What happens in the lungs
Alveoli are tiny sacs through the walls of which oxygen passes into the blood. Under the influence of tobacco smoke and other irritants, inflammation smolders in the lungs for years, and enzymes secreted by cells of the immune system destroy elastic fibers in the walls of the alveoli. The partitions between the bubbles disappear, large cavities - bullae - form. The surface area for gas exchange decreases, and the lungs lose their elasticity, which normally helps push air out. As you exhale, the small bronchi collapse, the air remains in the lungs, and the chest becomes barrel-shaped.
- Destruction of the walls of the alveoli
- Reduced gas exchange surface
- Loss of elasticity of lung tissue
- Air retention and overdistension of the lungs
- Formation of bullae
- Increased load on the right side of the heart
Causes and risk factors
Smoking remains the main reason: the longer the experience and the more cigarettes, the higher the risk. Passive smoking, hookah and electronic cigarettes are also important. The second most important factor is inhalation of dust and smoke at work and at home, including smoke from burning coal and biofuel in poorly ventilated areas. In a small proportion of patients, the cause is a hereditary deficiency of alpha-1 antitrypsin, a protein that protects lung tissue from its own enzymes; in this case, emphysema develops early and in non-smokers.
- Smoking, including hookah and electronic cigarettes
- Passive smoking
- Industrial dust and chemical fumes
- Smoke from burning fuel in the house
- Alpha-1 antitrypsin deficiency
- Frequent respiratory tract infections in childhood
Symptoms
The disease develops unnoticed, and in the first years a person attributes shortness of breath to age and lack of training. First, there is not enough air when climbing stairs and walking quickly, then during normal walking and household activities, and later shortness of breath appears at rest. The difficulty of exhalation is characteristic: patients involuntarily exhale through closed lips. There may be little or no cough, which distinguishes emphysema from chronic bronchitis. Over time, body weight decreases, muscle strength decreases, and the chest becomes barrel-shaped.
- Slowly increasing shortness of breath
- Difficulty prolonged exhalation
- Exhale through closed lips
- Scanty cough
- Reduced exercise tolerance
- Weight loss and weakness
- Barrel chest
Survey
A key method is spirometry with a bronchodilator test: it confirms persistent airflow limitation and distinguishes emphysema and COPD from bronchial asthma. Computed tomography shows areas of destroyed tissue, bullae and their location, which is important when discussing surgery. X-ray reveals increased airiness and a low diaphragm. Pulse oximetry and blood gas analysis evaluate oxygen saturation, echocardiography evaluates pulmonary artery pressure and the condition of the right side of the heart. In young non-smoking patients, alpha-1 antitrypsin levels are determined.
- Spirometry with reversibility test
- Computed tomography of the chest
- Chest X-ray
- Pulse oximetry and blood gas analysis
- Echocardiography
- General blood test
- Determination of alpha-1-antitrypsin in early onset
Treatment and lifestyle
Destroyed alveoli do not regenerate, so the goal of treatment is to slow progression, reduce shortness of breath and reduce the number of exacerbations. The most effective thing is to completely quit smoking; without this, any treatment works worse. The doctor selects long-acting inhaled bronchodilators and, with frequent exacerbations, adds other groups of drugs. Pulmonary rehabilitation plays a huge role: dosed walking, breathing exercises, muscle training. Annual influenza vaccination and pneumococcal vaccination are important. For severe respiratory failure, long-term oxygen therapy is prescribed, and for large bullae, surgery is discussed.
- Complete smoking cessation
- Inhaled bronchodilators as prescribed by a doctor
- Correct inhalation technique
- Pulmonary rehabilitation and breathing exercises
- Vaccination against influenza and pneumococcus
- Good nutrition and weight maintenance
- Oxygen therapy and surgical treatment according to indications