What Is Severe Emphysema?

Emphysema refers to a pathological condition in which the airway elasticity at the distal end of the bronchioles is diminished, overdilated, inflated, and the lung volume is increased or accompanied by airway wall destruction. There are several types of emphysema according to its causes: senile emphysema, compensatory emphysema, interstitial emphysema, focal emphysema, paraseptal emphysema, and obstructive emphysema swollen.

Basic Information

English name

emphysema

Visiting department

Respiratory Medicine

Multiple groups

Middle-aged and elderly

Common causes

Smoking, infection and air pollution are common causes

Common symptoms

Increased dyspnea due to cough, expectoration, etc.

Contagious

no

Causes of emphysema

The pathogenesis of obstructive emphysema is not fully understood. It is believed to be related to bronchial obstruction and protease-antiprotease imbalances. Smoking, infection, and air pollution cause bronchiolitis, narrowing or obstruction of the lumen. When inhaling, the bronchiolar lumen expands and air enters the alveoli; when exhaling, the lumen shrinks, air stays, and the internal pressure of the alveoli increases continuously, causing the alveoli to expand or even rupture. The loss of radial traction around the bronchioles causes the bronchioles to contract and narrow the lumen. Pulmonary vascular intimal thickening, decreased alveolar wall blood supply, weakened alveolar elasticity, etc., promote the expansion of alveolar rupture. In the case of infection, the protease activity in the body is increased. Those with 1 antitrypsin deficiency have less ability to inhibit proteases, so they are more prone to emphysema.

Clinical manifestations of emphysema

Clinical manifestations depend on the severity of emphysema. Early asymptomatic or shortness of breath only during work and exercise. As emphysema progresses, the degree of dyspnea increases, and shortness of breath is felt even after a little activity or even complete rest. The patient feels weak, loses weight, loses appetite, and has full stomach. Accompanied by symptoms such as cough and sputum, typical emphysema patients have increased anteroposterior diameter of the thorax, barrel-shaped chest, weakened breathing movements, weakened speech tremor, percussive voicelessness, reduced heart dullness, lowered liver dullness, and respiratory sounds Reduced, sometimes dry and wet murmurs can be heard, and heart sounds are low.

Emphysema examination

1. X- ray inspection

The rib cage was expanded, the intercostal space was widened, the ribs were parallel, the diaphragm was lowered and flattened, and the transillumination of both lung fields increased.

2. ECG examination

Generally there are no abnormalities, and sometimes it can be low voltage of limb conduction.

3. Respiratory function test

It is of great significance for the diagnosis of obstructive emphysema, and the residual air volume / total lung ratio is> 40%.

4. Blood gas analysis

If significant hypoxic carbon dioxide retention occurs, the arterial partial pressure of oxygen (PaO ₂ ) decreases, the partial pressure of carbon dioxide (PaCO ₂ ) increases, and decompensated respiratory acidosis may occur, and the pH value decreases.

5. Blood and sputum tests

Generally no abnormalities.

Emphysema diagnosis

A clear diagnosis can be made based on medical history, physical examination, X-ray examination, and pulmonary function tests. X-ray examination showed an enlarged anteroposterior diameter, anterior process of the sternum, widened posterior sternal space, low level diaphragm, reduced lung texture, increased light transmission in the lung field, draped heart, widened pulmonary artery and major branches, and peripheral blood vessels small. Pulmonary function tests showed residual gas, increased lung volume, increased residual gas / total lung ratio, significantly reduced FEV1 / FVC, and reduced diffuse function.

Differential diagnosis of emphysema

Attention should be paid to the differential diagnosis of tuberculosis, lung tumors and occupational lung diseases. In addition, chronic bronchitis and bronchial asthma are chronic obstructive pulmonary disease, and both chronic bronchitis and bronchial asthma can be complicated by obstructive emphysema. But the three are both related and different. Chronic bronchitis is mainly limited to the bronchus before emphysema, and may have obstructive ventilation disorder, but to a lesser extent, and the diffuse function is generally normal. The onset of bronchial asthma manifests as obstructive ventilation disorder and excessive inflation of the lungs, and the gas distribution can be severely uneven. However, the above changes are more reversible and respond better to inhaled bronchodilators. The change in diffuse dysfunction was also not significant.

Emphysema complications

Spontaneous pneumothorax

Spontaneous pneumothorax complicated by obstructive emphysema is not uncommon, mostly due to rupture of the subpleural bullae and air leakage into the pleural cavity. If the patient's basal lung function is poor, and the pneumothorax is tonic, even if the amount of gas is not large, the clinical manifestations are also serious, and it must be actively rescued.

2. Respiratory failure

Obstructive emphysema often has severely impaired respiratory function. Under the influence of certain inducements such as respiratory infections, blocked secretions, inappropriate oxygen therapy, and surgery, ventilation and ventilation dysfunctions are further aggravated, which can induce respiratory failure. .

3. Chronic pulmonary heart disease

When obstructive emphysema is accompanied by hypoxemia and carbon dioxide retention, alveolar capillary bed destruction, etc., can cause pulmonary hypertension. There was no manifestation of right heart failure during the period of cardiac function compensation. When the respiratory disease is further aggravated and the arterial blood gas is deteriorated, the pulmonary artery pressure is significantly increased, the heart load is increased, and factors such as myocardial hypoxia and metabolic disorders can induce right heart failure.

4. Gastric ulcer

Patients with obstructive emphysema can be complicated by gastric ulcers. Its pathogenesis has not been fully defined.

5. Sleep disordered breathing

Ventilation during sleep can be slightly reduced in normal people, while ventilation in patients with obstructive emphysema has decreased. Further reduction in sleep is more dangerous, and heart rhythm disturbances and pulmonary hypertension can occur.

Emphysema treatment

1. Proper application of diastolic bronchial drugs

Such as aminophylline, 2 receptor stimulants. When the condition requires, glucocorticoids can be used appropriately.

2. Apply effective antibiotics based on pathogenic bacteria or experience

Such as penicillins, aminoglycosides, quinolones and cephalosporins.

3. Respiratory function exercise

For abdominal breathing, narrow your lips and exhale slowly to strengthen the breathing muscles. Increase diaphragmatic mobility.

4. Home oxygen therapy

12 to 15 hours of oxygen per day can prolong life. If you can achieve continuous oxygen therapy 24 hours a day, the effect is better.

5. Physical therapy

Make plans based on the condition, such as Tai Chi, breathing exercises, quantitative walking, or climbing exercises.

Emphysema prevention

The first is to quit smoking. Keep warm, avoid cold, and prevent colds. Improve environmental hygiene, protect personal labor, and eliminate and avoid the effects of smoke, dust and irritating gases on the respiratory tract.