Generality
Pulmonary emphysema is a serious disease of the lungs, caused by a deterioration of the alveoli they contain. The most common cause is the inhalation of irritating substances, contained for example in cigarette smoke, in polluted air or in the fumes of certain industrial plants.
The main symptom of pulmonary emphysema is dyspnea, or breathing difficulty: this, at first, appears only under stress, then it becomes manifest even at rest.
Figure: lung affected by centrilobular emphysema, characteristic of smokers. The organ section makes various cavities appear covered with heavy deposits of black tar. From wikipedia
Diagnosis is based on diagnostic imaging tests, such as the Rx-thorax or CT scan, and other pulmonary function tests.
Definitely healing from pulmonary emphysema is, unfortunately, impossible. However, there are some treatments, useful for reducing the symptoms.
What is pulmonary emphysema?
Pulmonary emphysema is a disease of the lungs, characterized by an anatomical alteration of the glial cells and, in some cases, even terminal bronchioles; unfortunately, it is a negative alteration, as it causes more or less serious breathing difficulties.
Included in the list of so-called chronic obstructive bronchopneuomopathies ( COPD ), pulmonary emphysema represents a chronic and usually bilateral morbid condition (ie it affects both lungs).
Origin of the term emphysema. The term emphysema means "enormous expansion" or "enormous enlargement".
WHAT ARE ALVEOLI?
The alveoli are small pulmonary cavities, in which gas exchange takes place between the blood and the atmosphere.
Located at the ends of the terminal bronchioles, that is the final branches of the bronchi, the alveoli have an extensive, very elastic parietal surface, which serves to increase the area for gas exchange.
In fact, within them, the blood is enriched with the oxygen contained in the inhaled air and "free" of the carbon dioxide produced by the tissues.
Surrounded by elastic walls, the alveoli are separated from each other by the so-called alveolar septa ; these dividing structures are fundamental, because they greatly amplify the surface for gas exchange, allowing a better blood oxygenation.
A set of alveoli forms the so-called pulmonary berry ; the pulmonary berry, or simply a berry, resides at the end of a terminal bronchiol ; the terminal bronchioles are the last branches of the lower airways, which begin from the trachea and continue with the primary bronchi, the secondary bronchi, the tertiary bronchi, the bronchioles and, precisely, the terminal bronchioles.
A group of more pulmonary acini and more terminal bronchioles is the smallest lung structure visible to the naked eye: the lobule . In the pulmonary lobule, more internal berries can be recognized, called central, and peripheral berries, called distal.
Epidemiology
According to some estimates, worldwide, emphysema affects about 210 million people and causes the death, every year, of 3 million individuals.
At one time, it was more common among men, because the latter smoked more than women (NB: cigarette smoking is one of the main causes of emphysema) and they practiced jobs more at risk.
Today, however, things have changed and, given the large number of smokers, women and men get emphysema more or less at the same frequency.
Causes
Pulmonary emphysema usually arises after prolonged exposure of the lungs to irritating and toxic substances (phenols, quinone-hydroquinone, nitrogen compounds, etc.), contained in cigarette smoke (both active and passive), in polluted air and in exhalations. certain industrial plants .
However, although very rarely, it can also occur due to a hereditary defect, concerning a protein of the lungs, called Alpha 1-antitrypsin . The latter is essential for the health of the alveoli, as it guarantees their elasticity and the possibility of filling air in an adequate manner, without damage.
But what are the alterations of the alveolar implant that give rise to emphysema?
PATHOPHYSIOLOGY
According to the strictly medical definition, pulmonary emphysema is: "an abnormal enlargement of the air spaces placed distally to the terminal bronchiole (ie the cavities formed by the alveoli), associated with destructive lesions of the alveolar walls".
The lesions on the alveolar walls also concern the septa that divide the various alveoli, therefore the surface for gaseous exchanges is drastically reduced. The reduction of the exchange surface is followed by less oxygenation of the blood (and therefore also of the tissues) and the appearance of different respiratory problems.
Anatomically, the alveoli dilate more than normal and actually become one.
The gravity of these changes is represented by the fact that, once destroyed, the alveolar septa can no longer return as before, that is they are irreparably damaged.
TYPES OF EMPHYSEMA SECOND DEFINITION
Figure: Healthy alveoli and alveoli of a person with pulmonary emphysema. In the latter, the absence of alveolar septa and an abnormal extension of the berries can be noted. From the site: health9.org
Bearing in mind the aforementioned medical definition, based on the position of the berries concerned, pulmonary emphysema can be divided into at least four categories:
- Centrobular (or centeracin) pulmonary emphysema : shows a deterioration of the central acini of one or more lobules. It is the form of emphysema most closely related to cigarette smoking.
- Panlobular pulmonary emphysema (or panacinosa) : it presents a total alteration of one or more lobules; in other words, terminal bronchioles, central acini and even peripheral acini are involved.
- Paraseptal pulmonary emphysema : it is due to an alteration of the peripheral pulmonary acini of one or more lobules.
- Irregular pulmonary emphysema : shows damage to some central berries and some peripheral berries (this is why it is called irregular) of one or more lobules.
OTHER TYPES OF EMPHYSEMA
In fact, under the heading pulmonary emphysema it is possible to include also morbid states in which - instead of an enlargement of the alveolar spaces and a deterioration of the septa - there occurs an hyper dilation or atrophy of the lungs.
One speaks of hyperdilation (or hyper-distension) in the presence of abnormal air forfeiture and in inadequate areas of the lungs; this condition is recorded in the event of:
- Acute emphysema, typical of those suffering from asthma .
- Bullous emphysema, characterized by the formation of air bubbles.
- Interstitial emphysema, characterized by an accumulation of air around the lobules and below the pleura (lining of the lungs). It is generally caused by severe coughing attacks.
There is talk instead of atrophy of the lungs in the case of the so-called senile pulmonary emphysema . This condition is due to a shrinkage of the alveoli
Risk factors
The appearance of a pulmonary emphysema is favored by:
- Cigarette smoking, both active and passive. Large smokers and those who have spent many years together with large smokers are all at high risk.
- Exposure to environmental pollution. The most dangerous and most commonly breathed by human pollutants are the exhaust gases of cars and other combustion vehicles.
- Advanced age. Over the years, the lung tissue undergoes a physiological deterioration, which weakens and makes both the lungs and the alveoli more fragile.
Symptoms and Complications
To learn more: Symptoms Emphysema
The most characteristic clinical sign of pulmonary emphysema is dyspnea, that is the difficulty (or lack, in the most serious cases) of breathing.
Moments in which dyspnea can appear:
- Ascending the stairs
- Work that requires physical effort
- Walking uphill
- After meals
Initially, this symptom takes on the features of dyspnea on exertion, as it occurs only when the patient is engaged in physical activities that require an increase in respiratory rate.
Then, over time, the "air hunger" becomes more severe and appears even at rest and during the most trivial tasks ( dyspnea at rest ).
For respiratory disorders, they can be associated with : cough with chronic expectoration, cyanosis (in particular with the lips and with the nails), hyperinflation of the chest (due to an incomplete exhalation of inhaled air), feeling of exhaustion, fever, reduced respiratory mobility (especially when the patient has to take deep breaths) and, finally, heart problems .
PULMONARY EMPHYSEMA: A SOMETIMES SIDE DISORDER
One of the greatest dangers of pulmonary emphysema is that, in some situations, the initial manifestations are almost imperceptible and remain so for several months, if not even years. This causes the therapeutic treatments to start belatedly, when the situation is already very compromised.
WHEN TO REFER TO THE DOCTOR?
Breathing difficulties at rest or after not particularly intense efforts should always be promptly reported to your doctor, as they could be a sign of serious respiratory and / or heart problems.
COMPLICATIONS
Pulmonary emphysema can lead to the collapse of a lung due to a pneumothorax, the aggravation of heart problems and, finally, the formation of so-called "giant bubbles" at the level of the lungs.
Going into details:
- The pneumothorax occurs in the case of very severe pulmonary emphysema and is due to the rupture of the acini located near the pleura, ie the membrane that surrounds the lungs. This event, in fact, creates a passageway for the inhaled air, which, once it arrives in the lungs, exits into the adjacent pleural cavity, causing the lung to collapse.
- The aggravation of heart problems usually consists of the so-called pulmonary heart ; this complication is due to the increase in pulmonary artery pressure (ie the blood pressure flowing in the pulmonary artery) and is characterized by worsening dyspnea.
- The formation of "giant bubbles", that is empty spaces inside the lungs, reduces the capacity of the lungs to breathe properly. This exacerbates respiratory problems and promotes episodes of pneumothorax.
Diagnosis
To diagnose pulmonary emphysema, some diagnostic imaging tests (such as chest X-ray and CT scan), arterial blood gas analysis and, finally, spirometry are required.
Obviously, the patient is also subjected to an objective examination, during which the doctor analyzes the extent of dyspnea and the presence of some other particular sign (cyanosis, chest inflation, etc.).
CHEST RADIOGRAPHY
The chest X-ray, or chest X -ray, is a radiological imaging diagnostic exam, which allows the visualization of the main anatomical structures of the thorax: therefore heart, lungs, main blood vessels, most of the ribs and a portion of the spine .
The resulting images are obtained by exposing the patient to a certain dose of ionizing radiation ( X-rays ); in general, the information collected by chest radiograph is fairly clear and comprehensive, but in some particular cases of pulmonary emphysema may be free of abnormalities.
TAC
CT scan, or computerized axial tomography, is a more sensitive diagnostic imaging test than chest radiography, which can show the lungs from multiple angles.
Its execution, unlike the RX-chest, makes it possible to "find" any anomaly at the pulmonary and thoracic level, clarifying the exact origin of the complaints complained of by the patient.
Also the CT scan, like the X-ray, exposes those who undergo a not inconsiderable dose of ionizing radiation.
ARTERIAL HEMOGASANALYSIS
Arterial blood gas is a special diagnostic test, which takes place on a blood sample taken generally from the wrist. Through this examination, the doctor measures the pressure of the gases in the blood (therefore oxygen and carbon dioxide) and the blood pH. Based on the results of the measurements, therefore, it is able to predict lung function, the efficiency of gas exchange within the alveoli and the oxygen levels circulating in the blood.
In the case of pulmonary emphysema, the exchange of gases is, as has been said, deficient, therefore the blood is generally poor in oxygen.
SPIROMETRY
Figure: Spirometry. From Wikipedia
Spirometry is one of the most common and practiced diagnostic tests for estimating lung function, because it is fast, effective and painless.
During its execution, the patient must perform respiratory acts while it is connected by mouthpiece to an instrument, called a spirometer ; this device measures the inspiratory and expiratory capacity of the lungs and the patency (ie the opening) of the airways passing through them.
Spirometry, performed on a patient with pulmonary emphysema, has a characteristic outcome, which a doctor is able to decipher.
Treatment
To learn more: Drugs for the treatment of Emphysema
Pulmonary emphysema cannot be cured, as, unfortunately, the damage to the alveoli is irreparable.
However, to alleviate its symptoms and improve its quality of life, the patient can be treated with drugs, special therapies (such as pulmonary rehabilitation and oxygen therapy) and a special surgical procedure.
PHARMACOLOGICAL TREATMENTS
Depending on the severity of pulmonary emphysema and the associated conditions, the doctor may prescribe:
- Bronchodilators . These medications relieve cough, wheezing and all the various respiratory problems, as they improve the patency of the lower airways. Unfortunately, they are not as effective as in the case of asthma and chronic bronchitis.
- Inhaled corticosteroids . Some examples of inhaled corticosteroids:
- beclomethasone
- flunisolide
- Budesonide
- Fluticasone
- Antibiotics . Your doctor can take them if you fear that the patient may have some bacterial infection, such as pneumococcal pneumonia.
OTHER THERAPIES
To improve the symptoms caused by pulmonary emphysema, they provide excellent results: respiratory rehabilitation, respiratory physiotherapy, oxygen therapy and a tailored diet.
Respiratory rehabilitation consists of giving the patient a series of motor exercises (exercise bikes, climbing stairs, walking etc.) in order to improve tolerance to efforts and reduce the severity of dyspnea.
Respiratory physiotherapy aims to improve the patient's respiratory capacity, although it does not involve any benefit at the strictly pulmonary level.
Oxygen therapy serves to increase the amount of circulating oxygen, when this, due to a compromised pulmonary function, is scarce both at the blood level and at the tissue level (ie in the body tissues).
Finally, the tailored diet is a nutritional measure aimed at maintaining body weight or, in the case of obesity or being overweight, at slimming.
SURGICAL INTERVENTION
Surgery is used only in the case of very severe pulmonary emphysema. The usual operations are:
- Lung reduction . It consists in removing the damaged parts of the lung, so that the healthy parts left in place can work better. This is a particularly invasive, risky procedure (post-operative mortality, after a few years, is by no means negligible) and long preparation.
- Lung transplantation . It is the procedure by which the diseased lung is replaced by another healthy one, coming from a compatible donor. Given the considerable invasiveness and the fair probability of failure of the operation (rejection of the organ), lung transplantation is an operation practiced only in extreme cases and when all the other solutions mentioned above have not provided any benefit.
SOME IMPORTANT PRECAUTIONARY MEASURES
For those suffering from pulmonary emphysema, to improve the quality of one's life, it is advisable:
- Stop smoking . It is good practice to also avoid aspirating passive smoking, because it is just as harmful.
- Avoid places and environments in which airborne substances irritating the lungs circulate . It is advisable to stay away from cities and polluted areas, and do not use fireplaces, stoves and wood-fired ovens in your own homes.
- Practice physical activity regularly . Motor exercises must obviously be adapted to health conditions; requesting an exaggerated effort from your lungs could be dangerous.
- Protect yourself properly from cold air . During the winter season, it is good to repair, with a scarf, both the mouth and the nose, because the inhalation of cold air narrows the airways and complicates breathing.
- Prevent respiratory infections . It is of fundamental importance to resort to the anti-flu and anti-pneumococcal (pneumonia) vaccine and to avoid any direct contact with cold and flu patients.
Prognosis and prevention
The health of those suffering from pulmonary emphysema is definitively compromised, therefore the prognosis, given also the severity of the morbid state, can never be positive. However, if the treatments and the aforementioned rules are meticulously adhered to, it is possible to significantly improve the quality of life.
PREVENTION
Do not smoke, avoid exposure to passive smoking and protect yourself, in the case of occupational exposure to irritating / toxic substances, with adequate masks, are the main preventive measures against pulmonary emphysema.
