What are the stages of emphysema. How is emphysema diagnosed. What are the complications of untreated emphysema. What treatment options are available for emphysema. How can emphysema progression be slowed.

Understanding Emphysema: A Progressive Lung Disease

Emphysema is a serious lung condition that falls under the umbrella of Chronic Obstructive Pulmonary Disease (COPD). It develops gradually, often due to long-term exposure to tobacco smoke or other irritants. The disease causes damage to the air sacs (alveoli) in the lungs, leading to breathing difficulties and reduced oxygen intake.

While smoking is the primary cause of emphysema, accounting for 80% of cases, other factors can contribute to its development:

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

Individuals over 40 years old and those with a history of prolonged smoking are at higher risk for developing emphysema. Unfortunately, once the condition sets in, the damage is irreversible. However, early diagnosis and proper management can significantly improve quality of life and slow disease progression.

Recognizing Emphysema Symptoms: Early Warning Signs

Emphysema often progresses silently, with symptoms becoming noticeable only after significant lung damage has occurred. Typically, symptoms become apparent when 50% or more of the lung tissue is affected. Early signs of emphysema may include:

• Shortness of breath, especially during physical activity
• Persistent fatigue
• Gradual increase in coughing
• Chest tightness
• Wheezing
• Increased mucus production

As the disease advances, breathing difficulties may occur even at rest. Additional symptoms may emerge, such as poor appetite and weight loss, due to the increased effort required for breathing.

When should you seek medical attention for emphysema symptoms?

If you experience persistent shortness of breath, chronic cough, or any of the symptoms mentioned above, it’s crucial to consult a healthcare provider promptly. Early diagnosis and treatment can significantly impact the course of the disease and improve long-term outcomes.

Diagnosing Emphysema: Tests and Procedures

Diagnosing emphysema involves a combination of physical examinations, medical history review, and various diagnostic tests. Healthcare providers employ several methods to assess lung function and determine the severity of the condition:

1. Spirometry and Pulmonary Function Tests (PFT): These tests measure airflow during inhalation and exhalation, providing crucial information about lung capacity and function.
2. Physical examination: Doctors may tap on the chest to listen for hollow sounds, indicating trapped air in the lungs.
3. Blood tests: These assess how well the lungs transfer oxygen to the bloodstream and remove carbon dioxide.
4. Electrocardiogram (ECG): This test checks heart function and rules out cardiac conditions that may mimic emphysema symptoms.
5. Imaging studies: Chest X-rays or CT scans can reveal small pockets of air in the lungs, though these may not be effective for detecting early-stage emphysema.

How is the severity of emphysema determined?

The severity of emphysema is typically classified into stages based on symptoms and the results of pulmonary function tests. The forced expiratory volume in one second (FEV1) is a key parameter used to assess disease progression and predict life expectancy in COPD patients.

Emphysema Stages: From Mild to Severe

Emphysema progresses through several stages, each characterized by increasing severity of symptoms and declining lung function. While individual experiences may vary, the general progression of emphysema stages includes:

Stage 1: Mild Emphysema

In this early stage, individuals may experience minimal symptoms, often attributed to aging or being out of shape. Lung function tests may show slight abnormalities, but overall lung capacity remains near normal.

Stage 2: Moderate Emphysema

As the disease progresses, shortness of breath becomes more noticeable, especially during physical activities. Coughing and mucus production may increase, and lung function tests show more significant declines.

Stage 3: Severe Emphysema

At this stage, breathing difficulties become more pronounced, even during routine activities. Frequent exacerbations (flare-ups) may occur, and quality of life is significantly impacted. Lung function tests reveal substantial airflow limitations.

Stage 4: Very Severe Emphysema

In the most advanced stage, breathing problems are constant and severe. Oxygen therapy may be necessary, and even minimal exertion can cause extreme shortness of breath. Complications such as respiratory failure and heart problems are more likely to occur.

Complications of Untreated Emphysema: Beyond Breathing Difficulties

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

• Giant bullae: Large air pockets in the lungs that interfere with normal lung expansion and increase the risk of infections.
• Pneumothorax: A collapsed lung, which is particularly dangerous for individuals with already compromised lung function.
• Pulmonary hypertension: Increased pressure in the arteries connecting the lungs to the heart, potentially leading to heart enlargement and weakening.
• Cor pulmonale: Right-sided heart failure resulting from long-term pulmonary hypertension.
• Respiratory failure: Severe impairment of gas exchange in the lungs, often requiring mechanical ventilation.

Can emphysema-related complications be prevented?

While some complications may be inevitable as the disease progresses, early diagnosis, proper treatment, and lifestyle modifications can significantly reduce the risk and severity of complications. Regular medical check-ups and adherence to treatment plans are crucial in managing emphysema and preventing associated complications.

Treatment Options for Emphysema: Managing Symptoms and Slowing Progression

Although there is no cure for emphysema, various treatment options can help manage symptoms, improve quality of life, and slow disease progression. Treatment approaches are tailored to individual needs and may include:

Lifestyle Modifications

The first and most crucial step in treating emphysema is smoking cessation. Quitting smoking can significantly slow disease progression and improve overall health. Other lifestyle changes may include:

• Avoiding secondhand smoke and air pollutants
• Maintaining a healthy diet and weight
• Engaging in regular, moderate exercise as tolerated
• Practicing stress management techniques

Medications

Various medications can help manage emphysema symptoms and improve lung function:

• Bronchodilators: These medications help open airways, easing breathing difficulties and coughing.
• Corticosteroids: Inhaled or oral corticosteroids can reduce inflammation in the airways.
• Antibiotics: Used to treat respiratory infections that can exacerbate emphysema symptoms.
• Mucolytics: These drugs help thin and loosen mucus, making it easier to clear airways.

Oxygen Therapy

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

Pulmonary Rehabilitation

This comprehensive program combines exercise, education, and support to help individuals with emphysema improve their physical and emotional well-being. Pulmonary rehabilitation can enhance exercise capacity, reduce symptoms, and teach valuable self-management skills.

Surgical Interventions

In severe cases, surgical options may be considered:

• Lung volume reduction surgery: Removal of damaged lung tissue to allow healthier lung tissue to function more efficiently.
• Bullectomy: Surgical removal of large air spaces (bullae) in the lungs.
• Lung transplantation: A last-resort option for individuals with end-stage emphysema who meet specific criteria.

How effective are current treatments for emphysema?

While treatments cannot reverse lung damage, they can significantly improve symptoms, slow disease progression, and enhance quality of life. The effectiveness of treatment varies among individuals and depends on factors such as disease severity, overall health, and adherence to treatment plans. Regular follow-ups with healthcare providers are essential to monitor progress and adjust treatments as needed.

Living with Emphysema: Strategies for Daily Management

Managing emphysema extends beyond medical treatments. Adopting strategies for daily living can help individuals cope with symptoms and maintain a better quality of life:

Breathing Techniques

Learning and practicing specific breathing techniques can help manage shortness of breath and improve oxygen efficiency. Some useful techniques include:

• Pursed-lip breathing
• Diaphragmatic (belly) breathing
• Coordinated breathing during activities

Energy Conservation

Conserving energy throughout the day can help reduce breathlessness and fatigue. Strategies may include:

• Sitting while performing tasks when possible
• Using assistive devices for daily activities
• Planning activities and taking frequent rest breaks
• Organizing living spaces to minimize unnecessary movement

Nutrition and Hydration

Proper nutrition and hydration are crucial for individuals with emphysema. A balanced diet can help maintain strength and energy levels, while adequate hydration can help thin mucus secretions. Consider the following tips:

• Eat smaller, more frequent meals to avoid feeling overly full
• Choose nutrient-dense foods to meet caloric needs
• Stay well-hydrated throughout the day
• Consult with a dietitian for personalized nutrition advice

Stress Management

Living with a chronic condition like emphysema can be stressful. Implementing stress management techniques can improve overall well-being and potentially reduce symptom exacerbations. Some helpful approaches include:

• Practicing mindfulness or meditation
• Engaging in gentle yoga or tai chi
• Joining support groups for individuals with COPD
• Seeking counseling or therapy when needed

How can individuals with emphysema maintain a good quality of life?

Maintaining a good quality of life with emphysema involves a multifaceted approach. By combining medical treatments with lifestyle modifications, adopting coping strategies, and seeking support, individuals can effectively manage their symptoms and continue to engage in meaningful activities. Regular communication with healthcare providers and loved ones is essential in navigating the challenges of living with emphysema.

Emphysema Prevention: Protecting Lung Health

While not all cases of emphysema can be prevented, several measures can significantly reduce the risk of developing the condition or slow its progression:

Smoking Cessation

Quitting smoking is the single most important step in preventing emphysema. For those who have already developed the condition, smoking cessation can slow disease progression and improve overall health. Resources for quitting include:

• Nicotine replacement therapy
• Prescription medications
• Counseling and support groups
• Smartphone apps and online resources

Avoiding Environmental Irritants

Reducing exposure to environmental factors that can damage lung tissue is crucial. This includes:

• Minimizing exposure to secondhand smoke
• Using protective equipment when working with chemicals or in dusty environments
• Monitoring air quality and staying indoors on high-pollution days
• Properly ventilating living and working spaces

Regular Health Check-ups

Routine medical check-ups can help detect early signs of lung disease. This is particularly important for individuals with risk factors such as a history of smoking or occupational exposures. Regular check-ups may include:

• Lung function tests
• Physical examinations
• Discussions about lifestyle and occupational risks

Maintaining Overall Health

General health practices that support lung function and overall well-being include:

• Engaging in regular physical activity
• Maintaining a healthy diet rich in antioxidants
• Staying up-to-date with vaccinations, particularly for flu and pneumonia
• Managing stress through relaxation techniques and social support

What role does genetics play in emphysema risk?

While smoking is the primary risk factor for emphysema, genetic factors can influence susceptibility to the disease. The most well-known genetic risk factor is alpha-1 antitrypsin deficiency, a rare inherited disorder that can lead to emphysema even in non-smokers. Individuals with a family history of COPD or early-onset emphysema should discuss genetic testing options with their healthcare provider.

The Future of Emphysema Treatment: Emerging Therapies and Research

As our understanding of emphysema and COPD continues to evolve, researchers are exploring new treatment approaches and potential therapies. Some promising areas of research include:

Stem Cell Therapy

Investigations into the use of stem cells to regenerate damaged lung tissue are ongoing. While still in experimental stages, this approach holds potential for repairing emphysema-related lung damage.

Targeted Molecular Therapies

Researchers are developing medications that target specific molecular pathways involved in lung inflammation and tissue destruction. These targeted therapies aim to provide more effective treatment with fewer side effects.

Improved Inhaler Technologies

Advancements in inhaler design and drug delivery systems are enhancing the effectiveness of respiratory medications. Smart inhalers that track usage and provide reminders are also being developed to improve treatment adherence.

Gene Therapy

For individuals with genetic forms of emphysema, such as alpha-1 antitrypsin deficiency, gene therapy approaches are being explored to correct the underlying genetic defect.

Lung Microbiome Research

Studies on the lung microbiome are providing insights into how bacterial communities in the lungs may influence emphysema progression and exacerbations. This research may lead to new therapeutic approaches targeting the lung microbiome.

What is the potential impact of these emerging therapies on emphysema treatment?

While many of these emerging therapies are still in development or early clinical trials, they offer hope for more effective treatments and potentially even reversing lung damage in the future. As research progresses, individuals with emphysema may have access to more personalized and targeted treatment options, potentially improving outcomes and quality of life.

In conclusion, emphysema remains a challenging chronic lung condition, but advances in understanding and treating the disease continue to improve the outlook for affected individuals. By combining current treatment approaches with emerging therapies and maintaining a proactive approach to lung health, those living with emphysema can look forward to better management of their condition and enhanced quality of life.

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? »

Altitude sickness

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

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:

• Mostly for pilots in high-altitude flights terrain
• When lifting in pressure chambers

The pathogenesis of altitude sickness
The decrease in the partial pressure of oxygen in the inhaled air as you rise to a height causes the appearance of reflex adaptive reactions of all types of metabolism, the central nervous system and other organs.

If the adaptive mechanisms to compensate for the hypoxic factor are ineffective, 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 disturbed,
• 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

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

• Altitude and speed of ascent
• Duration and repetition of exposure
• Baseline
• Individual resistance
• The nature and intensity of the work performed

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

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

Latent stage 90 002 is detected at altitudes up to 3 km when breathing air or at 10. 5-11, 5 km while breathing oxygen only when performing 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 – 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 state
• 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 16 Mental and physical work requires strong will 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 impaired
• Visual acuity decreases
• Hearing and smell deteriorate

Prolonged stay at altitude is accompanied by: glands

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.

  Altitude sickness treatment
  Reoxygenation:

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

  9 0002 In severe cases – drug therapy:

  • Cerebral edema: mannitol, furosemide, diacarb
  • IV glucose
  • Hyperbaric oxygen therapy

  Prevention and protection 9 0004
  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: 6 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, during 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 clear 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 be detected only 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 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.
Often, patients complain of pain in the joints, muscles, bones and other organs that occur as a result of blockage of blood vessels by gas bubbles.

Prevention of decompression disorders
Special high-altitude diet, timely detection of gastrointestinal diseases.
Slowing down or stopping the descent (high-altitude jump method), swallowing movements, voluntary yawning.
Timely treatment of inflammatory processes in the nasopharynx, dental sanitation.
Correctly fitted high-altitude compensating suit and high-altitude suit.
Preliminary desaturation of the body from nitrogen by breathing pure oxygen before high-altitude flight

Pulmonary emphysema: symptoms, causes and treatment

Introduction

Emphysema is a disease that affects the respiratory system, resulting in reduced ability to ventilate the lungs.

A patient with emphysema shows a true change in the architecture of the lungs: the walls of the alveoli (the deepest parts of the bronchial tree) tend to expand, eventually collapsing and giving rise to an abnormal fibrous repair process.

In most cases, since smoking is the main causative agent of emphysema, this condition may be associated with chronic bronchitis; the combination of these two pathologies in the same patient is COPD (chronic obstructive pulmonary disease).

Most patients have very non-specific symptoms

• Chronic dyspnea (shortness of breath)
• and cough, with or without sputum production;

As the disease progresses, both symptoms worsen: if at first dyspnea is felt only during physical activity (this may be just climbing stairs), then over time the disorder becomes more frequent until rest is also affected. Some patients may find hissing during breathing due to airflow obstruction.

Diagnosis is predominantly clinical and is based on various types of examinations, the main of which is spirometry.

Treatment is mainly aimed at reducing risk factors, since the destruction of the walls of the alveolus in most cases becomes irreversible.

Causes

The respiratory tree originates in the oral and nasal cavities and then continues into the upper respiratory tract:

• nasal cavities,
• throat
• larynx,

and in the lower respiratory tract:

• trachea,
• main bronchi (arising from the carina, i.e. the bifurcation of the trachea) and gradually subdividing into branches of ever smaller caliber (and primarily with a thinner wall) until they reach the terminal bronchioles and respiratory bronchioles. Below them, the airways expand, forming small thin-walled sacs – alveoli.

Gas exchange takes place inside the alveoli due to the extremely thin walls.

In patients with emphysema, as a result of a series of injuries, the walls of the alveoli are worn out, which leads to their abnormal expansion. Over time, this leads to rupture of the walls and, ultimately, to the reparative process of fibrosis, which drastically reduces the necessary elasticity of the lungs.

The main risk factors are:

• Cigarette smoking (the most important risk factor for both emphysema and chronic bronchitis),
• passive smoking,
• exposure to irritants (environmental and occupational pollution),
• old age (due to weakening of normal alveolar structures)

These agents are believed to be responsible for the imbalance at the alveolar level between destructive and protective factors, with an increase in the former; Finally, we must be aware of the existence of congenital conditions, such as alpha1 antitrypsin deficiency, which may predispose to congenital weakness in the lung defenses, leading to the development of emphysema at a young age.

There are different types of emphysema, usually associated with different underlying causes:

• Centroacinar emphysema: Affects the region of the respiratory bronchioles (not the alveoli themselves), mainly in the upper lobes of the lungs. This is the most common form and is commonly seen in smokers.
• Paraseptal emphysema: affects the alveoli, especially in the peripheral lung parenchyma (located just below the pleura).
• Panlobular emphysema: equally affects the central part (respiratory bronchioles) and distal part (alveoli). It affects mainly the lower lobes of the lungs and is characteristic of patients with alpha1-antitrypsin deficiency.

Symptoms

Obstructive diseases, typified by emphysema, mainly affect pulmonary exhalation; therefore, the characteristic symptoms of this pathology are:

• Dyspnea: the main symptom of emphysema, the subject experiences severe breathing difficulties (especially in the expulsive phase), up to a real “air hunger”. This disorder begins with exercise, then becomes more frequent, and finally appears at rest.
• Cough, usually dry and coughy if there is only occult emphysema. In the presence of chronic bronchitis, it is usually manifested by the release of mucus and sputum.
• Weight loss.
• “Barrel” chest, a sign of air entrapment and severe damage to the alveoli.

Complications

The most serious complications associated with emphysema are:

• Pneumothorax is a change in the normal conformation of the lung (usually a true rupture of the alveolar anatomy) with the elimination of the pressure difference between pressure in the lung and pressure in the pleural cavity. This cancellation prevents the damaged lung from continuing to expand properly. Types of pneumothorax can be further divided into three subcategories:
  • Spontaneous penumothorax due to ruptured pulmonary bullae (subdivided into primary and secondary).
  • Open pneumothorax characterized by outward rupture.
  • Closed penumothorax, in which the pleural rupture looks towards the lung parenchyma.
• Bubble formation in the lung parenchyma (which may later lead to secondary spontaneous penumothorax).
• Pneumonia.
• Heart problems (due to increased pulmonary pressure congesting the right cavities of the heart).

Diagnosis

Diagnosis begins clinically, with a thorough history of risk factors (especially history of smoking or occupational exposure), but continues with instrumental examinations that allow for an accurate diagnosis, if needed, and the degree of damage.

The main exams are:

• Spirometry: a clinical test that identifies airway pathologies in two main categories (restrictive and obstructive, which includes emphysema). Then this test can be supplemented with the introduction of special drugs for differential diagnosis between various obstructive diseases.
• Chest x-ray.
• CT scan of the chest, in case the x-ray is inconclusive.
• EGA (arterial blood gas analysis): A blood sample, usually from the radial artery, showing oxygen deficiency in the blood caused by arterial obstruction.

Unfortunately, there is no real curative therapy, since the destruction of the alveolar walls is an irreversible process.