emphysema

Emphysema - a pathological process characterized by increased vozduhonapolneniem spaces distal to the terminal bronchioles, the destruction of alveolar walls, which reduces the surface of the capillary bed, resulting in a subsequent reduction in gas diffusion and the development of respiratory failure. In most cases, is the result of emphysema, small airway obstruction long associated with chronic bronchitis (secondary emphysema). There are so-called primary (idiopathic) pulmonary emphysema that develops without prior chronic bronchitis mainly due to a hereditary deficiency of enzymatic factors.

Both of these forms are diffuse emphysema. Along with diffuse release localized forms of emphysema arising from local bronchial obstruction with a valve mechanism, scarring in the lungs, reducing the amount of adjacent sections of the lung tissue, some congenital anomalies of the lungs.

The clinical picture. The main complaint of patients with emphysema is shortness of breath initially occurs during exercise and then at rest. Patients sometimes cover the glottis exhale and inflate the cheeks ( "puff"). This increases the intrabronchial pressure, reduced expiratory spadenie small bronchi and increased respiratory surface. On examination, the patient's attention is drawn to barrel chest, the expansion of intercostal spaces, flattening or bulging supraclavicular pit. Percussion defined box sound, the omission of the lower limits of the lungs, reducing the tour of the lower pulmonary region, the disappearance of cardiac dullness. Auscultation breath weakened.

The course is characterized by emphysema progression of respiratory failure, the rate of which may be different. In patients with primary emphysema for a long time there is a pronounced shortness of breath , which is supported by a satisfactory level of oxygen saturation of the blood. In the presence of obstructive emphysema develop relatively early arterial hypoxemia, compensatory polycythemia, pulmonary hypertension. Radiological signs of emphysema is to increase the transparency of the lung fields and depletion of lung pattern.

Treatment is symptomatic, aimed at reducing the severity and progression of respiratory insufficiency (limitation of physical activity, prevention of respiratory infections and exacerbations of chronic bronchitis, oxygen).

Prevention of secondary emphysema is to prevent the development of chronic bronchitis and adequate treatment of patients with chronic bronchitis.