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Underlying emphysema. Emphysema: Stages, Symptoms, and Treatment Options Explained

by alexxlab

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 contribute to emphysema development. 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 gradually develops over time, typically as a result of long-term smoking. It’s characterized by the weakening and damage of air sacs (alveoli) in the lungs, leading to breathing difficulties and reduced oxygen intake. As part of the broader spectrum of Chronic Obstructive Pulmonary Disease (COPD), emphysema presents unique challenges for patients and healthcare providers alike.

What Causes Emphysema?

While smoking is the primary culprit behind 80% of emphysema 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. It’s crucial to understand that once emphysema develops, the damage to the lungs is irreversible.

Recognizing the Symptoms of Emphysema

Early detection of emphysema can be challenging, as symptoms often don’t manifest until significant lung damage has occurred. Typically, symptoms become noticeable when 50% or more of the lung tissue is affected. Initial signs may include:

  • Gradual onset of shortness of breath
  • Persistent fatigue
  • Difficulty breathing during physical activities

As the condition progresses, additional symptoms may emerge:

  • Chronic coughing
  • Chest tightness
  • Wheezing
  • Increased mucus production
  • Shortness of breath even at rest
  • Poor appetite and weight loss

Diagnostic Procedures for Emphysema

Accurately diagnosing emphysema involves a combination of physical examinations, medical history review, and specialized tests. Healthcare providers employ various diagnostic tools to assess lung function and determine the severity of the condition.

Key Diagnostic Tests

  1. Spirometry and Pulmonary Function Tests (PFT): These measure airflow during inhalation and exhalation, providing crucial data on lung capacity.
  2. Chest Auscultation: Doctors listen for hollow sounds indicative of trapped air in the lungs.
  3. Blood Tests: These evaluate oxygen transfer efficiency and carbon dioxide removal.
  4. Electrocardiogram (ECG): Used to assess heart function and rule out cardiac conditions.
  5. Imaging Studies: Chest X-rays and CT scans can reveal air pockets in the lungs, though they’re less effective for early-stage detection.

Is it possible to detect emphysema in its early stages? While early detection can be challenging, regular check-ups and lung function tests for high-risk individuals can help identify the condition before it progresses significantly. Prompt diagnosis is crucial for effective management and slowing the disease’s progression.

The Stages of Emphysema: Understanding Disease Progression

Emphysema typically progresses through stages, with severity determined by symptoms and lung function test results. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has established a staging system based on the forced expiratory volume in one second (FEV1) measurement:

  • Stage 1 (Mild): FEV1 ≥ 80% predicted
  • Stage 2 (Moderate): 50% ≤ FEV1 < 80% predicted
  • Stage 3 (Severe): 30% ≤ FEV1 < 50% predicted
  • Stage 4 (Very Severe): FEV1 < 30% predicted or FEV1 < 50% predicted with chronic respiratory failure

How does staging impact treatment decisions? The stage of emphysema plays a crucial role in determining the most appropriate treatment approach. As the disease progresses, more aggressive interventions may be necessary to manage symptoms and maintain quality of life.

Complications of Untreated Emphysema

Left untreated, emphysema can lead to severe complications that significantly impact a patient’s health and quality of life. Understanding these potential complications underscores the importance of early intervention and proper management.

Potential Complications

  • Giant Bullae: Large air pockets in the lungs that hinder proper lung expansion and increase infection risk.
  • Pneumothorax (Collapsed Lung): A life-threatening condition, particularly dangerous for those with pre-existing lung damage.
  • Cardiovascular Issues: Increased pressure in pulmonary arteries can lead to heart enlargement and weakening.

Can these complications be prevented? While complete prevention may not always be possible, early diagnosis, smoking cessation, and adherence to treatment plans can significantly reduce the risk of developing severe complications.

Treatment Options for Emphysema Patients

Although emphysema cannot be cured, various treatment options aim to slow disease progression, alleviate symptoms, and improve overall quality of life. The choice of treatment depends on the disease stage and individual patient factors.

Smoking Cessation

The single most important step in managing emphysema is to stop smoking. This intervention alone can significantly slow disease progression and improve lung function.

Medications

Several types of medications are commonly prescribed for emphysema management:

  • Bronchodilators: These medications help open airways, improving breathing and reducing coughing.
  • Corticosteroids: Used to reduce airway inflammation and improve lung function.
  • Antibiotics: Prescribed 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 extend survival.

Pulmonary Rehabilitation

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

Surgical Interventions

In select cases, surgical options may be considered:

  • Lung Volume Reduction Surgery (LVRS): Removes damaged lung tissue to improve breathing efficiency.
  • Bullectomy: Removes large air spaces (bullae) from the lungs.
  • Lung Transplantation: Reserved for the most severe cases where other treatments have failed.

How effective are these treatments in managing emphysema symptoms? While individual responses vary, many patients experience significant symptom relief and improved quality of life with appropriate treatment. The key lies in early intervention and a comprehensive management approach tailored to each patient’s needs.

Living with Emphysema: Prognosis and Quality of Life

The outlook for individuals with emphysema varies depending on several factors, including the stage of the disease at diagnosis, adherence to treatment plans, and lifestyle choices. While emphysema is a progressive condition, proper management can significantly impact life expectancy and quality of life.

Factors Influencing Prognosis

  • Disease Stage: Earlier diagnosis generally correlates with better outcomes.
  • Smoking Status: Those who quit smoking typically have a more favorable prognosis.
  • Treatment Adherence: Consistent follow-through with prescribed treatments is crucial.
  • Comorbidities: The presence of other health conditions can affect overall prognosis.

Can emphysema patients lead fulfilling lives? With proper management and lifestyle adjustments, many individuals with emphysema can maintain a good quality of life. Engaging in pulmonary rehabilitation, staying physically active within prescribed limits, and maintaining a healthy diet can all contribute to better outcomes.

Life Expectancy Considerations

While it’s challenging to predict exact life expectancy for emphysema patients, the BODE index (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) is often used to estimate prognosis. This multidimensional grading system takes into account various factors to provide a more comprehensive assessment of disease severity and potential outcomes.

Preventing Emphysema: Steps Towards Lung Health

While not all cases of emphysema can be prevented, certain measures can significantly reduce the risk of developing this condition or slow its progression in those already diagnosed.

Key Prevention Strategies

  1. Avoid Smoking: The single most effective way to prevent emphysema is to abstain from smoking or quit if you currently smoke.
  2. Limit Exposure to Pollutants: Minimize exposure to secondhand smoke, air pollution, and occupational chemicals.
  3. Regular Exercise: Engaging in regular physical activity can help maintain lung function and overall health.
  4. Healthy Diet: A balanced diet rich in antioxidants may help protect lung tissue from damage.
  5. Vaccinations: Stay up-to-date with flu and pneumonia vaccines to prevent respiratory infections.

Is it ever too late to start protecting your lungs? It’s never too late to take steps towards better lung health. Even individuals with existing lung damage can benefit from lifestyle changes and preventive measures, potentially slowing disease progression and improving quality of life.

Importance of Regular Check-ups

Regular medical check-ups, especially for those at higher risk of emphysema, can lead to early detection and more effective management. Individuals with a history of smoking or exposure to lung irritants should discuss screening options with their healthcare providers.

By understanding the causes, symptoms, and management options for emphysema, individuals can take proactive steps to protect their lung health and improve their overall well-being. While emphysema presents significant challenges, advances in treatment and management strategies offer hope for better outcomes and improved quality of life for those affected by this condition.

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 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 the 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 reaching 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 (divided 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.
  • EHA (Arterial Blood Gas Analysis): A blood sample, usually from the radial artery, showing oxygen deficiency in the blood caused by obstruction of arterial metabolism.

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

Being an obstructive pathology, the main goal is to facilitate air exchange, so the therapeutic approach uses:

  • bronchodilators,
  • inhaled corticosteroids (cortisone),
  • antibiotics (in case of underlying bacterial infection)

They may be associated with rehabilitative methods of respiratory physiology aimed at teaching the patient some exercises that can support his spontaneous ventilation capacity.

Oxygen therapy can be used in cases where, despite the restoration of the mechanics of breathing, metabolic processes still do not guarantee an adequate supply of oxygen in the surrounding air.

As a last resort for extrema ratio, surgery to eliminate a non-functional part of the lung or even to transplant a lung (which is obviously the last therapeutic option) can be considered.

Prevention

Since emphysematous degeneration is an irreversible process, a thorough prevention process remains fundamental, in which abstinence from smoking is the pivot on which a healthier lifestyle is built, which also includes:

  • regular physical exercise that can simultaneously improve the functioning of the respiratory and cardiac systems,
  • avoid exposure to other irritants,
  • avoid respiratory infections, possibly supplementing prophylaxis with appropriate influenza and pneumococcal vaccinations (especially for the elderly or those at occupational risk).

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

Causes

Classification

Symptoms

Complications

Diagnosis

Treatment

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 coughed and breathed 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.

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 emergency 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 imaging, 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 case is identified, the following is required:

  • isolation of the case;
  • 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 Natalia Vladimirovna

therapist

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