What is lung emphysema and how is it treated?

Lung emphysema is a disease of the respiratory tract distinguished by the impaired gas exchange in the lungs due to changes in organ tissues. Pathology belongs to the group of chronic obstructive diseases.

The disease can develop in people of any race and ethnicity. It commonly affects elderly people, especially men.

Short information about lung emphysema

In 90% of cases, bullous lung emphysema develops in tobacco smokers who smoke for 20 years 20 or more cigarettes per day. However, the disease also affects passive smokers and especially kids whose respiratory system isn’t completely developed. Besides, the disease can spontaneously develop in infants in the first weeks of life due to the weak development of elastic tissue.

Under the effect of the damaging factors, the destruction of elastic fibers, due to which the lung lacks elastic strength to remove all air. Thus, after each exhalation, part of the air remains in the alveoli ((air bubbles that make up the lungs). This air accumulates, exerts pressure on the surrounding walls of the alveoli, destroying them, as a result of which large bubbles called bulla are formed.

The size of bullae can be from 1 to 10 and more centimeters. They are usually located closer to the surface of the organ below the pleura, however, there are cases of diffuse distribution.

Subsequently, the intact parts of the lung are squeezed by the bullae surrounding them, which leads to the development of atelectasis, i.e. a collapse of a part of the lung.

The disease affects around 4% of the total world population. In people older than 60, the incidence of the disease is higher.

Lung emphysema is not cancer but after the diagnosis of the disease at a late stage, life expectancy is 50% of patients is just four years. In mild emphysema, the 4-year period after the diagnosis is survived by 80% of people.

The prognosis highly depends on the severity of the respiratory violation and following the doctor’s recommendations on the lifestyle changes and treatment. If you think that you or someone from your family has the symptoms of the disease, especially combined with risk factors, go to your physician or pulmonologist to get diagnosed early to stop the progression of the life-threatening disease.

What are the symptoms of lung emphysema?

- Shortness of breath: in particular, for a patient, it is hard to fully exhale. At the early stages, shortness of breath develops in physical exercising while at the late stages it can occur at rest.
- Chest pain;
- The blueness of the skin;
- Breath becomes more frequent and deep;
- An increase in the volume of the chest: with the progression of the disease, the chest becomes bigger and deforms becoming barrel-like; intercostal spaces bulge, become wide; clavicles also bulge;

Worth noting that there are other health conditions that cause the same or similar symptoms. Thus, the correct diagnosis can be made only by a specialist based not only on the patient’s complains but also a number of tests we are going to discuss further in the article.

Besides, if emphysema develops on the basis of chronic bronchitis, other symptoms such as constant coughing and wheezing along with increased fatigue can occur.

The difficulty in timely recognition and treatment of the disease is that emphysema can be present for many years without any symptoms. Severe shortness of breath and respiratory failure can develop in several years and when a patient goes to a doctor, a late stage of emphysema is already diagnosed. Thus, for smokers, people exposed to passive smoking, working with hazardous gases, and having other risk factors, it is crucial to get their functions tested once a year doing at least an x-ray.

Lung emphysema commonly develops based on chronic obstructive pulmonary disease (COPD), so the main symptoms are the ones of COPD  - chronic coughing and coughing up of sputum, shortness of breath, and wheezing. Sputum is usually colorless. And shortness of breath usually develops by the age of 60 years.

The symptoms that a doctor should pay attention to are:

- Skinny physique (usually);
- Chest stuck in an inhalation position;
- Chest shape resembling a barrel (the distance between the sternum and the spine is close in magnitude to the distance between the armpits) - an emphysematous chest;
- Decrease of the visible chest movements in inhaling and exhaling;
- Widening the gaps between the ribs;
- Bulging areas above the collarbone;
- Box sound with the percussion of the lungs;
- Prolapse of the lower ribs, their immobility during breathing;
- Weakened breathing.
- Patients often exhale through a half-open mouth and during inhalation tightly close their lips.

The primary emphysema related to the congenital deficit of alpha-1-antitrypsin has some features of the clinical course and symptoms:

- Begins at the age of 30-40 years with the enhancing shortness of breath without coughing;
- Frequently occurs along with liver cirrhosis development in young age;
- Low body mass;
- Very poor physical activity tolerance;
- Pulmonary hypertension and the corresponding pathology of the heart appear only in the late stage of the disease;
- Increase in total lung capacity according to respiratory function test;
- The diffuse spread of the bullae.

What causes lung emphysema?

There are several causes for the development of the disease. The likelihood of disease development is higher if a patient has several risk factors combined:

- Tobacco smoking;
- Chronic bronchitis (usually develops in people aged older than 30-40 years);
- History of the disease in the family;
- Previous or present diseases of the lungs (tuberculosis, bronchial asthma, bronchiectasis, chronic bronchitis, pneumosclerosis, pneumoconiosis, sarcoidosis of the lungs);
- Circulatory disorders in the lungs;
- Exposure to harmful substances in the form of gases or dust at work (especially microparticles of dust, cadmium, nitrogen oxides);
- Poor ecology;
- Unfavorable working conditions associated with prolonged work in conditions of high dustiness of air.
- Congenital deficiency of alpha-1-antitrypsin.

The separate form of the disease is unilateral emphysema, or McLeod syndrome. It develops in young people. It is believed that the cause is frequent bronchitis under the age of 8 years. As a result, one lung is affected by emphysema, gets inflated displacing the mediastinum and squeezing a healthy lung. In the development of respiratory failure, surgery is indicated to remove a part or the whole affected lung.

Types of lung emphysema

The disease is divided into several forms based on the prevalence of bullae:

- Solitary – a single bulla;
- One-sided local - bullae are localized in no more than 2 segments of one lung;
- Unilateral generalized - bullae are located in 3 or more segments of one lung;
- Bilateral - bullae are localized in both lungs.

How is the diagnosis of lung emphysema made?

To ensure the correct diagnosis, it should include multiple tests including physical examination, laboratory tests, and visualization of the lungs using x-ray or computed tomography.

The steps for diagnosis are the following:

- Studying the medical history of a patient: the main attention is paid to the presence in the history of chronic diseases of the lungs and bad habits, as well as the environmental situation of the place of residence;
- Physical examination: the shape of the chest and the color of the skin are evaluated;
- Percussion: it is aimed at identifying areas of increased airiness;
- Auscultation with a stethoscope: it reveals characteristic dry wheezing;
- X-ray, computed tomography: it determines focal areas of increased airiness, surrounded by normal tissue (ring-shaped enlightenment);
- Analysis of the gas composition of the blood: it is aimed at determining the percentage composition in the blood of carbon dioxide and oxygen;
- Spirometry: it is an instrumental method of research that allows calculating tidal volumes on inhalation and exhalation.

Differential diagnosis of lung emphysema

When a diagnosis is made, the data of clinical, instrumental and laboratory studies can differentiate pulmonary emphysema from diseases such as:

- Asthma;
- Bronchiectasis;
- Diffuse emphysema;
- Chronic bronchitis;
- Pneumothorax;
- Pneumoconiosis.
- Lung cancer;
- COPD, and others.

How is lung emphysema treated?

The complete curing of the disease is possible only if it is caught at an early-stage and if the causing reason is eliminated. Thus, the primary element of the bullous emphysema therapy is quitting tobacco smoking and discontinuing exposure to the harmful substances inhaled at the workplace.

For the restoration of respiratory system moderate physical exercises are advised. However, it is important to remember that excessive physical exercising can not only not improve the condition but even cause harm to health. Therefore, certain recommendations should be followed:
 
- At the start of the therapy, walks in the fresh air are recommended instead of any other exercises. The distance during the first weeks should be not more than 800-1000 meters;
- It is advised to walk at a moderate pace;
- During the walks, a patient should uniform breathing with extended expiration;
- When the condition improves, rises to the 2nd-3rd floor are allowed while maintaining uniform breathing.
 
Drug therapy of lung emphysema

- Bronchodilators: a group of drugs that eliminate bronchospasm (acute suffocation attack) (Albuterol, berotek). They are used more often in the form of aerosols;
- Glucocorticoids: formulations based on hormones produced by the adrenal cortex (glucocorticosteroids), or their synthetic analogs (prednisone). They have anti-inflammatory and bronchodilating effects;
- Diuretics: drugs that enhance the excretion of water from the body (furosemide). Are prescribed in case of complication of bullous emphysema with respiratory and/or heart failure;
- Antibiotics: these medicines are used in cases when emphysema has developed against a background of diseases caused by a bacterial infection.
 
Oxygen therapy is considered effective in the treatment of bullous emphysema. This procedure involves inhalation of a gas-air mixture with high oxygen content. This method allows increasing the oxygen content in the blood, thereby increasing its delivery to tissues and organs.
 
Surgery for the treatment of lung emphysema

In the diagnosis of bullous emphysema in children, as well as in advanced cases when drug therapy is not effective, surgical intervention is recommended.

Today, such an operation is performed using high-precision equipment through a small incision on the surface of the chest, i.e. it is minimally invasive.
In the most severe cases, when the bullae are in large numbers located in many areas of the lung, removal of the lung or its transplantation is required.
 
Possible complications of bullous emphysema
 
If the disease is not timely diagnosed and treated, the following complications can develop:
 
- Spontaneous pneumothorax - sudden rupture of a portion of the lung with the release of air and its accumulation in the pleural cavity;
- Pulmonary hypertension - is an increase in pressure in the vessels of the lungs, which creates an additional load on the heart;
- Right ventricular heart failure - occurs against the background of progressive pulmonary hypertension, when the heart is not able to work and push blood against high blood pressure;
- Ascites - a manifestation of heart failure in the form of accumulation of free fluid in the abdominal cavity and a significant increase in the abdomen in size due to this;
- Swelling of the legs - appearing mainly in the evening and disappearing in the morning;
- Infection attachment - due to the inability of the respiratory system to resist infection, the process quickly turns into a chronic one, which increases respiratory failure.
 
The most dangerous complication of the disease is heart failure. This pathology inevitably leads to disability and death.

The disease is dangerous because rather soon after its occurrence, signs of respiratory and heart failure develop. However, with proper and timely therapy with the elimination of the cause of the disease, a complete cure is possible. Thus, if you have the first symptoms of pulmonary emphysema, you should immediately consult a pulmonologist, since only timely diagnosis and treatment can help to avoid the serious consequences of the disease.
 
Non-drug treatment of lung emphysema
 
- Drinking herbal teas made of chamomile, linden leaves, coltsfoot, sage, mint, flax seeds)
- Aromatherapy using oils of lavender, chamomile, and bergamot;
- Chest massage, enhancing sputum discharge.
 
These procedures help to relax the smooth muscles of the bronchi and reduce the accumulation of sputum in them. This helps in the treatment of bullous emphysema that has developed due to the aggravation of chronic lung diseases, but such methods of treatment can only be auxiliary to the main therapy.
 
Prophylaxis and prevention of lung emphysema

Since the main cause of the pathology is COPD, smoking cessation is the basis for the prevention of this condition.

Emphysema also occurs under the influence of occupational hazards, so compliance with safety precautions and respiratory protection in the workplace are very important.

Vaccination against pneumococcal infection every 5 years and annual vaccination against influenza are recommended.

To slow the progression of the disease, it is necessary to timely and correctly treat COPD and prevent its exacerbation.

In addition, it is necessary to eat properly, without limiting protein products, timely eliminate foci of inflammation in the bronchi, and avoid hypothermia.

Post by: John Avery, General Practitioner, Manchester, United Kingdom