Pulmonary emphysema
What is it?
Pulmonary emphysema is a chronic and progressive disease that causes a gradual deterioration in respiratory function and a significant limitation of daily activity and quality of life. These changes occur as a result of the constant expansion of the more peripheral air spaces of the lung tissue (acini of the lung), with the destruction of the elastic texture of the lung tissue and with the formation of bubbles. The disease is manifested by progressive shortness of breath, first with physical exertion, and then at rest. Treatment of emphysema is mainly pneumological and rehabilitative. However, in some cases, surgery can be combined with these forms of treatment to provide more effective treatment for emphysema.
Causes and risk factors
The main cause of pulmonary emphysema is exposure to factors such as cigarette smoking, which may be facilitated by genetic factors such as deficiency of alpha-1-antitrypsin, an enzyme that is involved in the preservation of lung tissue, as opposed to comparing the activity of other enzymes such as proteases, substances secreted by leukocytes that cause the destruction of lung tissue. Emphysema of the lungs can also be associated with other diseases with common risk factors, such as lung cancer.
Which are the symptoms?
Pulmonary emphysema is associated with progressive respiratory failure and is manifested by shortness of breath, first with exertion, and then at rest. In the most advanced stages, the structure of the chest changes due to the expansion of the lungs and takes on the so-called "barrel" shape. In the late stage, emphysema causes a serious deterioration in quality of life with a marked restriction of daily activity and is associated with a reduction in survival.
How is it diagnosed?
Spirometry with body plethysmography
Arterial blood gas analysis
Computed Tomography (CT)
Complementary investigations: lung scintigraphy, echocardiography, cardio-respiratory stress test
Suggested exams
How is it treated?
The treatment of pulmonary emphysema is usually medical and rehabilitative. In selected cases, such as in the presence of bulky bubbles or when rupture of the bubbles results in a collapse of the lung (pneumothorax), surgery may be indicated. In the treatment of advanced emphysema, in which medical and rehabilitative therapies are poorly effective, interventions such as lung volume reduction surgery, which consists in the surgical removal of the lung areas most affected by emphysema, may be indicated in order to improve the function of residual lung tissue and motility of the thorax and diaphragm muscle. This surgery has been shown to be effective in selected patients allowing not only to improve the quality of life of the operated patients, but also the long-term survival. In recent years, endoscopic procedures for lung volume reduction have been implemented, which are currently preferred in some cases to the surgical procedure. Finally, lung transplantation represents a further treatment option in patients with advanced emphysema.
Where do we treat it?
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