Emphysema, the lung is morbidly over-bläht. Chronic inflammation, genetic susceptibility and smoking play a significant role as causes. Also a therapy can undo no longer changes in pulmonary emphysema.
A chronic emphysema occurs mostly as a result of chronic bronchitis or a chronic obstructive bronchitis. Especially smokers and patients who suffer from a congenital deficiency – the Alpha-1-proteinase-inhibitor deficiency (called also Alpha-1-antitrypsin deficiency) – have an increased risk of emphysema.
There are also occupational causes of an emphysema. An emphysema may arise if the parties concerned for a long time are exposed to dust, certain chemicals, or a high pressure. At least dusts and chemicals concerned have chronic bronchitis first before an emphysema is created. This occurs because the Lungeauf sensitive to irritants such as chemicals or foreign objects such as dust. Also a to high pressure subjected to the body and lungs. He can overstretch the alveoli (alveoli) until they burst – and develops a lung emphysema.
An emphysema occurs – along with the chronic obstructive bronchitis – often within the framework of the so-called COPD (chronic obstructive pulmonary disease = chronic obstructive pulmonary disease) on. The term “obstructive” means that those affected suffer narrowed airway, making it difficult in particular the exhalation. Also asthma bronchial asthma is one of the obstructive lung disease, but differs from the COPD in development, therapy, and prognosis.
The doctor notes an emphysema by he asked those concerned to his complaints and by conducting various tests such as an X-ray, a computer tomography and a spirometry.
The therapy of Lungenemphysems limited to alleviate the symptoms and prevent progression and possible complications. The treatment can undo not but already existing damage to the lungs. The most important part of treatment is to avoid pathogenic substances such as cigarette smoke. In the prevention and treatment of Lungenemphysems, the flu shot and the pneumococcal vaccine also play an important role.
An over distension of the lungs is characteristic of the emphysema. This expansion of internal airspace reduces the normal lung function and is irreversible in the emphysema definition – that is, the change of lung tissue is not more undo. The emphysema occurs when those affected to have a hereditary disposition and/or the lungs is chronically inflamed or irritated, so the alveoli (alveoli) overstretch themselves until they burst. In addition the Foundation for lung and respiratory tract become unstable, which makes it difficult in particular the exhalation.
Structure of the lung
The emphysema belongs to the so-called COPD (chronic obstructive pulmonary disease = chronic obstructive pulmonary disease). It can occur as a result of chronic bronchitis or a chronic obstructive bronchitis.
In patients suffering from bronchial asthma, there may be an over distension of the lung during an acute asthma arises. This change is however completely back – it is so reversible.
When the emphysema, one assumes imbalances between divisive and protective enzymes in the alveoli (alveoli) as causes. In the lungs, certain white blood cells – the granulocytes – unlock these enzymes, divide the egg whites and hence tissues. The so called Alpha-1-proteinase inhibitor (also called Alpha-1-antitrypsin) prevents excessive reactions. This regulation is lacking in people with congenital Alpha-1-antitrypsin deficiency – the balance is shifted in favour of the divisive enzymes and those affected develop a lung emphysema. The severe form of this hereditary Alpha-1-antitrypsin deficiency is very rare (about one to two percent of all concerned with emphysema). Patients with a frequent but this lighter form have only an increased risk to develop when they are exposed to additional harmful substances such as cigarette smoke or dust emphysema.
Most frequent trigger for the chronic emphysema is smoking: causes are substances in cigarette smoke that inactivate the Alpha-1 – antitrypsin (Alpha-1-proteinase inhibitor). In addition an increased susceptibility to infection in smokers. Frequent inflammation of the bronchi cause of chronic bronchitis. Typical is also the morning cough after getting up, in which patients smelling mucus cough off – the so-called “Raucherhusten”. As a result it can to get that extra damage to the lung tissue and the small Airways of the lungs become unstable and collapse especially on exhalation and is so narrow. The airspace of the lungs over blähen this more and more, alveoli burst and larger, rough cavities occur. If the extension of the airspace in the lung is not more undo is, one speaks of the emphysema.
The emphysema might also work-related causes. So, dust pollution and a number of chemical substances can lead to emphysema. Fine dusts occur raw cotton or flax, inter alia in the coal industry, quarries, ore or organic mixed dust as from feedingstuffs. The emphysema may have chemical causes, for example aluminum, beryllium, cadmium, and lost.
Also Druckbelastungen of the lungs can also cause emphysema due to a distension of the alveoli. Such Druckbelastungen arise (Blaster) or glass-blowers such as professional musicians.
The emergence of a Lungenemphysems in a patient clearly to a professional cause can be attributed, a recognition of Lungenemphysems as an occupational disease is possible.
When the emphysema symptoms are changes in the lungs are as pronounced then. A diminished performance and severe shortness of breath are typical. People also suffer from coughs and phlegm. The chest is often barrel-shaped distended; the expiratory phase is significantly extended. Usually patients use the so-called lip brake, which means, they breathe out against the pointed mouth to avoid a coincidence (“collapse”) of the smaller Airways.
After the appearance of roughly two types can be distinguished, enabling smooth transitions between two types.
“pink puffer”: in the so-called “pink Keucher” is the emphysema in the foreground of the complaints. He is rather meager and suffers normal carbon dioxide levels in the blood, but without the features of cyanosis (blue discoloration as a result of a decreased oxygen saturation) most severe shortness of breath with low oxygen, but. Occasionally, a dry tickly occurs. A frequent complication in the advanced stage is at the “pink puffer”, that his breathing failed.
“blue bloater”: the “blue Huster” is rather overweight and zyanotisch, which means he has as a result of hypoxia blaurot discolored lips and nails. He suffers “pink puffer” less shortness of breath than that, but often has a cough with discharge. With this type, a participation of the heart – is a right heart weakness – a serious consequential.
The doctor is emphysema diagnosis primarily through the interviews of patients, the medical history: he asks the patient, for example, whether he smokes or over a longer period was smoking. In addition, the doctor asks for similar lung diseases with blood relatives. During the history of the doctor striking often, that the patient with gespitztem mouth exhales (“lip brake”).
After the discussion of medical history, the physical examination to diagnose adjoins on the suspicion of an emphysema: when listening to the lungs, the doctor hears a hum, for example. In knocking off the chest, a loud and hohlklingendes noise sound is created when the emphysema.
An important tool for assessing lung is the X-ray of chest. X-ray, the doctor detects changes which can indicate a lung emphysema and facilitate the diagnosis:
- horizontal ribs
- broadened intermediate ribs rooms
- a flat, low asterisk diaphragm
- the lung appears in the X-ray “blacker” (the so-called X-ray transparency is increased), because it contains more air
With high-resolution computer tomography, the so-called HRCT, the doctor can assess how far the emphysema already has spread, and thus complement the diagnosis. The HRCT occurs when the emphysema mainly used, if the doctor decides whether an operation is necessary.
Spirometry (determination of the inspired gas volume) to the doctor on the suspicion of an emphysema determine the lung function values that strengthen the diagnosis or allow a more accurate classification.
Already occurred changes of lung tissue due to a Lungenemphysems are final – therapy confined therefore to delay disease progression and making best use of the existing reserves.
When the emphysema, it is an essential part of the therapy to breathe no sick-making substances. An important step is to give up smoking. In addition, infections of the respiratory tract must be treated early and consistently. Also, those affected can strengthen your breathing muscles by physical therapy.
Patients where a congenital deficiency caused the emphysema, can access to the therapy for some time on the human Alpha-1-proteinase inhibitor (Alpha-1-antitrypsin), to compensate for the lack. You will receive the enzyme then for example once a week via an infusion into a vein.
In make cases it is advisable to remove large bubbles of emphysema operationally.
In advanced cases of Lungenemphysems, a constant additional oxygen is necessary. Only a lung transplantation remains as the only way of therapy in patients at a very advanced stage of disease of Lungenemphysems.
Emphysema, both acute and chronic complications can occur. Acute complications include a Spontanpneumothorax training: doing the lung collapse when emphysema bubbles burst and air escapes into the gap between the lung and chest wall. Infections of the respiratory tract can also complicate an emphysema. The chronic complications of Lungenemphysems concern also the heart: the pressure in the pulmonary circulation is increased by the over distension. The heart – more precisely the right ventricle – must pump the blood into the lungs so against this increased pressure. This leads to overwhelm and ultimately to a weakness of the right heart (right heart weakness, Cor pulmonale).
As the changes in the structure of the Lung also in treatment are back no longer, the prognosis is unfavorable when the emphysema and life expectancy is reduced. People with congenital Alpha-1-proteinase-inhibitor deficiency (Alpha-1-antitrypsin deficiency) have a poorer prognosis: particularly in the severe form, a lung emphysema can develop in younger years. In the lighter form, it is crucial whether the affected in addition harmful substances (e.g. cigarette smoke) are suspended for the forecast.
A consistent treatment, especially the giving up of smoking, increase life expectancy. Stakeholders, who continue to smoke, have an average life expectancy of 48 years, among those who do not smoke, it is, however, 67 years. Is the emphysema in the beginning of therapy is already far advanced, this also significantly reduces the life expectancy.
Experience complications and consequential damage to the heart (right heart weakness, Cor pulmonary), the prognosis worsened significantly when the emphysema.
To avoid pathogenic substances such as tobacco smoke, is the best way that you can prevent emphysema. Those affected with a severe congenital deficiency can prevent a progression of Lungenemphysems by. You can also prevent respiratory infections, which can complicate a COPD and promote the emergence of a Lungenemphysems so, with two vaccinations:
The flu shot is necessary every year because the flu pathogen change annually. It is only against the flu (influenza) effectively and not against simple colds.
Especially in older patients with COPD, it is advisable to vaccination against Streptococcus pneumoniae. Pneumococci are widespread bacteria, which can cause pneumonia.