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Pulmonary emphysema as a result of a chronic inflammatory lung disease such as COPD or chronic bronchitis is a common clinical picture in Germany. The main symptoms are a strong cough with phlegm and shortness of breath. It mainly affects people over the age of 50 who have been smoking for many years or have been exposed to other pollutants. What are other symptoms? What are the treatment options and what is the prognosis for pulmonary emphysema? You can read that and more here.

Definition: What is pulmonary emphysema?

The pulmonary emphysema is a chronic disease of the lower respiratory tract. This leads to overinflation and destruction of the smallest structures in the lungs, the alveoli. This greatly reduces the maximum area for air exchange, so the body gets less oxygen. In addition, the lungs lose some of their elastic restoring forces (i.e. their ability to contract again after expansion), which are primarily important for exhalation.

The term emphysema In medicine, it generally describes the occurrence of too much air (or gas) in a place where it should not be. For example, in skin emphysema, gas builds up in the subcutaneous tissue.

The lungs are paired, i.e. consisting of two parts that belong together, and can be divided into an upper and lower lobe on each side. On the right side there is even a middle lobe in between.

The lung spaces, called bronchi, run in these two or three lobes, which carry air from the windpipe to the air sacs (alveoli). This is where the gas exchange takes place, in which oxygen enters the blood and carbon dioxide is released.

You can imagine the bronchi as a huge network of ever smaller, sensitive tubes. While the upper tubes are still protected by a framework of cartilage, the lower ones rely solely on the protection of the elastic fibers of the lung tissue. Intact lung tissue is therefore a prerequisite for keeping the smallest parts of the lungs open and for ensuring smooth breathing.

Pulmonary emphysema never occurs on its own. Rather, it is the result of other chronic inflammatory lung diseases such as COPD (chronic obstructive pulmonary disease) or Asthma.

Chronic inflammatory processes in the small airways, i.e. the smallest bronchi and the even smaller bronchioles, result in destruction and scarring of the elastic fibers in the lung tissue. These normally ensure the expansion of the lungs during inhalation, but also keep them open during exhalation. When these fibers lose their function, those sections of the lung collapse (i.e. collapse) and air is trapped there. The lungs now lack the strength to exhale this air completely. For this reason, one also speaks colloquially of a lung hyperinflation.

These air reserves displace more air sacs with each inhalation, eventually leading to their expansion and destruction.

Risk factors: What causes the lungs to become inflamed?

Smoking is the most common risk factor for the development of pulmonary emphysema. The inhaled pollutants irritate the mucous membranes. This attracts inflammatory cells, which in turn activate substances that are involved in remodeling the lung tissue (so-called proteases).

In addition to smoking, long-term exposure to particulate matter also leads to the same processes. Furthermore, recurring infections such as chronic bronchitis or asthma can lead to pulmonary emphysema. In rare cases, the trigger is a genetic deficiency of a substance called alpha-1-antitrypsin (AAT), which is said to inhibit the lung remodeling processes described and protect the alveoli from degradation by proteases.

What forms of pulmonary emphysema are there?

The following forms of pulmonary emphysema can be distinguished:

  • This is the most common form centrilobular pulmonary emphysema. This is mainly in the upper lobe and is particularly common in people who smoke.
  • The second, much rarer form is this panlobular pulmonary emphysema, which is mostly found in the lower lobe.
  • There are also other types of pulmonary emphysema, including cicatricial emphysema and the bullous pulmonary emphysema. The latter is characterized by large cavities in the lungs that rupture and can then become very dangerous.

The so-called must be distinguished from this senile emphysema. The cause of this emphysema is that the elasticity of the connective tissue (and thus also the walls of the alveoli) naturally decreases with age. However, this is not a disease, but a normal sign of aging that does not cause any symptoms.

Symptoms: How does pulmonary emphysema manifest itself?

In the early stages of pulmonary emphysema, breathing becomes difficult during exertion, which later occurs, i.e. in later stages, also at rest. The feeling of having difficulty breathing can trigger shortness of breath in patients.

In addition, in most cases there is a chronic cough. This can be dry or productive (with expectoration). Blue discoloration of the lips and fingers (cyanosis) may be visible because the body does not receive enough oxygen. In general, physical performance is greatly reduced, those affected often feel tired and listless. Another characteristic of pulmonary emphysema is a widened chest (thorax), reminiscent of a barrel. A so-called barrel thorax is caused by the lungs being filled too much with air.

Other symptoms and consequences are:

  • edema (water retention)
  • congested jugular veins
  • right heart failure
  • weight loss
  • Susceptibility to respiratory infections

Diagnostics: What examinations are carried out?

If recurring coughing attacks with sputum occur over several weeks, you should definitely seek medical advice. The suspected diagnosis can often be made on the basis of the clinical appearance, i.e. the totality of the symptoms and complaints.

After the inspection with listening and tapping of the lungs, a blood test. In particular, the inflammation values ​​​​as well as the oxygen and carbon dioxide content in the blood are checked. A typical finding here is a low oxygen level, while the carbon dioxide level is elevated.

A lung function test is then carried out for further clarification and to confirm the diagnosis. This can be used to measure the volume of air in the lungs very precisely. A classic feature of pulmonary emphysema is an increased residual volume, which is the volume that cannot be exhaled. Finally, an X-ray or CT scan of the lungs is carried out. The x-ray can be used to assess the scarring, also called pulmonary fibrosis, and the barrel thorax. A lung reflection (endoscopic examination) is only required in severe cases.

Therapy: Is pulmonary emphysema curable?

Like all chronic inflammatory lung diseases, pulmonary emphysema cannot be cured. However, early treatment can delay the progression of the disease.

The most important step is this no smoking Even if the pollutants from the cigarette are not the cause, they definitely aggravate the course of the disease. Patients should therefore stop smoking immediately.

In addition, one should through targeted Atemtraining learn to breathe more effectively. An example of such a breathing exercise is the so-called pursed lip. After a deep inhalation, slowly exhale through the gently closed mouth. This process increases the pressure in the lungs, keeping the air sacs open and allowing air to escape more easily. Another method is the coach seat. Here you sit with your upper body bent forward and support your hands on your thighs while breathing. This position relieves the auxiliary respiratory muscles.

physical Movement and light sport are also recommended for treatment, even if the body can quickly become exhausted. In the beginning, however, you should never do sports alone, as you may overestimate yourself. Therefore, it makes sense to seek advice from other people affected, to seek medical advice or to attend a medical sports group.

medicated primarily the symptoms of pulmonary emphysema can be treated. Essentially, inhalation devices are used here. The substances it contains expand the lungs and have an anti-inflammatory effect. It is often necessary to inhale several medications several times a day to relieve the symptoms.

Course: quality of life with pulmonary emphysema?

The course of pulmonary emphysema progresses slowly and, even with appropriate treatment, leads to a reduced life expectancy. Due to the difficult breathing and the lack of oxygen, many patients feel limited in their performance, especially in the advanced stages. Especially very active people who do a lot of sport experience a partial loss of their quality of life.

In the final stages, acute outbreaks of the disease become more frequent, leading to recurring shortness of breath. Such an acute deterioration, for example as a result of infections, is called an exacerbation. In addition to frequent hospital stays, many of those affected are also permanently dependent on oxygen from the bottle. The most important measure to slow down the progression of the disease is and remains to stop smoking completely.

ICD codes for this disease: J43.-

Updated: 03/06/2023

Henrik Janke, student of human medicine

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