopathy – violation of pressure equalization in gas-containing body cavities, which is characterized by: 7 Barootopathy, barosinusopathy, barodentalgia (congestion and pain in the ears, sinuses)

• Barotrauma of the lungs (in pilots with a rapid decrease)

Altitude decompression sickness (deformation of tissues by gas bubbles formed in the blood, lymph and tissues at altitude with a decrease in pressure), which is characterized by: joint and bone pain; in severe cases – respiratory, hemodynamic, cerebral disorders.

High-altitude steam-gas emphysema (difficulty in moving the arms, impaired hemodynamics and heart function)

Barotrauma – physical damage to body organs caused by pressure difference between the external environment and internal cavities.
Barotrauma usually occurs when the ambient pressure changes, for example, when diving, freediving, during takeoff or landing of an aircraft , and also in some other cases.
Boyle-Mariotte’s law defines the relationship between air volume and ambient pressure. Damage occurs in the tissues around the air cavities in the body because gases are compressible and tissues are not. With an increase or decrease in ambient pressure relative to the internal tissue of the body, they begin to deform, compensating for the difference in pressure. These deformations can lead to injury to tissues and organs.

A characteristic symptom of lung barotrauma is pulmonary bleeding of varying intensity: from bloody-foamy sputum to pure blood. Bleeding that threatens the life of a patient with lung barotrauma is short-term, although in some cases it can last up to two to three days.
Sometimes the discharge of blood from the mouth is almost not noticeable and traces of it can only be detected by a careful examination of the edges of the lips of the victim or sputum released during coughing (streaks of blood are found in the sputum).
As a rule, with barotrauma, at the moment of rupture of the lung tissue or 1-2 minutes after the diver rises to the surface, loss of consciousness occurs. Upon regaining consciousness, patients complain of chest pain, aggravated by coughing, difficulty exhaling and general weakness. Breathing in victims is superficial, rapid (sometimes up to 30-45 times per minute).

Barotrauma of the lungs (clinic)
Pulse is frequent, weak tension, sometimes barely palpable. The skin of the face, neck and upper chest is bluish in color. The face is puffy. Often, subcutaneous emphysema (air swelling) is found on the neck and face, which is easily determined by the characteristic crunch that occurs when the swelling is stroked.
All of these disorders of the cardiovascular and respiratory systems develop as a result of pneumothorax (penetration of air into the pleural cavity), which occurs as a result of rupture of the lung tissue or blockage of gas bubbles in most of the vessels of the lungs.