Pulmonary emphysema: causes, symptoms and diagnosis


What is pulmonary emphysema?

Emphysema is a lung disease characterized by:

  • overinflation of the alveoli (alveoli),
  • Destruction and disappearance of the alveoli walls.

This breathing disorder mainly affects men over 40 years of age and old people.

Anatomy and physiology of breathing
When inhaled, the air enters the lungs via bronchi.
Inside the lungs, the bronchi are divided into many smaller airways called bronchioles.
The alveoli are located at the end of the bronchioles.
These structures are small air bubbles.
The exchange of oxygen and carbon dioxide between lungs and blood occurs in the small blood vessels (capillaries) in the alveolar walls.

When inhaling:

  • the thorax expands,
  • the air bubbles (alveoli) swell.

The natural tendency of the chest is to expand.
In the alveoli walls, on the other hand, there are elastic fasts that pull in the opposite direction to contract the chest.
The rib cage consists of 12 pairs of ribs that:

  • originate from the vertebrae,
  • end at the sternum.

Under normal circumstances, they are tilted downwards.
When inhaling:

  • the ribs are lifted by the intercostal muscles and take an increasingly horizontal position.
  • the diaphragm lowers and becomes flat.

The result is an increase in the volume of the chest to favor the entry of air.

Anatomical alterations caused by emphysema

The bronchioles become inflamed, which reduces the amount of air in the alveoli.

  • The capillaries and alveolar walls burst, so there are fewer blood vesselsavailable for gas exchange, which is necessary for the oxygenation of the blood.
  • The destruction of the alveoli walls causes the rupture of the elastic fibers, which, when exhaling, reduce the size of the thorax.
    If the elastic fibers are destroyed, the chest remains dilated as if inhaled.
  • The air remains trapped in the bloated alveoli and additionally reduces tissue elasticity.
  • The functioning of the lungs deteriorates.

Emphysema can be fatal.

What are the causes of emphysema?

Smoking Smoking
is one of the main causes of emphysema.
People who smoke have this form of the disease in mild or more severe form after just a few years.

Smoking damages the defense system of the lungs and causes:

1) Congestion, which narrows
the airways When a person smokes, he inhales toxic substances contained in cigarettes.
These chemical products:

  • irritate the airways,
  • accumulate in the inner workings of the lungs,
  • begin to destroy the fine hair-like pulmonary cilia.

The main function of cilia is to prevent mucus accumulation in the airways.
The destruction of cilia causes massive accumulation of mucus, which leads to secretion congestion.
Consequences of traffic jams:

  • narrowing of channels,
  • Reduction of airflow.

This causes chronic bronchitis, a manifestation of chronic obstructive pulmonary disease COPD.
Emphysema does not appear suddenly, but is the result of a long period of smoking.

2) Destruction of the alveoli
Smoking also causes the destruction of the tissue inside the lungs.
Secondhand smoke is also harmful.

Alpha-1-antitrypsin deficiency
Among the causes is also the lack of a protein: AAT (alpha-1-antitrypsin). This protein is produced by the liver and is required for the elasticity of lung tissues.

Air pollution
Exposure to pollutants (smoke, dust, etc.) – Emphysema is a common disease in areas where air pollution is a serious problem.
The inhaled pollutants have the same effect in the lungs as cigarette smoke.

Risk factors for pulmonary emphysema

Risk factors include:

  • Chronic bronchitis – in a person suffering from chronic bronchitis, the elasticity of the lungs decreases, often both diseases occur together.
    In this case, the patient has other symptoms, for example, fever and diffuse pain.
  • Asthma.

Classification of pulmonary emphysema

  1. Bullous emphysema is characterized by the formation of large isolated air bubbles in the lungs that impede breathing. If the blisters suddenly burst, this can cause pneumothorax.
  2. Centrilobular emphysema affects the bronchioli respiratorii in the middle of the lobe. The upper or proximal lobes (closer to the trachea) are affected. This type of emphysema particularly affects smokers and causes low oxygen levels in the blood, cyanosis and chest swelling. This is why patients suffering from centribular emphysema are called blue bloaters.
  3. Panlobular emphysema affects the entire lobe of the lungs and is more severe in the lower areas, where there is greater blood flow.
    It is mainly caused by alpha-1 antitrypsin deficiency (AAT) and worsens with smoking, drugs based on methylphenidate (Ritalin) or Swyer-James syndrome.
    Patients with panlobular emphysema have rapid breathing and exhale through the lips, which is why they are called pink puffers.
  4. Paraseptal or distal pulmonary emphysema affects the peripheral parts of the lungs, that is, near the pleura. Paraseptal pulmonary emphysema can form blisters below the pleura that cause spontaneous pneumothorax when they burst.
  5. Interstitial pulmonary emphysema occurs when air accumulates in the space between the lobules and under the pleura.
  6. Acute pulmonary emphysema is characterized by dilated alveolar walls due to asthma attacks in asthma.
  7. Age-related emphysema is found in older people whose alveolar walls are less elastic.
  8. Compensatory pulmonary emphysema affects the healthy lungs or the lobe of the lung, which seeks to replace the diseased organ segment

Symptoms of pulmonary edema

  1. Shortness of breathShortness of breath is the most common symptom.
    Unlike other respiratory diseases, the problem with emphysema is not inhalation, but exhalation.
    In the initial phase, the difficulties persist under physical stress, but as the disease progresses, the symptoms also appear at rest.
  2. Increased respiratory rate (tachypnea). Patients often breathe quickly.
    Under normal circumstances, a person breathes 12 to 20 times a minute, but in patients with emphysema, respiratory movements are much more common (40-60).
  3. Cough. Chronic and persistent cough that persists for a long time is another symptom. It may be accompanied by sputum (productive cough with catarrh).
    It can lead to increased mucus formation.
  4. Blue skin or cyanosis is a symptom seen in emphysema disease. It occurs mainly after strenuous activity and passes again at rest.
    This happens due to the poor oxygenation of various parts of the body.
  5. The barrel thorax is a pathological change in which the chest becomes larger and rounder, similar to a barrel.
    This is especially seen in advanced emphysema, where a large amount of air remains trapped in the alveoli and makes breathing difficult.
  6. Some patients also experience chest pain.
  7. Due to shortness of breath, some activities become difficult, for example eating.
  8. At the last stage of the disease, loss of appetite and weight loss are observed.

The signs and symptoms (shortness of breath or puffing) may also only appear after talking or laughing for a long time.
Sometimes patients also feel short of breath after eating.

These symptoms do not appear until 20% to 50% of lung tissue is damaged.

Diagnosis of pulmonary emphysema

The doctor must:

  • analyse the medical history,
  • perform a physical examination.

The doctor hears when tapping and listening to the lungs:

  • a very far-reaching and intensive to,
  • a prolonged exhalation phase,
  • whistling noises similar to those in asthma patients.

The doctor may order an imaging examination, such as:

  • X-ray (X-ray horax) – in patients with emphysema, the following are noticeable:
    • the diaphragm becomes straight,
    • the space behind the sternum increases;
    • the chest becomes rounder and wider because the elastic lung fibers are destroyed and the thorax thus changes its shape.
  • CT – shows which areas of the lung are affected by emphysema. In the cross-section (see figure below) you can see darker spots representing the lung area with emphysema. The black dots within these spots are the arteries.
  • Respiratory function test – this test assesses the patient’s ability to breathe.
  • Spirometry – this test measures the volume of air and the time of exhalation.
  • Breath gas analysis or blood gas analysis – this test indicates the amount of oxygen and carbon dioxide in the blood.
  • Genetic testing to detect possible alpha-1 antitrypsin deficiency.
  • Blood tests – these tests are designed to rule out other diseases.

Differential diagnosis

The doctor must rule out other conditions that cause shortness of breath and cough, such as:

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