What is Pulmonary Atelectasis, types, physiotherapy, has a cure?

What is atelectasis?

Atelectasis is characterized by a pulmonary collapse with consequent loss of volume and expansive capacity, caused by the emptying of the alveoli.

Often caused by obstructions in the air passages, atelectasis is characterized by a withered and little expansive lung, with less capacity to store air.

This collapse can occur in a unipolar manner, that is, reaching only one lung, and it can reach both the entire lung and only one lobe. But don’t worry, this does not mean that there is mistreatment of animals: the wolf is a word with the meaning of “piece”, which is pronounced as “wolf”.

It is more common in children because of their small lungs that can be more easily obstructed or as a postoperative complication by the use of general anesthesia.

At ICD-10 (International Disease Code, tenth edition), atelectasis is found by code J98.1.

How does the lung work?

We know that the lung is responsible for our breathing, expanding when we fill it with air and contracting when we exhale it. It is precisely this movement that allows for inhalation and exhalation, placing the oxygen-filled air inside and sending the carbon dioxide away. But the process is not as simple as you think …

To begin with, we have to make it clear that the lung is an even organ. What does that mean? It means that, although we refer to it in the singular, we have two lungs: one left and one right. And they are not the same.

In fact, the right lung is divided into three lobes: “pieces” of lung separated by fissures without being completely disconnected. The left lung is smaller and has only two lobes, precisely to give the perfect fit with the heart.

These lobes are the “lining” of the so-called bronchial tree, composed of main bronchi (connected to the trachea), secondary bronchioles and, finally, the alveoli or alveolar sacs. It is in this latter structure that gas exchange takes place, responsible for supplying oxygen to the entire body.

Causes of atelectasis

For the gas exchange to occur correctly, the alveoli must remain open. Otherwise, the resistance of the fabrics would prevent air from entering these bags, making this exchange unfeasible. That’s where atelectasis happens: with the closing of the alveolar sacs.

There are several reasons for this to happen. Some of them are as follows:

Problems with pulmonary surfactant

The natural tendency of the alveoli – as well as of several organs – is to close, gluing one wall on the other. To get around the situation, the body produces a surfactant substance that keeps the walls apart called pulmonary surfactant .

When there is a problem with this substance, after the gas exchange, the alveolar bags empty and close, preventing the entry of new air. Thus, the lung collapses and loses its expansive capacity, since the alveoli no longer fill with air.

Airway obstruction

An obstruction (“clogging”) of the airways may be the reason that the alveoli no longer receive air and close. Causes for obstructions are:

  • Accumulation of secretions: Especially during surgeries (more about this in “Anesthesia”), there may be an accumulation of secretions in the lower airways. In addition, it is quite common to occur in children, people with cystic fibrosis and asthma attacks;
  • Foreign body: It usually happens to children due to the aspiration of a small piece of a toy or food that, instead of following the normal path, ends up going through the windpipe;
  • Narrowing of the airways: Frequent infections, tuberculosis and fungal infections can damage the walls of the airways, generating scars that end up contracting the caliber of the airways;
  • Tumors: The existence of tumors can narrow the passage of air;
  • Blood clot: When there is bleeding in the lung, there is the possibility of clots forming that can obstruct the passages.

Pressure on the lungs

Another way to prevent air from entering the alveoli is the external pressure suffered by the lungs. Some conditions capable of causing such a problem are:

  • External injuries: Hitting the body somewhere, breaking the ribs or injuring some structure of the chest can put pressure on the external walls of the lung, making it difficult for air to enter;
  • Pleural effusion: The presence of fluids between the pleura compresses the walls of the lung, leading to atelectasis;
  • Pneumothorax: Similar to pleural effusion, pneumothorax is characterized by the presence of air inside the pleural cavity;
  • Tumors: Large tumors in the structures outside the lung can press on the walls, causing them to collapse.

Pneumonia

Some types of pneumonia are capable of causing temporary atelectasis.

Anesthesia

General anesthesia, widely used in surgical procedures, alters several functions that, together, can cause atelectasis. Due to changes in breathing patterns, gas absorption and pressure, the condition is quite common in patients during surgery.

In fact, about 90% of people who undergo surgery have a temporary atelectasis, which may or may not return to normal after the end of the operation.

It is worth remembering that atelectasis caused by anesthesia generally lasts longer in surgeries that directly touch the chest or abdomen, but this prolonged duration can occur in other types of surgeries as well. This is most likely due to pain and difficulty in breathing deeply after these procedures.

Medical conditions

There are also some medical conditions that can cause lung collapse. Among them, many are of neurological causes, in which there is an impossibility of movement of muscles in the region, preventing the movement of the lung.

Thoracic deformities and immobility are also included in this list.

Types of atelectasis

There is still no consensus regarding the types of pulmonary collapse. However, some frequently spoken names are:

Obstructive atelectasis

It is one of the most common types of atelectasis, in which an obstruction of the airways prevents the passage of air between the trachea and the alveoli.

It is also known as reabsorption atelectasis, because of the air that is “pulled” (absorbed) into the blood, while there is no new air entering the alveolar sacs.

Atelectasia compressiva

This type of atelectasis occurs when there is compression of the lung, often due to problems in the pleura, lesions in the chest and tumors, which “push” the lung and cause the air to escape from the alveoli.

Restrictive atelectasis

It results from some kind of restriction in relation to breathing capacity, such as pains to take a deep breath, deformities in the rib cage and spine, among others. These conditions prevent the lung from expanding, causing it not to fill up with enough air to keep the alveoli open.

Atelectasia cicatricial

Scarring atelectasis is the product of a lung injury that results in a scar on the organ, which prevents its full expansion.

Atelectasia tensiolítica

This type of collapse is caused by problems with the pulmonary surfactant, which has trouble leaving the alveoli open.

Middle lobe syndrome

The right lung has 3 lobes, the only one having a “medium lobe”. This lobe is surrounded by lymphatic tissue, which tends to increase when there are infections, both viral and bacterial. When this happens, this tissue compresses the middle lobe, leading to chronic total or partial atelectasis of that lobe.

Risk factors

Certain conditions can increase the chances of developing atelectasis. Are they:

Age

Children under 3 years old and the elderly are the most affected.

Obesity

Not infrequently, obesity limits the expansion of the rib cage. In addition, being overweight can put pressure on the lung.

Premature babies

With organisms even smaller than babies born on the expected date, it is easy to accumulate secretions in the lungs of premature babies.

Dysphagia

People who have trouble swallowing are more likely to suck in food, which will end up in the lungs.

Lung diseases

Asthma , COPD , bronchiectasis and cystic fibrosis are just a few examples of diseases that can prevent proper breathing and promote the accumulation of secretions in the airways.

Staying bedridden

Lack of movement and infrequent changes in position can end up putting pressure on the lungs.

Recent abdominal or thoracic surgeries

The pain resulting from these procedures can prevent the patient from taking a deep breath.

Recent general anesthesia

Because of the changes in breathing that anesthesia causes, there may be temporary atelectasis, especially if the patient is unable to breathe deeply again shortly thereafter.

To smoke

Smokers are more likely to suffer from several lung problems.

Diaphragmatic dystrophy

When the breathing muscle (diaphragm) is weakened, breathing becomes much more difficult, which can cause the alveoli to empty and, consequently, atelectasis.

Conditions that can lead to diaphragmatic dystrophy are muscular dystrophies, spinal cord injuries and neuromuscular problems.

Shallow breathing

Several conditions can cause shallow and shallow breathing, such as medication, mechanical limitations, pain, among others. By taking little air into the lungs on short breaths, the alveoli can undergo an emptying process.

Symptoms

Unfortunately, people who suffer from atelectasis may not even be aware of it, since, in most cases, it is asymptomatic. Occasionally, some people experience shortness of breath , but this will depend on the severity of the case: the greater the atelectasis, the less air the person can retain.

When it involves only a small number of alveoli, the condition may not even be noticed, especially if the progression is slow. However, when progression occurs rapidly and much of the lung is affected, shortness of breath can be very evident.

Especially when it comes to obstructions, there may be a cough , a natural reflex to try to expel from the airways what is hindering the flow.

Because of the lack of oxygen in the bloodstream in more severe cases, the heart may beat faster to try to pump more blood and compensate for the imbalance, and the individual may have a bluish color (cyanosis), especially in the extremities.

Sometimes, some symptoms may refer to the condition that caused the atelectasis – such as chest pain due to an injury – or to some complication of the condition itself, such as pain when breathing in case of pneumonia acquired by the collapse.

How is the diagnosis of atelectasis made?

When pulmonary collapse is suspected, the doctor – preferably a pulmonologist – should order imaging tests to check the condition of the lung. Some exams that can be ordered are:

Chest X-ray

The chest X -ray uses radioactive elements to create images from inside the body. In the image, the collapsed part of the lung appears clearly, while the healthy lung does not appear – there is only a dark cavity where it should be, as it is full of air.

Often, this test can also detect possible foreign objects that may be the cause of atelectasis.

Computed tomography (CT)

CT is an image examination more accurate than conventional radiography, being able to detect the volume of the lungs. It also helps to detect whether, by chance, the cause of atelectasis is a tumor, which does not normally appear on ordinary X-rays.

Oximetry

This test, carried out by means of a small device that is placed on one of the fingers, is able to measure the oxygen saturation in the blood. If there is little oxygen circulating, here is a great clue that it could be a lung collapse.

Broncoscopia

Through a thin and flexible tube with a camera at the tip, bronchoscopy shows clear images of the throat and part of the bronchial tree, being able to detect obstructions in these areas.

Often, this device – called a bronchoscope – is also equipped with tools to perform biopsies and remove these obstructions.

Atelectasis tern care?

Yes, atelectasis is curable . In fact, with the right treatment, the lung’s expansive capacity can be recovered. However, depending on the cause, some sequelae may still be present.

In the case of lung injuries, for example, scarring on the organ will certainly disrupt the process and, perhaps, the patient will never be able to breathe normally.

What is the treatment for atelectasis?

To treat atelectasis, it is necessary to have defined its cause beforehand. That’s because, depending on what caused the lung to collapse, the approach may be completely different.

When a small portion of the lung is collapsed, there is a tendency for the problem to resolve itself, without the need for interference. However, when the problem is further down, some options are:

Oxygen supplementation

In order to improve shortness of breath in cases of very large breakdowns, your doctor may recommend supplemental oxygen. This type of therapy can be done using equipment such as continuous positive airway pressure devices (CPAPs) or continuous positive airway pressure at two levels (BiPAPs):

CPAP

It is a high-tech equipment that compresses the air and, through a mask that covers the patient’s nose and mouth, releases a continuous flow of air in the airways. This uninterrupted flow would be able to expand the alveoli, without letting them collapse again.

BiPAP

It works in the same way as CPAP, with only two different pressures: one for the time of inhalation and the other, softer, so as not to disturb the time of exhaling air.

These two devices must be used and have their pressure regulated with the help of the doctor, as their misuse can be harmful.

Surgical procedures

In some cases, certain surgical procedures may be necessary. This is the case, for example, of the removal of tumors and foreign objects that may be obstructing the airways.

When there is excess mucus, aspiration from the lungs can be done in order to remove secretions that prevent breathing. In many cases, the removal of small tumors and foreign objects can be done through bronchoscopy.

Treatment of adjacent diseases

Other treatments can be applied depending on the cause. If there is a tumor, cancer treatment may be necessary. In case of infections, antibiotics can be prescribed . Neurological causes must be treated as a whole, atelectasis being only one of the targets of a more complex treatment program.

Pulmonary physiotherapy

Pulmonary physiotherapy focuses on several techniques that can help restore deep breathing, especially in the postoperative period, when there is a greater need for this activity.

Some techniques to use are:

  • Forced cough;
  • Tapotage: Lightly tapping the collapsed area to loosen and move the accumulated secretions – can be done by means of devices;
  • Deep breathing exercises with the possibility of performing a spirometry;
  • Apparatus that help to force the cough;
  • Postural drainage: technique in which the head is positioned at a level below the chest to cause the mucus to drain from the lower to the upper airways.

Medications for atelectasis

When atelectasis is caused by accumulation of mucus in the airways, the doctor may prescribe the use of mucolytics: drugs that facilitate the expectoration of these secretions.

Some examples are:

  • Acetylcysteine ;
  • Carbocisteína;
  • Ambroxol.

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Complications of atelectasis

Because it affects an extremely important organ for life – the lung -, the complications of atelectasis can be devastating. Some of them are:

Hypoxemia

Because of the closure of the alveoli, the blood cannot be oxygenated again and, therefore, there is a low oxygen level in the blood, a condition known as hypoxemia.

Although not fatal in itself, hypoxemia restricts oxygen levels in tissues that, in turn, are injured. One of the clearest signs that oxygen is lacking in the blood is cyanosis, in which the skin turns bluish.

Pneumonia

Especially in cases where atelectasis lasts for a long time, the impossibility of moving the mucus increases the chances of infections, especially pneumonia. It is worth remembering that certain types of pneumonia can also lead to temporary pulmonary collapse.

Respiratory failure

When the collapse is very large and involves a lobe or an entire lung, there is a high chance of causing respiratory failure, especially in people with lung diseases. In children, who have small lungs, the risk is even greater.

It is worth remembering that this condition can be fatal and needs urgent treatment.

How to prevent atelectasis?

It is not always possible to prevent atelectasis, especially when it is caused by other diseases and chest injuries. In case of obstruction and surgical procedures, there are some tips to avoid the problem. Are they:

  • Keep children away from toys and small objects with parts that can be vacuumed;
  • Before having surgery, ask your doctor what can be done to reduce the risk of atelectasis;
  • If you smoke, stop smoking between 6 and 8 weeks before any surgery, in order to reduce the chances of lung collapse;
  • After surgical procedures, try to take a deep breath and cough when possible, in order to keep the alveoli open;
  • Avoid staying in bed for a long time, as this increases the risk of a breakdown;
  • Elderly people should always be up to date with their dental appointments, in order to avoid aspiration of a tooth or parts of poorly fixed prosthesis.

The lung is one of Organs most important organs for our survival and, therefore, any condition that complicates its healthy functioning presents a great risk. Many people are still unaware of atelectasis and its causes, and may suffer from the problem without even being suspicious.

Share this text with your friends and relatives so that more people understand this sign and seek help in case of suspicion!

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