What are emphysematous changes in the lungs. How are they detected on CT scans. Can emphysema-like lung be present without obstructive lung disease. What health risks are associated with emphysematous lung changes.

Understanding Emphysematous Lung Changes

Emphysematous changes in the lungs refer to structural alterations that occur in lung tissue, specifically affecting the tiny air sacs called alveoli. These changes are often associated with emphysema, a progressive lung disease that falls under the umbrella of chronic obstructive pulmonary disease (COPD). However, recent research has shown that emphysema-like lung changes can be present even in individuals without diagnosed obstructive lung disease.

What Causes Emphysematous Changes?

The primary causes of emphysematous lung changes include:

• Smoking tobacco
• Long-term exposure to air pollution
• Occupational exposures to dust and chemicals
• Genetic factors (such as alpha-1 antitrypsin deficiency)
• Aging

While smoking remains the leading cause, it’s important to note that emphysema-like changes can occur in non-smokers as well.

Detection of Emphysematous Changes on CT Scans

Computed tomography (CT) scans have become an invaluable tool in detecting emphysematous lung changes, often before symptoms become apparent or lung function tests show abnormalities. These scans can reveal areas of low attenuation in lung tissue, which are characteristic of emphysema.

How Are Emphysema-Like Changes Identified on CT?

Radiologists look for specific features on CT scans to identify emphysema-like lung:

1. Areas of decreased lung density
2. Bullae (air-filled spaces larger than 1 cm in diameter)
3. Thinning or destruction of alveolar walls
4. Irregular distribution of lung tissue density

The presence of these features, even in the absence of clinical symptoms or airflow obstruction, can indicate emphysematous changes.

Emphysema-Like Lung Without Obstructive Disease

One of the most intriguing findings in recent research is the presence of emphysema-like lung changes in individuals who do not have obstructive lung disease. This phenomenon raises important questions about the nature and progression of lung damage.

Is It Possible to Have Emphysematous Changes Without COPD?

Yes, it is possible to have emphysema-like lung changes without meeting the diagnostic criteria for COPD. This condition is sometimes referred to as “subclinical emphysema” or “early-stage emphysema.” These individuals may have normal lung function tests but show characteristic changes on CT scans.

Health Implications of Emphysematous Lung Changes

The discovery of emphysema-like lung changes, even in the absence of diagnosed lung disease, has significant health implications. Recent studies have shown that these changes are associated with increased mortality risk.

What Are the Risks Associated with Emphysematous Lung Changes?

Research has identified several potential risks:

• Increased all-cause mortality
• Higher risk of developing COPD in the future
• Potential for accelerated lung function decline
• Increased susceptibility to respiratory infections
• Possible link to cardiovascular disease

These findings underscore the importance of early detection and intervention, even in asymptomatic individuals.

The Role of Smoking in Emphysematous Lung Changes

While emphysema-like lung can occur in non-smokers, smoking remains a significant risk factor. The relationship between smoking and emphysematous changes is complex and multifaceted.

How Does Smoking Contribute to Emphysematous Changes?

Smoking contributes to emphysematous lung changes through several mechanisms:

1. Direct damage to lung tissue by toxic substances in smoke
2. Inflammation of the airways and lung parenchyma
3. Oxidative stress leading to cell damage
4. Impairment of lung repair mechanisms
5. Alteration of the balance between destructive enzymes and protective factors in the lungs

Even after smoking cessation, the risk of emphysematous changes may persist, highlighting the long-term impact of smoking on lung health.

Diagnosis and Monitoring of Emphysematous Lung Changes

Given the potential health implications of emphysema-like lung, accurate diagnosis and monitoring are crucial. CT scans play a central role in this process, but other diagnostic tools are also important.

What Methods Are Used to Diagnose and Monitor Emphysematous Changes?

Several methods are employed in the diagnosis and monitoring of emphysematous lung changes:

• High-resolution CT scans
• Pulmonary function tests (spirometry)
• Diffusion capacity tests
• Blood gas analysis
• Exercise tolerance tests

Regular monitoring using these methods can help track the progression of lung changes and inform treatment decisions.

Prevention and Management Strategies

While emphysematous lung changes cannot be reversed, there are strategies to prevent further damage and manage existing changes effectively.

How Can Emphysematous Lung Changes Be Prevented or Managed?

Prevention and management strategies include:

1. Smoking cessation
2. Avoidance of environmental pollutants
3. Regular exercise to maintain lung function
4. Pulmonary rehabilitation programs
5. Vaccination against respiratory infections
6. Proper nutrition to support overall health
7. Medications to manage symptoms and prevent exacerbations

Early intervention and lifestyle modifications can significantly impact the progression of emphysematous changes and improve quality of life.

Future Research Directions

The discovery of emphysema-like lung changes in individuals without obstructive lung disease opens up new avenues for research. Understanding the mechanisms behind these changes and their long-term implications is crucial for developing targeted interventions and prevention strategies.

What Are the Key Areas for Future Research?

Future research should focus on:

• Identifying biomarkers for early detection of emphysematous changes
• Developing more sensitive imaging techniques to detect subtle lung changes
• Investigating the genetic factors that contribute to emphysema-like lung
• Studying the relationship between emphysematous changes and other systemic diseases
• Evaluating novel therapeutic approaches to prevent or slow the progression of lung damage

These research directions hold promise for improving our understanding and management of emphysematous lung changes.

Emphysematous changes in the lungs represent a significant health concern, even when not associated with diagnosed obstructive lung disease. The ability to detect these changes through CT scans provides an opportunity for early intervention and prevention of further lung damage. As research continues to uncover the complexities of emphysema-like lung, it becomes increasingly clear that a proactive approach to lung health is essential. By understanding the causes, detection methods, and health implications of emphysematous lung changes, individuals and healthcare providers can work together to implement effective prevention and management strategies, ultimately improving long-term health outcomes and quality of life.

The association between emphysema-like lung changes and increased mortality risk underscores the importance of regular health screenings, particularly for individuals with risk factors such as smoking history or occupational exposures. As we continue to explore the nuances of lung health, it’s clear that a comprehensive approach, incorporating advanced imaging techniques, pulmonary function testing, and lifestyle modifications, is key to addressing the challenges posed by emphysematous lung changes. Future research in this field holds the promise of developing more targeted interventions and potentially reversing early-stage lung damage, offering hope for improved lung health across diverse populations.

How Serious Is It, Treatment Options and More

Written by Paul Frysh

Medically Reviewed by Paul Boyce, MD on November 17, 2021

• Stage 1 Emphysema
• How Serious Is Your Emphysema?
• Lifestyle Treatment
• Medical Treatment

Emphysema happens gradually as tobacco smoke or other pollutants damage the tiny air sacs in your lungs called alveoli. Normally, some 300 million alveoli help bring oxygen into your body and get rid of carbon dioxide. As the alveoli break down, your bronchial tubes can start to collapse, too.

Emphysema can’t be cured. It’s progressive, so over time it will get harder and harder for you to catch your breath. But you might not know you have the disease for the first few years unless your doctor tests your breathing.

Emphysema stages are a measure of how well you can breathe. One widely used guideline is called the Global Initiative for Chronic Obstructive Lung Disease (GOLD). It’s a formula that ranks emphysema in four stages, with 4 being the most serious. Doctors use it as one of many ways to measure your emphysema.

A machine called a spirometer tests your breathing for the GOLD stages. It takes two key measurements:

Forced vital capacity (FVC). This is how much air you can breathe out after taking the biggest breath you can.

Forced expiratory volume-one second (FEV1). This is how much air you can breathe out in the first second after that big breath.

Your doctor uses those numbers to calculate how well you compare to your healthy peers.

You have emphysema if the ratio of FEV1 to FVC is less than 70%. That means that after you exhaled for 1 second, 30% or more of the air in your lungs hasn’t emptied out.

Stage 1 emphysema is when the amount of air you can breathe out in 1 second (your FEV1) is 80% or more of the average for someone of your age, sex, and height.

Stage 1 is also called mild emphysema. But that doesn’t mean your disease is mild.

You could have significant lung damage before you even notice the breathing problems of stage 1, especially if you’re relatively young and otherwise healthy. On the other hand, if you’re older, especially over age 65, even minor breathing problems can start to interfere with basic daily tasks like dressing, cooking, or climbing stairs, and they’re more likely to cause symptoms or send you to the hospital.

Once your doctor diagnoses your emphysema and determines your GOLD stage, they’ll look at a number of other signs and symptoms to fully evaluate your condition. They’ll want to know if you:

• Have problems sleeping
• Make high-pitched wheezing sounds when you breathe
• Cough often, or cough up colored mucus
• Have low blood-oxygen levels
• Have flare-ups when your breathing worsens
• Have gone to the hospital for your emphysema symptoms
• Get lung infections
• Show signs of scarring, holes, or enlargement in your lungs on X-rays and other imaging scans

You can’t reverse your emphysema. But you can ease your symptoms and slow the progress of the disease. And the earlier you act, the better.

Quit smoking. It’s the No. 1 cause of emphysema. If you smoke, quitting is the single best step you can take.

Breathe smarter. You can learn to breathe with pulmonary rehabilitation therapy. You follow a set of breathing techniques and physical exercises to lessen breathlessness and boost your stamina. Your doctor or a specialized breathing therapist can help design a program for you.

Get to a healthy weight. In early emphysema, you may need to lose some pounds. But as your disease gets worse, you might find yourself needing to put weight back on. Nutritional therapy from your doctor or a nutritionist can help you customize a diet based on your size, health, and activity level.

Bronchodilators. You inhale these medications to relax and to expand your airways. This allows more air into your lungs so your body gets more oxygen. Talk to your doctor about which type is right for you.

Oxygen. If your blood oxygen levels get low for too long, your doctor might suggest taking in extra oxygen from a machine through tubes that go into your nose. It helps the most if you have severely low blood oxygen levels, not just moderately low. You and your doctor will go over your oxygen needs every 2 to 3 months.

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Emphysema-like lung on CT associated with increased mortality

1. The presence of emphysema-like lung detected on computed tomography (CT) scans was associated with increased all-cause mortality in patients without obstructive lung disease.

2. This link was also associated with patient smoking status.

Evidence Rating Level: 2 (Good)

Study Rundown: Although obstructive lung diseases like emphysema are typically associated with smoking, there is a relatively high prevalence of emphysema among non-smokers. Emphysematous lung changes (i.e., emphysema-like lung) can be detected on computed tomography (CT) imaging, and are frequently found as incidental findings in smokers and non-smokers alike. However, its significance is unclear among patients without clinical evidence of obstructive lung disease. This study evaluated the relationship between mortality and CT-detected emphysema-like lung among patients without chronic obstructive pulmonary disease (COPD). Overall, the presence of emphysema-like lung was associated with increased all-cause mortality, and risk of death increased as the amount of emphysema-like lung increased. The association between emphysematous lung changes and increased mortality was particularly pronounced among current smokers. The primary limitation of this study arose from the type of imaging used; patients received cardiac, not pulmonary, CT scans, which typically cannot capture the uppermost portion of the lungs where emphysematous changes are most common. Additionally, the role of this evaluation in clinical practice is unclear, particularly since there are currently no mortality-reducing treatments for emphysema. Nevertheless, these results suggest that incidentally-detected emphysema-like lung may have negative implications for patients, even when those patients do not have clinical signs of obstructive lung disease.

Click to read the study today in the Annals of Internal Medicine

Relevant Reading: Cigarette smoking is associated with subclinical parenchymal lung disease: the Multi-Ethnic Study of Atherosclerosis (MESA)-Lung study.

In-Depth [prospective cohort]: This study analyzed CT scan and mortality data from 2,965 participants without COPD in the Multi-Ethnic Study of Atherosclerosis. Emphysema-like lung was detected on cardiac CT scan and was defined as a continuous variable computed from the number of air-density lung voxels normalized to total imaged lung voxels. After controlling for a number of potential confounders, emphysema-like lung was significantly, linearly associated with all-cause mortality when all patients were considered together, with an adjusted hazard ratio (aHR) of 1.14 (95% CI 1.04-1.24) per one-half interquartile range of emphysema-like lung. The effect was most pronounced among current smokers, less pronounced but statistically significant among former smokers, and trending upward, but not significantly, among never-smokers. However, addition of emphysema voxels to a predictive model based on other predictors of mortality (including smoking) only marginally increased the predictive value of the model (c-statistic increased from 0.786 to 0.791). Regardless, these results highlight the potentially adverse effects of sub-clinical emphysematous lung changes and highlight the need to develop new therapies to target this widespread disease.

More from this author: Midlife diabetes associated with cognitive decline, Atrial fibrillation likely increases risk of silent strokes, HIV rebound observed after therapeutic stem cell transplant, USPSTF recommends behavioral counseling to reduce cardiovascular disease, ACP recommends non-pharmacologic treatment of urinary incontinence in women

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Tags: emphysema

Bullous emphysema in Kyiv – private clinic Oberig. Bullous emphysema

Emphysema is a disorder in which the alveoli (the “sacs” in which gas exchange between blood and air takes place) stretch and contract poorly. As a result, less oxygen enters the body, and less carbon dioxide is excreted. Respiratory failure develops.

One of the varieties of the disease is called bullous emphysema. A bubble filled with air is formed in the lung tissue – a bulla. Bullae are 1-5 cm in diameter on average. Giant bullae are 10-15 cm in diameter. Bullae tend to enlarge and rupture into the pleural cavity, compressing the surrounding lung tissue.

They are most common in the upper lobes of the lungs. The walls of the bullae are stretched and thinned, so they can easily rupture. Bullae can be either single or multiple. According to the prevalence in the lung, localized (within 1-2 segments) and generalized (with more than 2 segments affected) form is distinguished.

CAUSES OF BULLOUS EMPHYSEMA

The disease is more common in men than in women. The development of bullous emphysema is promoted by chronic obstructive pulmonary disease, bronchial asthma, and viral infections of the respiratory tract.

Hereditary factors also influence – genetically determined weakness of the connective tissue. Some people have a congenital deficiency of the elastase inhibitor-α1-antitrypsin, resulting in enzymatic destruction of lung tissue.

The risk of the disease is significantly increased in smokers. Patients typically smoke more than 20 cigarettes a day for 10 to 20 years before the first symptoms of bullous emphysema appear. Passive smoking also contributes to the development of the disease. Another risk factor is air pollution.

SYMPTOMS AND SIGNS OF BULLOUS EMPHYSEMA

Bullous emphysema may not be noticeable until the bulla ruptures. In this case, air enters the pleural cavity. This condition is called pneumothorax. It leads to complete or partial collapse of the lung and requires urgent surgery, which is performed by a thoracic surgeon. In 70-80% of cases, the cause of spontaneous pneumothorax is bulla rupture.

In some cases, the clinical signs of bullous emphysema are manifested in the form of shortness of breath, cough, mild chest pain, scanty sputum, weakness. Shortness of breath, which is initially felt on exertion, usually occurs 10 years after the cough. Patients often have a lean physique, underdeveloped musculature, curvature of the spine and deformity of the chest.

Bullous emphysema is diagnosed using radiography and high-resolution CT. If in doubt, a diagnostic thoracoscopy is performed.

TREATMENT OF BULLOUS PULMONARY EMPHYSEMA

Bullous emphysema increases the risk of spontaneous pneumothorax, so resection (removal) of the altered parts of the organ is recommended. Surgery is performed by thoracoscopic method. All manipulations are carried out through small punctures of the chest wall, so the operation is low-traumatic.

Patients with asymptomatic bullous emphysema should be observed. They should avoid situations that can lead to bull rupture – physical overexertion, colds. It is imperative to quit smoking. It is possible to use conservative methods of treatment of bullous enphysema.

The patient is managed by a pulmonologist, and if complications develop, by a thoracic surgeon. At the Oberig Universal Clinic, you can undergo a complete examination of the respiratory system and receive modern treatment at a specialized Thoraco-Pulmonological Center. Make an appointment by phone:

(044) 521 30 03

November 17 – World COPD Day – Health Harmony

17 November is World COPD Day every year.

Chronic obstructive pulmonary disease (COPD) , as defined by WHO, 2017, is a lung disease characterized by chronic airflow limitation in the airways. The symptoms of COPD get worse over time. Shortness of breath during exertion gradually turns into shortness of breath at rest. This disease often goes undiagnosed and can be life-threatening. In the past, COPD was often referred to by the terms “chronic bronchitis” and “emphysema”.

Key Facts

• Chronic obstructive pulmonary disease (COPD) is a progressive, life-threatening lung disease that causes shortness of breath (initially on exertion).
• According to the Global Burden of Disease Study, the global prevalence of COPD in 2018 was 251 million cases.
• More than 90% of COPD deaths occur in low- and middle-income countries.
• The main cause of COPD is tobacco smoke (as a result of tobacco consumption or inhalation of secondhand smoke).
• Other risk factors include outdoor air pollution and indoor air pollution, and exposure to air pollution from smoke and dust in the workplace.
• Indoor air pollution can adversely affect unborn children and put them at risk of developing COPD later in life.
• In some cases, COPD is associated with long-term asthma.
• Many cases of COPD are preventable through smoking cessation or early cessation.
• COPD has no cure, but treatment can improve symptoms, improve quality of life, and reduce the risk of death.

How is the diagnosis made?

Mostly people over 50 who smoke or have smoked before (smoking experience – more than 20 pack-years) get sick. The main symptom is progressive dyspnea . It is usually accompanied by cough with phlegm and asthma attacks . Cough, as a rule, either precedes shortness of breath, or appears simultaneously with it. The sputum is pale gray in color and comes out in the morning, but may also be coughed up during the day.

Long-term cough with sputum and mild dyspnea are typical for bronchitis type COPD . At emphysematous type of COPD , on the contrary, a rare cough with scanty sputum and severe shortness of breath are disturbing. A change in the nature of sputum from mucous (pale gray) to purulent indicates the addition of an infection – acute bacterial bronchitis. Wheezing and choking attacks are the result of bronchospasm or narrowing of the airways due to inflammation. COPD in close relatives means that the cause of the disease may be alpha1-antitrypsin deficiency, especially if the first symptoms appear before age 50. Hemoptysis is usually due to an acute bacterial infection (bronchitis or pneumonia), but lung cancer must be ruled out. If the disease began with progressive shortness of breath on the background of bronchial asthma, especially in a non-smoker, chronic asthmatic bronchitis is likely.

In the bronchitis type of COPD, there are usually no complaints at rest. Over time, hypoxemia inevitably develops (decrease in the level of oxygen in the blood), which leads to changes in the heart (cor pulmonale) and to heart failure (which is manifested, in particular, by edema).

With COPD, especially severe, complaints are possible that are not directly related to damage to the respiratory system: fatigue, weight loss, loss of appetite . There are also sleep disorders and mental disorders : depression, impaired concentration and memory.

To detect COPD, the Harmony Zdorovya Polyclinic resorts to laboratory and instrumental diagnostics:

• 0062 where vital capacity, forced expiratory volume in 1 second and other indicators are measured according to a certain scheme.
• Cytological examination of sputum allows you to assess the nature of inflammation in the bronchi and lungs, to identify the presence of bacteria and viruses.
• Patients with severe symptoms of respiratory failure must take blood gas analysis .
• X-ray of the lungs helps to rule out other diseases of the respiratory system. Usually, in patients with COPD, the x-ray shows thickening and deformation of the bronchial walls, emphysematous changes in the lung tissue.
• During the initial examination, complete blood count with the determination of the leukocyte formula, electrocardiography (ECG) and often echocardiography (ultrasound of the heart) are also advisable. In addition, in case of suspected deficiency alpha1-antitrypsin determine its level in serum, and in case of suspected chronic asthmatic bronchitis, skin tests with allergens are performed and the level of IgE in serum is determined 9004 0 . Clinical research is carried out by our own laboratory.

Such a comprehensive diagnosis allows you to determine the nature of the lung disease and prescribe a full-fledged treatment for COPD. Modern COPD therapy can reduce the manifestations of shortness of breath and improve the patient’s quality of life . In the Health Harmony Polyclinic, special attention is paid to the prevention of relapses . Individual medical tactics guarantee relief of periods of exacerbation and a significant increase in the duration of remission of the disease.

For all patients with COPD, we recommend seasonal influenza and pneumococcal vaccination, – it reduces the risk of infectious exacerbations of this disease by 5-10 times.

Benefits of treatment in our clinic:

• if you have the first symptoms, you can immediately contact us, we work even on holidays and weekends;
• a pulmonologist will immediately prescribe an instrumental examination, tests that can be done on the day of contacting the clinic;
• the results of laboratory clinical examinations will be ready very quickly;
• if chronic obstructive pulmonary disease is detected, pulmonologist PhD Associate Professor NRU BelSU Bontsevich R.