emphysema - lung disease, characterized by destructive changes of the alveolar walls and expansion of the air space, which they constitute. This pathology is an integral part of chronic obstructive pulmonary disease.
- 1 Epidemiology
- 2 Classification emphysema
- 3 Causes
- 4 pathogenesis
- 5 mechanism Symptoms of emphysema
- 6 difference of the clinical picture of primary and secondary emphysema
- 7 Treatment of emphysema
- 8 Prognosis
- 9 prevention of emphysema
Among the total population the number of patients with symptoms of emphysema, is about5%. The probability of the onset of the disease increases with age, this pathology becomes one of the leading in persons over the age of sixty.
Classification Classification emphysema
disease based on the following criteria :
- Depending on the anatomical location and the degree of pulmonary involvement in the process acinus distinguished: a proximal acinar, panatsinarnuyu( whole lung lobe impressed), distal acinar, irregular( irregular).There is also
- Depending on the pathogenesis of the following: primary or congenital and secondary, resulting from chronic inflammatory processes that occur in the lungs;
- a result of expansion of air space of lung emphysema isolated form:
- senile, which is characterized by the increase and expansion of the alveoli and airways without pulmonary vascular lesion. In this case there will be no bronchoconstriction syndrome( bronchial obstruction), a lack of oxygen( hypoxia);
- compensatory( hypertrophic), which most often develops after removal of the lung or its part and compensatory enlargement of the remaining lung tissue;
- acute swelling of the lungs - compensation reaction, which is reversible and occurs by ingestion of a foreign object into the bronchi and their partial blockage, drowning, in the development of bronchial asthma attack as a result of sudden physical overload. With prolonged exposure to the causative factor, the process passes into a chronic form. Reasons
disease The main etiological factors are following:
- All the reasons which cause the development of chronic inflammation in the alveoli, stimulate the formation of symptoms of emphysema, for example, pneumonia, bronchitis;
- Deficiency in lung factors preventing the breakdown of proteins;
- smoking, which causes chronic inflammation and sluggish in the airways, thus contributing to the progressive failure of leukocyte enzymes, precipitating protein decomposition;
- Presence of chronic obstructive pulmonary disease, in which emphysema occurs again;
- The presence of occupational hazards, which are one of the most aggressive factors( miner's pneumoconiosis);
- Pollutants in the environment;
- Infectious processes of the respiratory tract( alveolitis);
- Taking certain medicines for a long time( systemic glucocorticosteroids);
- Genetic deficiency of the enzyme? 1-antitrypsin, which predisposes to the development of emphysema and is found in 5% of patients. The lack of this enzyme increases the susceptibility of lung tissue to destruction by its own proteolytic enzymes. In individuals who are homozygous for the defect of a given gene, emphysema develops even without the action of additional factors.
Mechanism of the pathogenesis of
At the heart of the pathogenesis of emphysema is the destruction of elastic fibers of the lung tissue as a result of imbalance among the enzymes that break down the proteins .Also, the function of fibroblast cells is important.
As a result of the deficiency of? 1-antitrypsin, the activity of neutrophilic leukocyte enzymes increases, which begin to break collagen and elastic fibers, which leads to the destruction of lung tissue. The destruction of the walls of the alveoli and the structures that support them leads to cavities in the air spaces of the lungs. It is believed that as a result of the absence of a skeleton in the lower respiratory tract, their constriction arises due to a drop in exhalation. And, among other things, the respiratory surface( its area) decreases because of the destruction of the membrane between the capillaries and the alveoli.
Symptoms of emphysema
Very often, this pathology has no characteristic signs and is associated with a number of pathological processes in the lungs of .The number of complaints made by patients increases with the progression of the disease. There is shortness of breath, which grows gradually, reaching a maximum of sixty years, and increases with the occurrence of respiratory infections. The nature of the cough also depends on the underlying comorbidities. The amount of sputum is poor, the character is slimy. Also characteristic is a decrease in body weight, which is associated with a worsening of the muscles that provide breathing, due to increased resistance to the final sections of the respiratory tract.
In the anamnesis of such patients there is almost always a fact of smoking, there are professional injuries, chronic recurrent respiratory diseases. It is also possible the presence of "family weakness of the lungs" - various pathological processes of the respiratory tract in several generations of relatives. Bullous emphysema is characterized by frequent recurrent spontaneous ruptures of the lung tissue.
With external examination of the patient, one can see a chest barrel shaped, with breathing, its mobility is limited, the auxiliary musculature actively participates in the act of breathing. When tapping over the lungs, the sound has a deaf tint, the expansion of the upper and lower boundaries of the pulmonary fields is noted. Characteristic of the weakening of breathing.
Difference in clinical picture of primary and secondary emphysema
Primary form of pathology is congenital, most often with 1? Antitrypsin deficiency, occurs mainly in young people of thirty or forty years .The disease begins with the appearance of dyspnea, signs of bronchitis are often absent, symptoms of pulmonary hypertension appear in the late stage of the disease. The patient's body weight, as a rule, decreases, and the tolerance of exercise is also sharply worsened. On the X-ray of the lung, signs of inflammation are most often absent, with functional examination, there is no evidence of bronchial obstruction in the early stages of the disease.
Secondary emphysema develops as a result of bronchial asthma or chronic obstructive bronchitis, with a predominance of symptoms of the underlying disease, more often in individuals over the age of forty. The first sign of pathology is cough, then there are severe symptoms of bronchitis. Also characteristic is the early appearance of signs of pulmonary hypertension, a sharp decrease in tolerance to physical exertion, possibly an increase in body weight. There are inflammatory changes in the x-ray of the lungs and signs of constriction of the bronchi in the study of bronchial function.
Treatment of emphysema
There is no specific etiologic therapy, the basis is the treatment of pathology leading to the development of emphysema. First of all, it is necessary to eliminate the factors that cause the formation of the disease( smoking, occupational hazards, chronic inflammation of the respiratory tract).
The following groups of drugs are medically applied:
- Expanding bronchus, which includes drugs from groups of M-cholinoblockers( ipratropium), short-acting β-adrenomimetics( salbutamol) and long-acting( salmeterol), their combinations, theophylline derivatives. Elderly people are advised to prescribe m-holinoblokatory, the use of theophyllines should be limited;
- Glucosaccharide drugs are prescribed in case of severe course of the pathology: prednisolone by a short course through the mouth for 1-1.5 weeks. In the absence of effect, repeated courses are not shown. With positive dynamics in cases of application of systemic GK go to treatment with inhaled forms( budesonide);
- It is planned to introduce in the treatment of substitution therapy with human 1-antitrypsin;
- Antioxidant therapy with acetylcysteine reduces the incidence of recurrence of chronic obstructive pulmonary disease and reduces the rate of secondary emphysema.
Surgical methods of treatment are also used:
- Decrease in pulmonary tissue volume by surgical intervention and removal of bullous formations( bullectomy, preferably by thoracoscopic method).A fairly new method of therapy is still little used. Removal of peripheral regions of the lung is carried out, which causes release from compression of the rest and improvement of its functional state. This method can be applied to approximately 20% of patients with severe emphysema, especially in the presence of bulls, which are located on the periphery of the lung;
- Methods and methods of lung transplantation are developed and applied;
- With the breakdown of lung tissue and the formation of pneumothorax, the setting of drainage and aspiration of air that has entered the pleural cavity is shown.
Prognosis of the disease
Forecasting the further course of emphysema is made taking into account the degree of decrease in vital volume of lungs and patency of the bronchi, the nature of the main process( if emphysema is secondary) and the possibility of eliminating risk factors. If the patient is young, does not have an enzyme deficiency, 1-antitrypsin and residual lung volume is retained by 50% or more, then the prognosis is quite favorable.
Prevention of the development of emphysema
Programs aimed at promoting healthy lifestyles and harming smoking are important for reducing the incidence of the disease. It is also necessary to prevent the development of chronic inflammatory processes in the lungs and the respiratory tract, vaccine prophylaxis and the timely detection, treatment and observation of patients with respiratory diseases that have a chronic course.