Pulmonary Emphysema - Information Overview

Pulmonary emphysema is a pathological process characterized by the expansion of the alveoli located distal to the terminal bronchioles and accompanied by destructive changes in the alveolar walls (elastic fibers of the lung tissue).

The prevalence of pulmonary emphysema is more than 4%, and according to autopsy data, it is recorded in 60% of deceased men and in 30% of women.

The incidence of pulmonary emphysema increases significantly after age 60. Pulmonary emphysema is a chronic obstructive pulmonary disease.

According to origin, a distinction is made between primary (genuine or idiopathic) pulmonary emphysema, in which bronchial obstruction is a complication, and secondary (obstructive) emphysema, which complicates the course of chronic bronchitis.

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Causes of pulmonary emphysema

Smoking is considered one of the most aggressive factors in the development of chronic obstructive pulmonary diseases in general and emphysema in particular. The development of pulmonary emphysema in smokers is due to the fact that tobacco smoke causes the migration of neutrophils to the terminal section of the respiratory tract. Neutrophils produce large amounts of proteolytic enzymes elastase and cathepsin, which have a destructive effect on the elastic base of the alveoli.

In addition, with chronic smoking, tobacco smoke tar accumulates in the alveolar macrophages, and the formation of alpha1-antitrypsin in them is sharply reduced.

Causes and pathogenesis of pulmonary emphysema

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Symptoms of pulmonary emphysema

The main complaint of patients with emphysema is dyspnea. At the beginning of the disease, it occurs only with significant physical exertion, then, as emphysema progresses, it becomes permanent. With the development of bronchial obstruction, dyspnea becomes expiratory.

Shortness of breath in primary pulmonary emphysema differs from shortness of breath in secondary emphysema. In primary pulmonary emphysema, the nature of breathing changes: inhalation becomes deep, and exhalation is long, through closed lips. Patients try to increase the pressure in the airways during exhalation, so when exhaling, they slightly close their mouth and puff out their cheeks, which reduces the expiratory collapse of the small bronchi. This type of breathing resembles puffing.

Symptoms of pulmonary emphysema

Diagnosis of pulmonary emphysema

X-ray examination of the lungs and heart. Characteristic signs of pulmonary emphysema are a low position of the diaphragm dome and its flattening, noticeably reduced excursion of the diaphragm; increased airiness of the lung fields; an increase in the retrosternal space (Sokolov's sign); depletion of the lung fields of vascular shadows (the vascular pattern becomes thread-like and significantly weakens toward the periphery). The cardiac shadow is narrowed, elongated ("drop heart").

Pulmonary emphysema is characterized by hyper-airiness of the lung tissue, depletion of the vascular pattern, and bullae are clearly visible compared to conventional X-ray examination.

In the presence of chronic bronchitis, high density of the bronchial wall and infiltration along the bronchi are revealed.

Emphysema - Diagnosis

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