Types of emphysema

Emphysema - a chronic lung disease characterized by an increased content of air in the lung tissue. This is due to the expansion of lung tissue, located behind the smallest branches of the bronchi (bronchioles), accompanied by changes in the walls of the alveoli (sacs at the ends of the bronchioles - the final part of the human respiratory tract, where gas exchange occurs).

Emphysema can occur independently and then it is called primary, or may develop on the background of other pulmonary diseases (which is much more common) - this is a secondary pulmonary emphysema. In some cases, emphysema covers the whole lung tissue (diffuse form), in others, the expansion of the lung tissue occur at some particular lung region (local or focal form) is most often on the background of bronchial constriction or proliferation of connective tissue in the lungs (pulmonary fibrosis).

Of great importance in the development of emphysema has a genetic predisposition congenital defects in the structure of the lung tissue and the enzyme system (congenital deficiency of some antienzymes, resulting in certain circumstances, to the destruction of the alveolar walls). The result of these defects is broken lung elasticity and strength of the structural elements, which leads to the development of primary, always diffuse emphysema: during exhalation small bronchi subsides, thereby increasing the pressure increase in the alveoli. Bronchial obstruction on inspiration in primary emphysema is not broken.

Secondary diffuse emphysema is mainly due to chronic obstructive (in violation of the road) bronchi diseases, mainly inflammatory. In partial obstruction of small bronchi air enters the alveoli, but exhaled with difficulty, resulting in increased pressure, stretching occurs alveoli, alveolar passages and adjacent bronchioles. The next stage - the spread of the inflammatory process with the bronchioles to the alveoli adjacent to the development of inflammation and destruction of the alveolar walls.

The reason focal emphysema may be incomplete blockage of any one bronchus amid inflammation, fibrosis or tumor (proliferation of connective tissue in place as a result of the completion of pulmonary inflammation).

For any type of emphysema is smoking and a variety of industrial air pollution. Smokers emphysema occurs 15 times more often than non-smokers.

How is

Primary diffuse emphysema develops mainly in men, on average, and sometimes at a young age. Patients complain of dyspnea and a sharp decline in exercise tolerance. Often there is a decrease in body weight. The chest in these patients has a barrel shape, which, as it is constantly in a state of deep breaths. The supraclavicular area appear bulging pillow, vybuhayut and intercostal spaces, in the act of breathing involves muscles of the chest and neck. Performing even minor physical activity, patients inhale air at serried lips, puffing out his cheeks (puff). In this manner, they increase instinctively intrabronchial pressure to restrict the flow of air to the obstructed bronchi, followed by exhalation.

Signs of secondary emphysema Emphysema - a deadly disease   It combines the features of bronchial inflammatory diseases and emphysema. A feature of the secondary pulmonary emphysema is a rapid increase in cardiopulmonary diseases Heart failure - when the heart is unable to cope with the work   - Stagnation of blood in the lungs and the formation of the oud cardiac dyspnea with cyanosis (cyanosis) persons.

Diagnosis of emphysema

In the diagnosis of emphysema in addition to the characteristic features are important studies of respiratory function and radiographic methods. Investigation of pulmonary respiratory volumes in most cases, to identify the characteristic restructuring of the total lung capacity.

The X-ray light in the primary homogeneous emphysema seen increasing transparency of the lung fields and blurred lung pattern, especially in the lower regions of the lungs, low standing diaphragm. In secondary emphysema transparency lower lung is less pronounced due to inflammation of the tissue around the bronchial tubes, the diaphragm can not be omitted, as the total amount of light does not change so much as in primary emphysema.

What to do

Treatment of emphysema is aimed at suspending or slowing the progression of the main process and the possible relief available in patients with respiratory failure phenomena. The main measures are the elimination of smoking and other harmful substances (including occupational) factors affecting the lung tissue, sustainable employment and limitation of physical activity

In the treatment of primary pulmonary emphysema focuses on breathing exercises aimed at training and inclusion in the process of breathing diaphragm, rates of oxygen therapy (oxygen therapy).

Secondary pulmonary emphysema in addition to the above methods of treatment comprises the treatment of exacerbations of inflammatory diseases of the bronchi and pulmonary-cardiac insufficiency.

Both primary and secondary pulmonary emphysema require perhaps earlier appointment of adequate treatment, so it is necessary to timely treatment to the doctor with any diseases of the lungs and bronchi.

Galina Romanenko

How is spirometry

Spirometry is considered the founder of J. Hutchinson, who constructed the first Spirograph and developed the basics concepts of lung volumes. After that, the measurement of various parameters of lung volume become a part of the volume of diagnostic tests for chronic lung diseases.

Spirometry - a method of lung function by measuring the pulmonary tidal volumes. When conducting spirometry patient inhales and exhales with maximum force that can determine how much light do their job. In liters or milliliters measured:

• tidal volume (UP) - the volume of air inhaled and exhaled at each breath;
• vital capacity (VC) - the maximum amount of air exhaled after a maximum deep breath;
• forced vital capacity (FVC) - the difference between the amount of air in the lungs at the beginning and at the end of the forced exhalation;
• functional residual capacity (FRC) - the amount of air in the lungs after a tidal;
• residual lung volume (OOL) - the amount of air remaining in the lungs after a maximal exhalation;
• total lung capacity (TLC) - it is vital capacity plus OOL;
• forced expiratory volume in the first second forced expiratory volume (FEV1); in relation FEV1 / FVC ratio, expressed as a percentage (index Tiffno) can detect the degree of airway obstruction;
• peak volume velocity (PIC) - the maximum flow achieved during exhalation;
• instantaneous velocities (MOS) - air flow rate at the time of forced exhalation;
• respiratory minute volume (MOU);
• maximum ventilation (MVV).

With spirometry explore the mechanics of breathing disorders and assess its reserves of respiratory function.

How is

The procedure is painless. The study is conducted on an empty stomach or 2-3 hours after a light breakfast. The subject is introduced into the mouthpiece, through which the contact with the device, is applied to the nose clip. Please register spirogram during quiet breathing to determine the MOD and the oxygen consumption. The patient is then offered to make the most deep breath, followed by a full deep breath and calm (for measurement of vital capacity). Then offer to take a deep breath and forced a full forced expiration (to determine the index Tiffno).

After a short break, the subject breathes in several minutes with a mixture of helium and air, which is used as an indicator for the calculation of FRC, OOL, TLC. Indicators can be poorly soluble and other gases in the blood - xenon or nitrogen. Investigation complete the definition of MVL. The subject breathes with the maximum depth and frequency.

Evaluation of the results of spirometry

The survey results are expressed in absolute terms and as a percentage of predicted values ​​for healthy people of the same sex, age, height and body weight.

Reducing the majority of indicators by 20% or more of normal values ​​are regarded as a sign of lung function. Unfavorable sign is the growth of OOL and FRC. According to the results of spirometry establish the presence and severity of obstructive and restrictive disorders. Restriction - this difficulty stretching the lungs and chest, it is a decrease in lung volumes (mainly TLC and VC). When obstruction - worsening airway reduces the rate of forced exhalation and inhalation, as well as ALL and increased FRC due to concomitant emphysema (persistent enlargement of the alveoli - tiny sacs at the ends of the bronchi). Indicator of obstruction of larger (central) of the bronchi - reduced FVC, exhaled in the first second.

Spirography are critical in the diagnosis of asthma, chronic inflammatory diseases of the lungs and bronchi, disease caused by exposure to light dust (pneumoconiosis) and other diseases that can cause a reduction in lung function.

Instruments for measuring respiratory volumes

Such devices are called Spirograph. They are attached to the airway of the subject and responsive to volumetric displacement of air from the lung or lungs. Spirographs which one or both respiratory phases communicate with the atmosphere, called open and spirographs with a message only to breathing, - closed.

Spirograph is a simple open water (during inhalation and exhalation in water raised or lowered a special bell). There is also a dry open spirographs in which a sensing element is expandable fur.

The Spirograph gated measurement of respiratory volume is carried out in principle as well, but in addition to the respiratory volumes and indicators of pulmonary ventilation, they can determine the rate of oxygen uptake.

Galina Romanenko