pulmonary emphysema



OVERVIEW

Definition.

Emphysema is a chronic respiratory pathology, a pathological condition in which the alveolar walls become less elastic and the alveoli become overinflated from various causes. In severe cases, it can lead to impaired ventilation and air exchange, and is one of the pathologic changes of chronic obstructive pulmonary disease (COPD).

Classification

Classification according to the cause and location of the lesion

It is mainly caused by bronchial stenosis and decreased alveolar elasticity.

Common in chronic obstructive pulmonary disease, followed by bronchial asthma, bronchiectasis, severe tuberculosis, pneumoconiosis and other combined emphysema.

Obstructive diseases of the airways such as tracheal foreign bodies, tumors, etc. can sometimes cause diffuse obstructive emphysema in both lungs.

Emphysema occurs when the healthy lung tissue on the opposite side of the lung expands compensatorily due to severe impairment of lung function on one side of the lung or pleural lesion.

It is common in atelectasis, lung destruction, after lung resection and severe pleural hypertrophy.

The structure and function of the human respiratory system generally begin to decline with age after 30 years of age and become more pronounced after 60 years of age.

No lung disease, but only due to age caused by the physiological aging phenomenon of the lungs is called geriatric lung.

It is a consequence of degenerative changes in the lung tissue of the elderly.

It is related to genetic factors.

It is mainly emphysema that occurs due to congenital α1-antitrypsin deficiency of the organism.

This type of emphysema is rare in China and has been reported in some European and American countries.

Interstitial emphysema can be divided into spontaneous and secondary according to the triggering factors.

Spontaneous emphysema can be caused by severe coughing, excessive breath holding, or congenital dysplasia of the bronchial or alveolar walls somewhere, and it most often occurs in patients with interstitial lung lesions such as emphysema or interstitial pneumonia.

Secondary cases can be caused by a number of factors, such as chest trauma and chest puncture.

Classification of emphysema according to the area of involvement of the lung lobules

Emphysema is classified into three types: central lobular type, total lobular type and mixed type in between, with central lobular type being the most common.

The central lobular type is characterized by narrowing of the lumen due to inflammation of the terminal bronchioles or primary respiratory bronchioles, and cystic dilatation of the distal secondary respiratory bronchioles, with the cystic dilatation of the respiratory bronchioles being located in the central part of the secondary lobules.

The total lobular type is a narrowing of the respiratory bronchi, causing dilatation of the alveolar ducts, alveolar sacs and alveoli, and is characterized by smaller cystic cavities of the empyema, which are spread throughout the lobules of the lung.

Sometimes the two types exist in one lung called mixed emphysema, mostly on the basis of the central lobular type, complicated by expansion of lung tissue in the peripheral lobular area.

Morbidity

Emphysema is widespread worldwide, with patients mainly found in heavily polluted and industrialized countries.

Causes

Causes

Smoking

Smoking is the most common cause of emphysema. Smoking can lead to inflammation of the lungs, which can easily lead to blockage of the bronchial tubes, lowering the resistance of the lungs and secondary infections. Regular cigarettes, e-cigarettes, and cigars all contribute to this damage. The degree of damage increases with the amount and duration of smoking.

Prolonged exposure to irritating gases

Second-hand smoke, dust, haze, chemical fumes, and biofuels all increase the probability of emphysema with long-term exposure.

Infections

Long-term recurrent lung infections increase the risk of developing emphysema.

Age

Although emphysema has a slow onset, emphysema that is generally due to smoking typically develops symptoms between the ages of 40 and 60.

Genetic factors

A small percentage of patients with emphysema are more likely to develop emphysema because of a deficiency of alpha 1-antitrypsin, which causes the alveolar walls to become less elastic. The development of emphysema in this group of patients is influenced by genetic factors.

Pathogenesis

Normal alveoli are elastic, filling up like a balloon during inhalation and releasing gas during exhalation.

When emphysema is present, the alveolar walls become less elastic, resulting in the alveoli not maintaining their normal shape.

As the disease progresses, the walls of the alveoli break down and cause the alveoli to fuse, forming large cavities called “bullae”.

Emphysema results in a decrease in the surface area for gas exchange in the lungs, a decrease in gas exchange function, and an enlargement of the lungs.

Symptoms

Main Symptoms

Emphysema develops slowly, and symptoms may not appear for several years. As the disease progresses, the anterior and posterior thoracic diameters may increase, giving rise to a “barrel chest” appearance:

Shortness of breath, especially after physical activity, which may gradually worsen or even lead to dyspnea.

Cough and sputum.

Cyanosis: blue, gray, purple lips and nails.

Psychoneurologic symptoms: drowsiness, apathy, excitement, etc., and in severe cases, blurred consciousness.

Complications

Spontaneous pneumothorax: Spontaneous pneumothorax is the result of rupture of the lung blisters and air leakage into the pleural cavity. Severe dyspnea, chest pain, fever, cough and other symptoms will occur.

Respiratory failure: When emphysema is severe, symptoms such as respiratory failure dyspnea, cyanosis, palpitations and chest tightness often occur.

Chronic pulmonary heart disease: emphysema will gradually lead to increased cardiac load, coupled with myocardial hypoxia and other factors, can induce right heart failure. Early-stage patients will gradually experience weakness and shortness of breath; late-stage patients will experience respiratory distress, cyanosis, and psychoneurological symptoms.

Sleep apnea: ventilation is slightly reduced during sleep in normal people, and ventilation will be further reduced during sleep in emphysema patients. Patients will stop breathing several hundred times a night, and they will wake up when breathing stops and then fall back to sleep, which seriously affects their sleep, and can lead to hypoxemia in the long term, which is even more dangerous, and can lead to symptoms such as cardiac arrhythmia and respiratory distress, and in serious cases, they may die during their sleep at night.

Consultation

Department of Medicine

Respiratory Medicine

When coughing, chest tightness, shortness of breath, etc. occur, it is recommended to consult a doctor promptly.

Emergency Department

If you have difficulty breathing, coughing up pink foamy sputum, palpitations and cyanosis, we recommend that you consult the Emergency Department immediately.

Preparation

Preparing for your visit: registration, preparation of documents, common questions

Tips for seeking medical treatment

Chest X-rays or chest CT are often needed, so avoid wearing clothing made of metal, and those who are pregnant or planning to become pregnant should inform the doctor in a timely manner.

Preparation Checklist

Pay particular attention to the time of onset of symptoms and special signs and symptoms.

Is there a cough? How long has the cough lasted?

Is there phlegm? What kind of phlegm?

Is there breathlessness or dyspnea?

How long have the symptoms been present?

Under what circumstances do the symptoms worsen or lessen?

Have you been smoking for a long time?

Have you been exposed to irritating gases, dust, harmful metal particles, etc.?

Are you suffering from bronchial asthma, allergic rhinitis, chronic bronchitis, etc.?

Test results in the past six months, which can be brought to the doctor

Laboratory tests: blood test, blood gas analysis

Imaging tests: Chest X-ray, Chest CT scan

Lung function test: pulmonary ventilation function test

Medication in the last 3 months, bring along the box or package if available

Bronchodilators: salbutamol, terbutaline, aminophylline, ipratropium bromide

Expectorants: Ambroxol, Bromhexine

Anti-inflammatory drugs: budesonide, fluticasone

Antibiotics: amoxicillin clavulanic acid, cefazoxime, levofloxacin

Diagnosis

Diagnosis is based on

Medical history

Patients with emphysema often have a history of chronic bronchitis, bronchial asthma, bronchiectasis, pneumoconiosis, tuberculosis and other chronic bronchopulmonary diseases, or a history of smoking, environmental pollution and occupations that cause emphysema.

Clinical manifestations

Cough, sputum, dyspnea, gradually aggravated dyspnea symptoms, doctor’s examination found barrel chest, pestle-shaped fingers, lips and nails cyanosis and other manifestations.

Laboratory tests

Arterial blood gas analysis: It is necessary to test the oxygenation of arterial blood, so as to determine the air exchange function of the lungs.

Imaging tests

Chest X-ray: can help diagnose advanced emphysema and rule out other causes of shortness of breath. However, the accuracy of X-ray examination is relatively low. In the early stage of emphysema, there may be no obvious changes in the image, and with the progression of the disease, non-specific changes such as increased lung texture and disorder may appear on the image.

Chest CT examination: Compared with plain X-ray examination, CT examination can better observe the changes in the lungs. It has higher sensitivity and specificity in recognizing different types of emphysema and determining the size and number of pulmonary blisters, and can help to evaluate the effects of surgical procedures, such as pulmonary blister resection and/or lung reduction surgery.

Lung Function Tests

Lung function tests will involve a series of non-invasive tests that can help doctors determine how impaired a patient’s lung function is.

Differential Diagnosis

Pneumothorax

Similarities: Both have symptoms such as breathlessness, chest pain and shortness of breath.

Differences: Pneumothorax and emphysema have different imaging manifestations, and clinicians can make a differential diagnosis based on X-ray films.

Tuberculosis

Similarity: Both have symptoms such as cough and sputum.

Differences: Patients with tuberculosis have a history of night sweats and fever, thicker cavity walls are seen on imaging, and Mycobacterium tuberculosis can be detected in sputum.

Lung cancer

Similarity: both have symptoms such as cough, sputum and shortness of breath.

Differences: Lung cancer patients’ cough is mostly irritating, and there may be blood in sputum. Clinical differential diagnosis can be made by chest CT, bronchoscopy, sputum exfoliative cytology and other examinations.

Treatment

Aims and principles of treatment

Emphysema cannot be cured at present, but can only be treated to relieve symptoms, slow down disease progression and improve quality of life.

Treatment Methods

Medication

Medications can relieve symptoms such as coughing, wheezing and shortness of breath caused by emphysema.

Commonly used medications include theophylline, beta 2 receptor stimulants (salbutamol sulfate aerosol, terbutaline), anticholinergic drugs (ipratropium bromide, tiotropium bromide), or long-acting bronchodilators combined with inhaled glucocorticosteroids (salmeterol fluticasone, budesonide formoterol).

Inhaled glucocorticosteroids should not be used for emphysema alone, but should be used in combination with long-acting bronchodilators, which can enhance the efficacy of bronchodilators.

Commonly used drugs include budesonide and fluticasone.

Emphysema is often combined with infection according to the pathogenic bacteria application of effective antibacterial drugs, such as penicillin, cephalosporins and quinolones.

Commonly used bromhexine, ambroxol hydrochloride, acetylcysteine, etc., used in patients with a lot of sputum, to relieve the discomfort of sputum is not easy to cough out.

Chinese medicine treatment is useful in relieving the discomfort of coughing up phlegm, coughing and wheezing caused by emphysema.

Commonly used drugs include Baihe Granules, Phlegm Cough Cleaner Tablets, Expectorant Cough Granules, Emphysema Tablets and so on.

Oxygen therapy

If emphysema is severe and the oxygen level in the blood is low, oxygen inhalation is needed to meet the body’s oxygen demand. In severe cases, hospitalization is required for treatment.

If your doctor allows out-of-hospital treatment, you can carry a lightweight oxygen cylinder with you and administer oxygen as needed. The strategy for home oxygen therapy is to administer low-flow oxygen, 1 to 2 liters per minute, for 8 to 15 hours per day to maintain peripheral oxygen saturation at 92% or higher.

Surgery

Surgery is usually used for people with very severe symptoms that do not improve with medications. Surgery is performed to remove damaged lung tissue, lung blisters, or to perform a lung transplant. The main surgical procedures include pneumonectomy and lung reduction.

Conditions that require surgery include: lung blisters that are more than 30% of the size of the chest; recurrent lung blisters or pneumothorax; lung blisters combined with a pneumothorax or hemopneumothorax; and simultaneous rupture of the blisters on both sides.

In patients with emphysema, the diameter of the pulmonary blisters is usually 1 to 4 cm, sometimes reaching 1/3 of the chest cavity on one side. large pulmonary blisters can compress the surrounding lung tissues.

Removal of the pulmonary blisters can reexpand the compressed lung tissue, improve function, and improve the symptoms of emphysema.

Air leakage is a common postoperative complication.

Also called lung reduction plasty, postoperative lung function and quality of life can be improved, but not the survival of patients.

Serious postoperative complications are mainly pneumonia and persistent air leakage.

Prognosis

Cure

After actively receiving treatment, patients’ clinical symptoms will be relieved, respiratory function will be improved, and their ability to live and work will be enhanced.

The prognosis of emphysema is related to the extent of the disease and reasonable treatment, and the difference in life expectancy between individuals is quite large. Early diagnosis and treatment, as well as regular follow-up, can effectively slow down the progression of the disease.

Hazards

Daily life

Long-term shortness of breath and coughing symptoms of emphysema seriously affect the quality of life of patients.

Mental health

Emphysema is a long and incurable disease, and patients are prone to depression, anxiety and other negative emotions.

Complications

When emphysema is severe, it can lead to complications such as spontaneous pneumothorax, respiratory failure and chronic pulmonary heart disease, which may lead to death.

Daily

Daily Management

Diet

Patients undergoing surgical treatment should be especially careful to avoid spicy and stimulating foods after surgery.

High protein diet: Inadequate protein intake can cause malnutrition, which may lead to symptoms of respiratory muscle weakness. Eating more protein helps to repair diseased and damaged tissues. Therefore, it is advocated that patients with emphysema should increase their high protein diet appropriately on the basis of adequate energy intake, such as lean meat, animal liver, tofu and soy milk. However, dairy intake should be limited, because dairy products can make sputum thickened, not easy to discharge, may aggravate the infection.

High-fiber, high-vitamin diet: High-fiber, high-vitamin diet can prevent respiratory infections and accelerate the repair of damaged tissues in the respiratory tract. Fresh vegetables and fruits are high-fiber, high-vitamin foods, such as carrots, pumpkin, apricots, jujubes, grapefruit, green peppers, tomatoes and so on.

Mushrooms, fungus, shiitake mushrooms and other fungal foods are advisable: consumption of the above foods by emphysema patients helps to improve the body’s immunity.

Drinking more water: patients with emphysema should usually drink more water (at least 2,000 milliliters per day), which is good for diluting phlegm and keeping the airway open.

Lifestyle habits

Quit smoking: Smoking is the most important cause of emphysema, once diagnosed with emphysema, you should quit smoking immediately.

Avoid exposure to irritating gases: including second-hand smoke, haze, smog, chemical gases, etc.

Exercise management

With proper exercise and breathing exercises, training abdominal breathing and lip-contraction breathing exercises can help improve respiratory symptoms.

Breathing Exercises

Lip-contraction breathing: Relax your neck and arm muscles, inhale through your nose for 2 seconds, then pucker your lips and exhale for 4 seconds. Try to slow down your breathing rate during the exercise and focus on the puckering and exhaling process.

Physical Exercise

Physical exercise helps to develop a good mood and energy. You can start with an amount of exercise that suits you and exercise 2 to 4 times a week for 20 to 40 minutes.

Note: Do not perform loaded strength training and very strenuous exercise to prevent tearing of the pulling lung blisters and subsequent spontaneous pneumothorax.

Prevention

Strengthen physical exercise to enhance physical fitness.

Take good precautions to prevent respiratory infections.

Quit smoking and avoid exposure to respiratory irritants.