What are the first signs of emphysema. How is COPD staged using the GOLD criteria. What factors contribute to the development and progression of lung diseases. How can early detection and proper management improve quality of life for those with respiratory conditions.

The Prevalence and Impact of Lung Disorders

Lung disorders affect a significant portion of the adult population, with far-reaching consequences on health and quality of life. According to the Centers for Disease Control and Prevention (CDC), approximately one in seven U.S. adults, ranging from middle age to advanced age, suffer from some form of lung disorder. While about 10 percent of these cases are considered mild, lung issues have emerged as the third leading cause of death in the United States.

Common lung diseases such as asthma, emphysema, chronic bronchitis, and chronic obstructive pulmonary disease (COPD) share a key characteristic: reduced airflow. This limitation in breathing capacity can lead to shortness of breath, impacting daily activities and overall well-being. For seniors residing in specialized communities like Lakeland Rehabilitation and Health Care Center, access to expert care can be crucial in managing symptoms and maintaining an enjoyable lifestyle.

Recognizing the Early Signs of COPD in Seniors

Chronic Obstructive Pulmonary Disease (COPD) often develops gradually, with symptoms that may go unnoticed in the early stages. However, being aware of the initial signs can lead to earlier diagnosis and more effective management. The first signs of COPD in seniors typically include:

• A persistent cough lasting longer than two months
• Excessive mucus production
• Fatigue and shortness of breath

As COPD progresses, individuals may experience additional symptoms such as:

• Chest pain and tightness
• Wheezing
• Coughing up blood
• Swelling in the lower extremities
• Unintended weight loss

Is COPD more prevalent in certain age groups? While COPD can affect individuals of all ages, it is more commonly diagnosed in older adults. This is often due to the cumulative effects of long-term exposure to risk factors such as smoking or occupational hazards.

Understanding Emphysema: A Common Form of COPD

Emphysema, a type of COPD, is one of the most well-known lung diseases. It primarily results from long-term exposure to irritants that damage the lungs, with tobacco smoke being the most common culprit. As emphysema progresses, breathing becomes increasingly difficult. The first signs of emphysema often include:

• A cough producing large amounts of mucus
• Frequent coughing or wheezing
• Chest tightness
• A squeaking sound while breathing
• Shortness of breath, particularly during or after physical activity

How does emphysema differ from other forms of COPD? Emphysema specifically affects the alveoli, or air sacs, in the lungs. It causes these structures to break down over time, reducing the surface area available for oxygen exchange and making it harder to exhale completely.

The GOLD System: A Framework for COPD Classification

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has developed a comprehensive system for classifying COPD severity and guiding treatment decisions. This system, known as the GOLD staging or grading system, takes into account multiple factors to provide a more holistic view of a patient’s condition.

Key Components of the GOLD System

The GOLD system evaluates COPD based on several criteria:

1. Symptoms
2. Frequency of COPD exacerbations
3. Hospitalization history due to COPD
4. Spirometry test results

Why is the GOLD system important for COPD management? The GOLD system allows healthcare providers to tailor treatment plans more effectively, ensuring that patients receive appropriate interventions based on the severity and specific characteristics of their condition.

Spirometry: A Crucial Tool in COPD Assessment

Spirometry plays a central role in the diagnosis and staging of COPD. This lung function test measures two key parameters:

• Forced Expiratory Volume in one second (FEV1): The amount of air you can forcefully exhale in one second
• Forced Vital Capacity (FVC): The total amount of air you can forcefully exhale after taking a deep breath

The ratio of these two values (FEV1/FVC) is used to determine the presence and severity of airflow limitation. A lower ratio indicates more severe obstruction.

Interpreting Spirometry Results

The GOLD system uses the following grades based on post-bronchodilator FEV1:

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

How often should spirometry be performed in COPD patients? Regular spirometry testing, typically annually or more frequently if symptoms worsen, helps track disease progression and adjust treatment plans accordingly.

Assessing Symptom Burden and Exacerbation Risk

In addition to spirometry results, the GOLD system incorporates symptom assessment and exacerbation history to provide a more comprehensive picture of COPD severity.

Symptom Assessment Tools

Two commonly used questionnaires help evaluate symptom burden:

• The Modified Medical Research Council (mMRC) Dyspnea Scale: Assesses breathlessness
• The COPD Assessment Test (CAT): Measures the overall impact of COPD on daily life

Exacerbation Risk

Exacerbations, or sudden worsening of COPD symptoms, are important indicators of disease severity and future risk. The GOLD system considers:

• The number of exacerbations in the past year
• Any hospitalizations due to COPD exacerbations

Why are exacerbations significant in COPD management? Frequent exacerbations can accelerate lung function decline and negatively impact quality of life. Identifying patients at high risk for exacerbations allows for more targeted preventive strategies.

COPD Groups: A Comprehensive Classification Approach

The GOLD system combines spirometry grades, symptom scores, and exacerbation history to place patients into one of four groups: A, B, C, or D. This classification helps guide treatment decisions and predict outcomes.

Group Characteristics

• Group A: Low symptom burden, low exacerbation risk
• Group B: High symptom burden, low exacerbation risk
• Group C: Low symptom burden, high exacerbation risk
• Group D: High symptom burden, high exacerbation risk

How does group classification influence treatment strategies? Each group has specific recommended interventions, ranging from bronchodilators and pulmonary rehabilitation to more intensive pharmacological treatments and consideration of surgical options in severe cases.

Beyond GOLD: The BODE Index and Multidimensional Assessment

While the GOLD system provides valuable insights, other assessment tools can offer additional prognostic information. The BODE Index is one such multidimensional grading system that considers:

• Body mass index (B)
• Airflow Obstruction (O)
• Dyspnea (D)
• Exercise capacity (E)

The BODE Index has been shown to be a better predictor of survival in COPD patients than FEV1 alone. It provides a score ranging from 0 to 10, with higher scores indicating a higher risk of mortality.

How does the BODE Index complement the GOLD system? While GOLD focuses on current symptoms and exacerbation risk, the BODE Index offers a more comprehensive view of overall health status and prognosis, helping to guide long-term management strategies.

Strategies for Slowing COPD Progression

While COPD is a progressive disease, there are several strategies that can help slow its advancement and improve quality of life:

1. Smoking cessation: The single most important intervention for COPD patients who smoke
2. Regular exercise: Improves cardiovascular fitness and muscle strength
3. Pulmonary rehabilitation: A comprehensive program combining exercise, education, and support
4. Proper nutrition: Maintaining a healthy weight and balanced diet
5. Vaccination: Preventing respiratory infections through immunization
6. Medication adherence: Following prescribed treatment regimens
7. Avoiding triggers: Minimizing exposure to air pollutants and irritants

Can COPD progression be completely halted? While current treatments cannot reverse lung damage, early intervention and adherence to management strategies can significantly slow disease progression and improve outcomes.

The Role of Specialized Care in COPD Management

For seniors with COPD, access to specialized care can make a significant difference in disease management and quality of life. Facilities like Lakeland Rehabilitation and Health Care Center offer comprehensive support, including:

• Personalized care plans developed in collaboration with physicians and specialists
• Fitness programs tailored to individual capabilities and goals
• Respiratory therapy and education
• Nutritional support
• Social and recreational activities to promote overall well-being

How does specialized care impact COPD outcomes? By providing a supportive environment with access to expert care and resources, specialized facilities can help patients better manage their symptoms, reduce exacerbations, and maintain independence for longer periods.

Emerging Trends in COPD Research and Treatment

The field of COPD management is continuously evolving, with ongoing research into new treatment modalities and management approaches. Some promising areas of investigation include:

• Targeted biologics: Drugs designed to address specific inflammatory pathways in COPD
• Gene therapy: Exploring genetic factors that influence COPD susceptibility and progression
• Lung regeneration techniques: Investigating methods to repair or regrow damaged lung tissue
• Advanced bronchoscopic interventions: Minimally invasive procedures to improve lung function
• Artificial intelligence in disease monitoring: Using AI to predict exacerbations and optimize treatment

What potential breakthroughs are on the horizon for COPD treatment? While many of these approaches are still in experimental stages, they offer hope for more personalized and effective COPD management strategies in the future.

The Importance of Early Detection and Intervention

Recognizing the early signs of emphysema and COPD is crucial for timely intervention and improved outcomes. Regular check-ups, especially for individuals with risk factors such as smoking history or occupational exposures, can lead to earlier diagnosis and more effective management.

Key steps for early detection include:

1. Annual physical examinations with lung function assessments
2. Prompt reporting of persistent respiratory symptoms to healthcare providers
3. Participation in lung cancer screening programs for eligible individuals
4. Awareness of occupational risks and appropriate protective measures

How does early detection impact COPD prognosis? Early diagnosis allows for timely implementation of lifestyle changes, smoking cessation programs, and appropriate medical interventions, potentially slowing disease progression and preserving lung function for longer periods.

Living Well with COPD: Empowering Patients and Caregivers

While COPD presents significant challenges, many individuals can maintain a good quality of life with proper management and support. Key aspects of living well with COPD include:

• Education: Understanding the disease, its triggers, and management strategies
• Self-management skills: Learning to monitor symptoms and respond appropriately
• Emotional support: Addressing the psychological impact of chronic disease
• Family involvement: Engaging loved ones in the care process
• Community resources: Utilizing support groups and local COPD programs

How can patients and caregivers stay informed about COPD management? Regularly consulting with healthcare providers, participating in patient education programs, and staying updated on new research and treatment options can empower individuals to take an active role in their COPD management.

In conclusion, understanding emphysema and COPD, from early signs to advanced stages, is crucial for effective management and improved quality of life. The GOLD system provides a comprehensive framework for assessing disease severity and guiding treatment decisions. With ongoing advancements in research and care approaches, individuals with COPD have increasing opportunities to manage their condition effectively and maintain an active, fulfilling lifestyle. Early detection, adherence to treatment plans, and access to specialized care can make a significant difference in the journey of living with COPD.

Understanding the First Signs of Emphysema

The Centers for Disease Control and Prevention (CDC) estimates that about one in seven U.S. adults, from middle age to advanced age, suffer from a lung disorder. While as many as 10 percent of those people have mild cases, lung issues are the third leading cause of death in the U.S.

People who have common lung diseases, like asthma, emphysema, chronic bronchitis and chronic obstructive pulmonary disease (COPD) have reduced air flow, which causes shortness of breath. No matter what your age, shortness of breath can impact your daily life and limit your ability to participate in activities you enjoy. Seniors who live in communities, like Lakeland Rehabilitation and Health Care Center, are in the care of experts with experience supporting symptoms of these diseases and helping to maintain a lifestyle they enjoy.

If you or a loved one may have a lung disease, it helps to understand the first signs of COPD in seniors, as well as the first signs of emphysema and how to find the support you need on your health journey.

What are the First Signs of COPD in Seniors?

In the early stages, COPD may be mild enough that you do not experience or notice any symptoms. Overall, symptoms vary from person to person; however, the disease is progressive and the first signs of COPD in seniors often include:

• A chronic cough (meaning a cough that persists for longer than two months)
• Producing too much mucus
• Tiredness and shortness of breath

Because your lungs are in a weakened state, COPD patients are more susceptible to chest infections, such as pneumonia, the common cold and the flu. As the disease progresses, you might exhibit symptoms such as:

• Chest pain
• Wheezing
• Chest tightness
• Coughing up blood
• Swelling in the lower legs
• Unintentional weight loss

What are the First Signs of Emphysema?

Emphysema is one of the most commonly known diseases of the lungs and it is a type of COPD. The most common cause of emphysema is long-term exposure to irritants that can damage your lungs, such as tobacco smoke. The disease causes breathing to become more difficult over time. So, what are the first signs of emphysema? Those include:

• A cough that produces a large amount of mucus
• Frequent coughing or a cough that wheezes
• Tightness of the chest
• A squeaky sound when you breathe
• Shortness of breath, especially during or after physical activity

It is common for people with emphysema to frequently get sick with respiratory infections, like the flu or a cold. In severe cases of emphysema, patients can have weakness in the lower muscles, swelling in the ankles, legs or feet and weight loss.

Finding Care and Comfort

At Lakeland Rehabilitation, our focus is to help you or your loved one to reach established health goals, in a safe environment, by following a personalized care plan. We work closely with your specialty doctors, personal physician and your family to create an individual plan based on your health goals and your lifestyle. From our fitness programs to our on-site salon and barber shop, we are ready to provide you with a healing experience for your mind, body and spirit.

Contact us today to schedule a tour and learn more about our services and our community.

COPD Stages and the GOLD Criteria: 4 Stages Explained

Written by Matthew Hoffman, MD

Medically Reviewed by Poonam Sachdev on May 15, 2023

• What Is the GOLD System for Grading COPD?
• Spirometry and Your COPD Stage
• GOLD Stages or Grades
• Symptom Grades
• Spirometry Grades
• Exacerbation Risk
• Other Health Problems
• COPD Groups
• COPD Stages
• Can You Postpone Advanced or End-Stage COPD?
• The BODE Index
• More

Chronic obstructive pulmonary disease (COPD) may sound like a single condition, but it includes three kinds of lung disease:

• Chronic bronchitis
• Emphysema
• Chronic obstructive asthma

 All of them can make you feel breathless. Doctors use stages to describe how severe your COPD is. This system is called the GOLD staging or grading system. Your grade will affect what treatment you get.

The system looks at many things. The basic idea is to understand how severe your COPD is and what type of treatment you need.

The GOLD system bases the stage of your COPD on several things:

• Your symptoms
• How many times your COPD has gotten worse
• Any times you’ve had to stay in the hospital because your COPD has gotten worse
• Results from spirometry, a test that checks the amount of air and speed that you can exhale

GOLD stands for the Global Initiative for Chronic Obstructive Lung Disease. The National Heart, Lung, and Blood Institute, National Institutes of Health, and the World Health Organization started it in 1997.

GOLD helps raise awareness of COPD and works with doctors and other health experts to create better ways to prevent and treat this condition. It also creates the guidelines most doctors use to classify and treat COPD.

Spirometry results are based on two measurements:

• Forced vital capacity (FVC). This is the largest amount of air you can breathe out after breathing in as deeply as you can.
• Forced expiratory volume (FEV-1). FEV-1 shows how much air you can exhale from your lungs in 1 second.

The original GOLD system used the term “stages” to refer to the different levels of COPD. Now they’re called “grades.” Experts believe this new system allows doctors to better match patients with the right treatments. The original stages also relied only on FEV results. But now doctors consider other things, too.

Your doctor will assign grades to these four things:

• How severe your current symptoms are
• Your spirometry results
• The chances that your COPD will get worse
• The presence of other health problems

You’ll answer some questions, either on the COPD Assessment Test (CAT) or the Modified Medical Research Council (mMRC).

CAT scores range from 0 to 40, and mMRC scores have five grades. For example, if you report that you only get winded when you do hard exercise, you might have mMRC grade 0. If you report being so breathless you can’t even leave the house or get dressed, you could have mMRC grade 4.

To check how well your lungs work, your doctor will look at your spirometry results. These results have four grades, too:

• GOLD 1: Mild
• GOLD 2: Moderate
• GOLD 3: Severe
• GOLD 4: Very severe

Another thing that’s part of your overall COPD assessment is your exacerbation risk. An exacerbation is a time when your COPD symptoms get so much worse that you need to make a change in your medication. Your doctor might also call it a flare. These flare-ups are more likely if your spirometry result is GOLD 3 or GOLD 4.

Your doctor will consider other health problems you have, too. It’s all part of grading your COPD and deciding what type of treatment is best for you.

Based on all of these things – your symptoms, spirometry results, and exacerbation risk – your doctor will put your COPD into one of these groups:

• Group A (GOLD 1 or 2): Your symptoms are very mild. Your FEV-1 is 80% or more. You might have had no flare-ups over the past year, or perhaps just one. You weren’t hospitalized for your symptoms.

• Group B (GOLD 1 or 2):Your FEV-1 is between 50% and 80%. You have more symptoms than people in Group A. This is the stage where most people see their doctor for coughing, wheezing, and shortness of breath. You might have had one major flare-up, but you haven’t been in the hospital for your symptoms within the past year.

• Group C (GOLD 3 or 4): Air flow into and out of your lungs is severely limited. Your FEV-1 is between 30% and 50%. You’ve had more than two flare-ups in the past year, or you’ve been admitted to the hospital at least once.
   
• Group D (GOLD 3 or 4): It’s extremely hard for you to breathe in or out. You’ve had at least two flare-ups in the past year, or you’ve been hospitalized at least once. Doctors call this “end-stage” COPD. That means you have very little lung function. Any new flare-ups could be life-threatening.
   

You may hear people talk about the old system, which staged COPD based on your FEV-1 score alone. There were four stages:

• Stage 1: Mild – FEV-1 ≥ 80%: You may have no symptoms. You might be short of breath when walking fast on level ground or climbing a slight hill.
• Stage 2: Moderate – FEV-1 50-79%: If you’re walking on level ground, you might have to stop every ­few minutes to catch your breath.
• Stage 3: Severe – FEV-1 30-49%: You may be too short of breath to leave the house. You might get breathless doing something as simple as dressing and undressing.
• Stage 4: Very Severe – FEV-1 ≤ 30%: You might have lung or heart failure. This can make it hard to catch your breath even when you’re resting. You might hear this called end-stage COPD.

It depends on how advanced your COPD is and how well you respond to treatment. No two people are the same. But following these steps for a healthy lifestyle can help:

• Don’t smoke. If you do, get help to quit.
• Avoid unhealthy air. Keep away from dust, fumes, and smoke. Stay inside on bad air days.
• Get a yearly flu shot. Ask your doctor if you need the pneumonia vaccine, too.
• Eat healthy food. Talk to your doctor about how to keep your weight where it should be.
• Keep moving. Make sure you get enough exercise.

The BODE Index staging system is an alternative or addition to the GOLD criteria. It measures how much emphysema impacts your daily life. It looks at four main areas:

• B for body mass index: This describes how much body fat you have, compared to your height and weight.
• O for obstruction of air: Your doctor can tell how damaged your lungs are by how well you do on pulmonary (lung) function tests.
• D for dyspnea (breathlessness): Your doctor will ask you a series of questions about how often you feel like you’re out of breath, and when.
• E for exercise capacity: This measures how far you can walk in 6 minutes.

Studies show the BODE Index gives doctors a good sense of your prognosis. And they can use those findings to see how well you’ll respond to medications, lung rehab therapy, and other treatments.
 

Top Picks

disease treatment and prevention methods – clinic “Dobrobut”

Main

Medical Library Dobrobut

Publication date: 2020-03-24

Emphysema: symptoms, causes, diagnosis, treatment

Emphysema is a pathological condition characterized by the expansion of the alveoli and destructive changes in their walls. There are primary (idiopathic) emphysema – an independent nosological form that develops without previous bronchopulmonary pathology, and secondary (obstructive) that occurs against the background of other respiratory diseases. The frequency of pathology increases significantly in the age group over 60 years. The disease belongs to COPD (chronic obstructive pulmonary disease). You should know what emphysema is and how to treat it.

Signs of pulmonary emphysema, causes of the disease

Symptoms of pulmonary emphysema:

1. Shortness of breath. At the first stage of the disease, it worries patients only with significant physical exertion. With the progression of emphysema, shortness of breath becomes permanent.
2. Cough. Usually hoarse, unproductive.
3. Cyanosis. Characteristic for patients with secondary pulmonary emphysema.
4. Weight loss. Patients are slender and may appear cachectic.

Signs of pulmonary emphysema upon examination of the patient – barrel-shaped chest, hyperfunctioning of the auxiliary respiratory muscles (shoulder girdle, neck, abdominals).

X-ray examination reveals a low location of the dome of the diaphragm, an increase in the retrosternal (retrosternal) space (the so-called Sokolov’s sign), the thread-like nature of the vascular pattern. The most characteristic sign of the condition is a decrease in VC (vital capacity of the lungs) with an increase in their total capacity (TLC). The ECG shows a deviation of the electrical axis of the heart to the right. Data from laboratory studies of the lung disease emphysema – an increased level of hemoglobin and the number of red blood cells.

Causes of the disease

Secondary emphysema develops due to COPD. In primary pulmonary emphysema, the causes may be:

1. Ecology. Environmental pollution causes damage to the alveolar walls, which leads to the development of emphysema.
2. Smoking. Tobacco smoke causes the migration of neutrophils, which produce proteolytic enzymes that destroy the walls of the alveoli.
3. Genetically determined deficiency of alpha-1 antitrypsin, shift towards proteolysis and damage to the alveolar walls.
4. Occupational hazardous environment, eg miners.
5. Senile age.

In case of bullous emphysema, bullae are present in the tissues of the organ – swollen areas larger than 10 mm. There is also a decrease in the content of alpha-1-antitrypsin in the blood. This type of emphysema is characterized by the development of spontaneous pneumothorax (accumulation of air in the pleural cavity).

Pulmonary emphysema: treatment

There is no specific treatment for emphysema, therefore, general therapeutic programs are used for all COPD. It is important to eliminate all the factors that caused the development of emphysema (smoking, chronic infection, exposure to polluted air).

Treatment of pulmonary emphysema:

1. The drugs of choice are bronchodilators: β2-agonists, m-anticholinergics, long-acting theophylline preparations.
2. Glucocorticosteroids are given orally in short courses. If there is no effect, hormone therapy is no longer prescribed. With a positive result of therapy, it is advisable to continue treatment with inhaled hormonal drugs.
3. Long-term use of acetylcysteine ​​reduces the frequency of exacerbations of COPD and, consequently, the progression of secondary emphysema.
4. Thoracoscopic bullectomy – surgical reduction of lung volume by resection of peripheral areas. After the operation, the functional state of the lungs improves significantly.
5. With the development of spontaneous pneumothorax, the pleural cavity is drained and air is removed.
6. In severe respiratory failure, oxygen therapy is indicated.
7. A group of American researchers reported that regular intake of acetylsalicylic acid (aspirin) slows down the progression of emphysema and COPD.
8. Respiratory gymnastics for pulmonary emphysema is aimed at training the respiratory muscles.

Prevention consists in smoking cessation, prevention of respiratory diseases, influenza vaccination, adequate treatment of chronic inflammatory diseases of the respiratory tract, improvement of working conditions, sanatorium treatment of patients with COPD. Read more about the prevention of emphysema on our website dobrobut.com.

Do you want to get an online explanation from the doctor of the Dobrobut MS?

Download our Google Play App and App Store

Our Doctors

See all doctors 776

Our certificates

Certificate no. QIZ 804 468 C1

Certificate no. QIZ 804 469 C1

Certificate No. QIZ 804 470 C1

Certificate no. QIZ 804 471 C1

See all certificates

Request a call back

Enter your phone number

Other articles

Down syndrome

Down’s Syndrome

GALACTORRHEA – SYMPTOMS AND TREATMENT OF THE CONDITION

The human body produces various hormones every day that are necessary for its normal functioning. Their balance is directly responsible for the well-being of a person, the proper functioning of all his organs and systems.

Myths about varicose veins. Myth 6: Veins will reappear after surgery

Let’s talk about a common misconception that concerns the consequences of the operation. The most common question patients ask is: When you remove a vein, do other veins get loaded afterward and then reappear?

AEROPHOBIA OR HOW TO OVERCOME THE FEAR OF FLIGHTS?

The natural way of movement of a person, laid down in him by nature, is on foot, feeling a solid support (earth) under his feet. And only scientific and technological progress offered mankind the opportunity to move much faster in space – to fly.

View all articles

Request a call back

Enter your phone number

Bullous emphysema and bullous disease

Emphysema is a disease of the lung in which the lung tissue is “overinflated” due to the gradual destruction of the alveoli. There is a lot of air, but this air does not participate in gas exchange. With bullous emphysema, air bubbles form in the lungs. These blisters are called bullae and are filled with air.

• Bulla is an air bladder with a diameter of at least 1 cm and having a thin wall (no more than 1 mm).
• Single or multiple bullae constitute bullous emphysema and bullous lung disease.
• Bullous emphysema and bullous lung disease are different.
• 12% of people over 30 years of age have various bullous changes in the lungs.

Bullae occur when the structure of the alveoli and the walls between them are destroyed. Alveoli are tiny sacs made up of a thin membrane. In the alveoli, the process of respiration takes place – oxygen enters the blood, and carbon dioxide from the blood enters the exhaled air.

The process of forming bulls is similar to blowing soap bubbles, when small bubbles combine into large ones, and then even larger ones. The cause of the destruction of the alveoli and interalveolar septa is COPD or congenital pathology of the lungs.

Bullous emphysema is more common in patients with COPD due to panacinar and centrilobular emphysema of both lungs.

In bullous disease – lung tissue without emphysema, and there may be several or one bull. In congenital syndromes such as Marfan and Ehlers-Danlos syndromes, primary bullous lung disease is distinguished

Classification

For convenience of description and classification, bullae can be single or multiple.

In case of multiple spread, variants are determined:

1. several bullae within one (focal) lobe
2. several bullae in several lobes (multifocal).
3. bullae are observed in all lobes of the lungs and are called diffuse.

Bullae located near the pleura or scars in the lung tissue can be large. There are such bullae with paraseptal emphysema, they are devoid of blood vessels and interalveolar septa. Another type of bullae are located superficially, may contain vessels and fragments of lung tissue. These bullae lead to pneumothorax.

The third type of bulla is located deep in the lungs. These bullae are rich in vessels and contain a lot of lung tissue.

A special place is occupied by giant bullae – this is a super bulla that occupies more than 1/3 of the lung and compresses the surrounding lung tissue. Giant bullae are characteristic of the lungs of a person who smokes tobacco or marijuana.

Bullous patients, younger than patients with bullous emphysema. This is mainly due to congenital deficiency of α1-antitrypsin, as well as congenital genetic diseases (see Marfan syndrome of Ehlers-Danlos syndrome).

Symptoms of bullous emphysema

Bullous lung disease may be asymptomatic or have severe and life-threatening consequences.

The asymptomatic course of bullous lung disease is a characteristic feature of the disease. Even giant bullae may not cause shortness of breath. After all, there is no emphysema in this condition and gas exchange may not be disturbed.

Shortness of breath, cough are typical symptoms of COPD, against which bullous emphysema occurs as a complication of COPD. Bullae occur in this case against the background of panacinar or centrilobular emphysema.

Bullae may or may not increase in size. Cases of their disappearance or reduction are also described.

Bullae in the lungs can lead to respiratory failure, pneumothorax, bullae suppuration, empyema, hemoptysis.

Bullous deformity may predispose to cancer. According to the literature, lung cancer develops four times in the lung tissue adjacent to the bullae. Therefore, it is necessary to carefully evaluate the lung tissue around the bullae.

Diagnosis of bullous disease

Bullae are detected by CT of the lungs. This study measures the number of bullae, their size and shape. Also, CT will allow you to assess changes in lung tissue, the presence or absence of emphysema, bronchiectasis or other cavities.

CT scan of the lungs excludes cystic diffuse lung disease. They may resemble a bullous deformity.

When diagnosing bullous changes in the lungs, respiratory tests are used – respiratory function, body plethysmography and diffusion test.

For example, bullous emphysema is characterized by obstructive disorders of pulmonary ventilation. And for bullous disease, restrictive violations will be more expected. The exact answer to restriction and obstruction is given by the body plethysmography test.

The diffusion test will evaluate respiratory failure.

Measurement of α1-antitrypsin levels is mandatory for all patients with giant bullae.

All diagnostic tests are required for the following tasks:

• Exclude other lung diseases similar to bullous disease
• Determine contraindications for surgical treatment
• To identify the cause-and-effect relationship of the occurrence of bulls: smoking, marijuana, connective tissue diseases.

Treatment of bullous emphysema

Conservative treatment

If bullous lung disease is detected, a person must stop all types of smoking.

If bullous changes are part of COPD, then standard COPD therapy is used. Bull pills and inhalers do not exist.

During life, bullae may increase in size and number. The patient should be aware of this possibility and understand what symptoms to look out for. The patient should know what symptoms indicate immediate medical attention.

Because bullae may progress over time, patients need to be monitored closely and informed about warning symptoms that require medical attention. There is no conservative treatment for bullous changes.

Surgical treatment

Surgical treatment is called a bullectomy. If a person has a giant bulla, then this is an indication for surgical treatment. The small size of the bullae is difficult to surgically treat and the effect of the operation is negligible.