Emphysema

definition

Pulmonary emphysema is the term used to describe the overinflation of the alveoli. Pulmonary emphysema often occurs as a result of longstanding, chronic lung diseases.

Read more about: End-stage COPD

The fine air sacs, the so-called "alveoli", are separated from one another by thin walls. The walls between the alveoli also help push air out of the lungs when you exhale. Long-term changes as a result of lung diseases cause the alveolar walls to perish and the air cannot be breathed out. The lungs over-inflate and form emphysema bubbles. The air that remains in the lungs is called “trapped air”.

causes

The exact biochemical development in which the alveolar walls perish is not fully known. A number of are responsible Enzymeswho have favourited the delicate Remodel lung tissue.

By far the most common cause is long-term smoking. The inhaled pollutants activate the harmful enzymes, which can lead to the breakdown of lung tissue. In addition, emphysema leads to Narrowing of the airways, especially the so-called "bronchioles". This also contributes to the fact that the air cannot be sufficiently exhaled.

The lung tissue can through the breathe in any Pollutants Get damaged. People who are exposed to toxic gases and pollutants at work have a similarly high risk of developing emphysema as a heavy smoker.

Chronic obstructive pulmonary disease (COPD) is a typical secondary disease of smoking. In the long run, it leads to pulmonary emphysema, which is often limited to the upper sections of the lungs.

Pulmonary emphysema cannot always be prevented by a healthy lifestyle. It can too hereditary forms come. The affected produce too little proteinwhich is supposed to protect the lung tissue from remodeling. In these cases, the disease increasingly affects the lower lungs.

Less common forms of emphysema arise as a natural consequence of the Aging process. They cannot be traced back to any more precise cause and in most cases do not require treatment.

Symptoms

The air trapped in the lungs can be passed through the Absence of the alveolar walls do not breathe completely. It is not enriched with sufficient oxygen and does not take part in the regular exchange of air in the lungs. The section of the lung affected by emphysema lung therefore not operational. The immediate consequence is one Undersupply of the body with oxygen. The symptoms that come with it are Shortness of breath, bluish lips (cyanosis), Fingers and toes and quick exhaustionwhich increases with the extent of emphysema.

Because of the pollutants that accumulate in the lungs of smokers, the mucous membranes produce one yellowish-brown mucus to protect the respiratory tract. This has to be coughed up, which is typical "Smoker's cough“Is known. Long-time smokers suffer from this severe one for many years to cough. Cough suppressants can only help to a limited extent here.

If the pulmonary emphysema is already very pronounced, it can become too Exacerbations and one Barrel chest come. In an "exacerbation" the condition and the shortness of breath worsen so drastically that the patient mandatory for hospital and sometimes ventilated Need to become. If the lungs are so over-inflated that it can be seen externally, one speaks of a barrel chest. The chest and ribs deform under the pressure into a kind of barrel.

diagnosis

Pulmonary emphysema develops over many years as a result of chronic inflammatory lung diseases. The detailed anamnesis can provide many clues. If the patient presents himself with a lung disease, as a chronic smoker, with shortness of breath, strong cough, yellow-brown sputum or if a barrel chest can already be seen, this can already substantiate the suspicion of emphysema.

Lung function tests can then be carried out at a lung specialist or in a hospital.
Using a so-called "spirometer", lung volumes in different breathing phases and breathing activity can be checked. On the basis of these values, the doctor can precisely determine whether there is a functional impairment of the lungs and, if so, whether there is a restriction or an obstruction. If the latter is the case, it means a narrowing of the airways, which makes it difficult to breathe out and is typical of COPD. If this is present, pulmonary emphysema is also suspected.

With the help of X-ray or CT examinations, the suspected diagnosis of pulmonary emphysema can finally be made. The severity of the disease can also be assessed, which is ultimately what the therapy is based on.

Read more on the topic: Chest x-ray (chest x-ray)

Blood tests that reveal the enzyme deficiencies typical of emphysema can also confirm the diagnosis.

CT

The Computed Tomography is the more detailed variant of the conventional one roentgen. The radiologist can detect emphysema in the early stages based on various changes in the chest. Also leaves that CT image much earlier the diagnosis of emphysema than the pulmonary function tests or clinical symptoms.

From the beginning of the disease one can use the computed tomography step by step development follow closely. On the basis of the CT examination of the thorax is then decided on future therapy.

therapy

The therapy of the pulmonary emphysema is suspended some building blocks together. These include the Lifestyle change, Sports, physical therapy and drug therapy. The breakdown of lung tissue cannot be reversed, but the progression of the disease can be stopped and patients learn to live with the lung disease and improve their quality of life.

With more advanced emphysema it can be therapeutic too permanent oxygen supply and ventilations come. At acutely life threatening Pulmonary emphysema also moves operative interventions in the foreground. One possibility to cure the disease completely is one Lung transplant represent.

After diagnosing emphysema, the most important step in stopping the disease is stop smoking immediately or to prevent other possible causes. If the patient continues to smoke, the progression of the disease will be difficult to stop and the prognosis will worsen.

Furthermore, the medical therapy. The aim is to widen the airways and with cortisone Medication a lung infection to prevent. The drugs are called Cortisone spray administered so that they can act as specifically as possible on the lungs.

By physical therapy and Endurance sportsIf possible, the lung function can largely rebuild and the patient gains quality of life. The result is that the shortness of breath is reduced even when exercising.

Also in the Naturopathy there are now some approaches that can bring relief from the symptoms. There are different points of application of the therapy. Some patients have used it to relieve shortness of breath Kneipp chest wrap, Hydrotherapy, Stays in Brine thermal baths and Steam baths, such as Acupressure and acupuncture proven. To solve the slimy cough, there are various herbal remedies that are based on herbal antibacterial effects. Which includes Oil dispersion baths out ginger, eucalyptus or sage. Also Cough syrups from thyme and ivy are often used.

A new approach is that implantation so-called "coils". Coils are Wire spiralsthat are inserted into the lung tissue and can stop the disease from progressing to relieve symptoms of shortness of breath.

This works because the coils contract the diseased lung tissue, thus stopping the overinflation and creating space in the chest for the remaining healthy sections of the lung.
The first clinical studies since 2010 have proven the effectiveness with the help of lung function tests that are carried out after the implantation.

course

The course of the disease can vary from patient to patient differently be. The disease can not heal, however, it can slow it down or stop. In most cases, the chronic lung diseases destroy the sensitive lung tissue over years or decades.

Of the Degree of illness is among other things through the Symptoms certainly. The onset of emphysema is mainly characterized by the smoker's cough and slight shortness of breath, for example after climbing stairs. If no therapy is used, these symptoms will become more severe over time until the permanent oxygen long-term therapy and advanced symptoms like the barrel chest.

The disease can be acute or chronic Complications that aggravate the course and fuel the disease. Life expectancy is also significantly reduced depending on the course.

Life expectancy

Already a COPD as a secondary disease of long-term smoking reduced the general Life expectancy at about seven years. If pulmonary emphysema sets in as a result, the prognosis worsens statistically. However, if the therapy is started immediately, the progression of the disease can be slowed down.

The general life expectancy depends strongly on the success of the therapy. The quality of life can be effectively improved and complications can be avoided. In particular, the secondary diseases of the cardiovascular system can be prevented with consistent treatment.

In severe genetic forms of pulmonary emphysema due to enzyme deficiency, life expectancy is significantly reduced when it occurs at a young age.

Complications

The disease can acutely worsen if there is an exacerbation. The alveoli can also burst. It can happen that air gets into the gap between the lungs and pleura and the lung with it coincides. Medical professionals refer to this as Pneumothorax, which is an emergency and should be treated immediately.

Heaviness Infections of the lungs, which are favored during the illness, can take a life-threatening course.

Long-term complications and secondary diseases affect this Cardiovascular system. The functioning of the lungs is impaired and the high pressure caused by the overinflation puts an enormous strain on the heart. A so-called "Cor pulmonale" and a Right heart failure (Right heart failure) are the consequences.