Emphysema - Causes, Symptoms and Treatment .MF .
Emphysema - a disease that occurs when the increased airiness of lung tissue development.Emphysema is characterized by a prolonged course, and very often leads to disability.Women suffer twice as often as men.In the age group over 60 years of emphysema is more common than in younger people.
causes of emphysema
all the factors under the influence of which can be formed emphysema, can be divided into two large groups.The first group includes the factors that violate the elasticity and strength of the lung tissue.This, above all, birth defects of the enzyme systems of the body (the change of surfactant properties deficit a1-antitpipcina).Also play an important role gaseous toxic substances (cadmium compounds, nitrogen, dust particles) which enter the lungs during breathing.Repeated respiratory tract viral infections reduce pulmonary cell protective properties and to their damage performed.
can not say about smoking, which is a major cause of emphysema.Tobacco smoke promotes accumulation of inflammatory
Elizabeth Gipps, writer, radio broadcaster, to explore alternative ancient cultures;died of respiratory failure on the background of long-term smoking
second group includes factors, which under the influence of increased pressure in the pulmonary alveoli.First of all previous lung diseases such as chronic obstructive bronchitis, bronchial asthma.
Emphysema, formed under the influence of factors of the first group, called the primary, the second group - the secondary.
Symptoms of emphysema
To understand the mechanism of development of emphysema and its symptoms should discuss the main features of the structure of the lung tissue.The basic structural unit of the lung tissue is acinus.
Schematic structure of the acinus
acini composed of alveoli - lung cells, the wall of which is closely bordered by the blood capillaries.This is where the exchange of oxygen and carbon dioxide.Between adjacent alveoli is a surfactant - a special fatty film that prevents friction.Normally, the alveoli are elastic, expanding and falls in accordance with the respiratory phases.Under the influence of the primary factors in pathological emphysema alveolar elasticity is reduced, and the secondary - there is an increase of pressure in the alveoli and accumulation of excess air.The wall between adjacent alveoli is destroyed, formed a single cavity.
Diagram of the alveoli in emphysema of the lungs.The top figure shows the alveoli in emphysema.Below are presented normal alveoli.
Some authors describe the cavity, the size of which is more than 10 cm. In the formation of cavities lung tissue becomes more air.By reducing the number of alveoli suffers oxygen and carbon dioxide exchange, respiratory failure occurs.The formation of cavities is continuous, and eventually affects all parts of the lungs.
disease develops unnoticed by the patient.All symptoms appear with significant lesions of the lung tissue, so early diagnosis of emphysema complicated.As a rule, shortness of breath begins to disturb the patient after 50 -60 years.She first appears during physical exertion, then begins to disturb and alone.Characteristic appearance of the patient at the time of the attack of breathlessness.The facial skin becomes pink.The patient usually sits leaning forward, often clinging to his chair, standing in front of him.Exhale emphysema long, noisy, the patient puts his lips, trying to ease breathing.Inhalation patients do not experience difficulty exhaling given very hard.Due to the characteristic appearance at an attack of shortness of breath in patients with emphysema is sometimes called "pink pyhtelschikami".
«Pink pyhtelschik" - a characteristic appearance of the patient during an attack of shortness of breath.
Cough usually occurs some time after the manifestation of shortness of breath that distinguishes emphysema bronchitis.The cough is not long, scanty sputum, mucous, transparent.
characteristic feature of emphysema is to reduce body weight.This is due to fatigue of the respiratory muscles, which work at full capacity to facilitate exhalation.Severe weight loss is an unfavorable sign of the disease.
Patients with emphysema attention is drawn to the extended cylindrical shape as if frozen on the breath, chest.Often, it is figuratively called a barrel.
barrel chest in a patient with emphysema
light tops vybuhayut in supraclavicular areas, there is the expansion and retraction of the intercostal spaces.
Noteworthy bluish color of the skin and mucous membranes, as well as the characteristic change of fingers according to the type of drum sticks.
Clubbing by type drumsticks
These external signs indicate prolonged oxygen starvation.
The diagnosis of pulmonary emphysema is a great pol STUDY OF respiratory function.To assess the degree of narrowing of the bronchial tubes used a peak flow meter.In the quiescent state after a couple of breaths, exhale produced in a special recording device, pikfluometr.
Data from pikfluometrii allow to distinguish emphysema from asthma and bronchitis.Spirometry helps determine the change in tidal volume lung and identify the degree of respiratory failure.The data recorded at the time of quiet breathing, the doctor then asked to perform a few forced breaths.Tests using bronchodilator drugs also make it possible to distinguish between the different lung diseases, as well as to evaluate the effectiveness of treatment.
Pentgenologicheckie The studies of the chest is of great importance for the diagnosis of emphysema legkix.At the same time in different parts of the lungs revealed enlarged cavity.In addition, the increase in lung volume is determined, indirectly evidenced by the low CENTERED dome diaphragm and flattening it.Computed tomography also allows to diagnose lung cavity, as well as their greater lightness.
Treatment of pulmonary emphysema
All therapeutic measures emphysema should be directed at alleviating the symptoms and decrease the progression of respiratory failure and treatment of lung disease, which led to the development of emphysema.Treatment is carried out, usually on an outpatient basis, under the guidance of a therapist or pulmonologist.Hospitalization is indicated for infections accession, severe respiratory failure, as well as in the event of surgical complications (pulmonary hemorrhage at break cavity, pneumothorax).
diet and lifestyle adjustment with emphysema
Patients with emphysema recommended a balanced diet with plenty of vitamins and trace elements.The diet should always be present raw fruits and vegetables as well as juices and puree them.In severe respiratory insufficiency eating large amounts of carbohydrates can lead to an even greater lack of oxygen.Therefore, in this case a low-fat diet is recommended calorie of 600 kcal per day and then at positive dynamics calorie food expands to 800 kcal per day.
great importance is quitting smoking, active and passive.One shot quitting smoking is the best effect compared with the phasing.Currently it has a large arsenal of medical products (gums, patches) that can help the patient in this difficult matter.
Drug treatment of pulmonary emphysema
antibiotics prescribed for acute inflammation.In bronchial asthma or bronchitis with bouts of breathing difficulties are recommended drugs that enhance the bronchi (theophylline, Flomax, salbutamol).To facilitate the removal of sputum shows mucolytics (ambrobene).
Oxygen with emphysema
to improve gas exchange in the initial stage of the disease has been successfully used oxygen therapy.This method of treatment is inhalation of air with reduced oxygen for 5 minutes, then the same time the patient is breathing air with a normal oxygen content.The session includes six cycles.Course of treatment: one session per day for 15-20 days.At impossibility of use of the above techniques will help alleviate the condition of the patient breathing humidified oxygen through a nasal catheter.
Massage with emphysema
Massage promotes discharge of phlegm and bronchiectasis.It uses classical, segmental and acupressure.It is believed that acupressure has the most pronounced bronchodilator effect.
Exercising with emphysema emphysema
When respiratory muscles are in a constant tone, so quickly get tired.To prevent muscle tension has a good effect of physiotherapy.
apply the following exercises:
• exercises with artificial creation of positive pressure on exhalation.The patient was asked to carry out a deep exhale through the elongated tube, one end of which is in the pot with water.Water barriers and creates a lot of pressure when you exhale.
• exercises for diaphragmatic breathing.Starting position: standing, feet shoulder width apart.The patient need to take a deep breath and as you exhale pull your hands in front of you and lean forward.During exhalation is necessary to involve the stomach.Starting position: lying on his back, hands on his stomach.On the exhale, hands pressed against the anterior abdominal wall.
• exercises for breathing rhythm.
1. After a deep breath, hold the breath briefly, then breathe out air pushes through the small tube folded lips.In this case the cheeks should not inflate.
2. After a deep breath, hold the breath, then exhale a sharp push through an open mouth.At the end of exhalation lips is necessary to lay down a tube.
3. Take a deep breath, hold your breath.Extend your arms forward, then squeeze the fingers into a fist.Bring your hands to your shoulders, slowly dissolve in hand, and return to his shoulders again.Repeat this cycle 2-3 times, then exhale with force.
4. We believe in the mind.The breath for 12 seconds, breathing 48-second delay, 24 second exhale.Repeat this cycle 2-3 times.
Possible complications of emphysema
• infectious complications.Perhaps the development of pneumonia, lung abscess.
• Respiratory failure.It involves a violation of the exchange of oxygen and carbon dioxide in the modified light.
• Heart failure.In severe emphysema is increased pressure in the pulmonary artery.Compensatory increases right ventricle, the right atrium.Over time, the changes cover all parts of the heart.The pumping function of the heart is suffering greatly.
• Surgical complications.When you break the cavity next to the large bronchi possible penetration of the large volume of air in the cavity.Formed pnevmatoroks.Damage to the wall between the alveoli may cause pulmonary hemorrhage.
prognosis of pulmonary emphysema
Complete cure with emphysema impossible.A feature of the disease is its continuous progression, even with treatment.With timely treatment for medical assistance and compliance with therapeutic interventions to slow down the disease manage multiple, improve quality of life and delay disability.With the development of emphysema in the background of a congenital defect of the enzyme system prognosis is usually unfavorable.
As preventive measures recommended:
• smoking cessation;
• observance of rules of personal hygiene when working with harmful gaseous substances.
• timely treatment of lung disease (bronchitis, asthma) which may lead to the development of emphysema.
therapists Sirotkin EV