Internal illnesses. Emphysema (lecture notes)

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Internal illnesses. Emphysema (lecture notes)

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LECTURE No. 31. Emphysema

Pulmonary emphysema is a condition characterized by an increase in the size of the air spaces located distal to the terminal or non-respiratory bronchioles, due to the expansion or destruction of their walls.

Etiology. The cause of the disease can be chronic obstructive pulmonary disease (chronic bronchitis, bronchial asthma), chronic pneumonia, pneumoconiosis, tuberculosis.

Pathogenesis. There is a narrowing of the lumen of the bronchi, an increase in intra-alveolar pressure, thinning of the walls of the alveoli, a violation of their trophism, elasticity, development of alveolitis, destruction of the interalveolar septa.

Classification. Emphysema has forms: interstitial, mediastinal, compensatory.

Clinically, pulmonary emphysema is classified:

1) by origin: primary (idiopathic) - hereditary deficiency of α-1-antripsin, α-2-macroglobulin, secondary (due to the development of chronic obstruction of the bronchial lumen);

2) by the nature of development: acute (due to sudden prolonged bronchial obstruction - after an attack of bronchial asthma), chronic (due to the presence of permanent bronchial obstruction);

3) by complications.

Clinic. Primary emphysema occurs in young and middle age, is manifested by shortness of breath (uncaused) of an expiratory nature, an unproductive cough, the appearance of an emphysematous (dyspnea) type of obstruction ("pink puffers" - to combat the collapse of the airways, exhalation is made through lips folded into a tube and is accompanied by a kind of panting).

RџSЂRё secondary emphysema there is a pink complexion, dry cough, with exacerbation of chronic bronchitis with mucopurulent or purulent sputum, expiratory dyspnea; develops gradually, begins to disturb in the 6th-7th decade of life, barrel-shaped chest, retraction of the intercostal spaces during inspiration, participation in breathing of auxiliary muscles, short neck, swelling of the cervical veins, acrocyanosis. There is a bronchial type of obstruction ("cyanotic edema"), patients lose body weight, often sleep sitting. With percussion, a box shade, the lower borders of the lungs are lowered by 1-2 ribs, their mobility is limited, bulging of the tops of the lungs above the collarbones. Auscultatory noted sharply weakened breathing. Cor pulmonale is formed according to the right ventricular type (in the terminal stages), liver enlargement.

Additional diagnostic study. A general blood test is performed, where compensatory erythrocytosis, a moderate increase in ESR are noted. A functional study of the lungs is carried out (determination of volume and speed indicators) - there is a decrease in the forced expiratory rate, a decrease in the Tiffno index, a decrease in lung capacity with an increase in total and residual capacity, a decrease in the diffuse capacity of the lungs). Inhalation tests with bronchodilators are negative. On the ECG - hypertrophy of the right atrium (increased P II-III) and the right ventricle (S I-III). X-ray examination - increased transparency of the lung fields, low standing of the diaphragm, dilated intercostal spaces. The pressure in the pulmonary artery remains at a normal level for a long time or increases only during exercise.

Complications. Complications of the disease are pneumosclerosis, respiratory failure (I-III degree), cor pulmonale.

Treatment. In the presence of a bronchopulmonary infection, antibiotics are prescribed. Bronchodilators are shown (M-anticholinergics, β₂ -agonists, methylxanthines), mucolytics, oxygen therapy, physiotherapy, therapeutic exercises, spa treatment (in the absence of severe pulmonary heart failure).

Prevention. There is no cure for primary pulmonary emphysema. With secondary emphysema, it corresponds to the prevention of chronic bronchitis.

Flow. Chronic, progressive.

Forecast. Adverse.

Author: Myshkina A.A.

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