X-ray picture
X-ray studies of the masses of the brain cell are of great importance for the diagnosis of pulmonary emphysema. Attention is always paid to the low location of the dome of the diaphragm and its flattening. If functional tests are carried out, it can be found that the excursion of the diaphragm is noticeably reduced. These changes correlate with the increased airflow of the pulmonary fields and the increase of the retrotransport space (Sokolov’s character); the heart shadow is narrowed and extended (“drip heart”);
The judged drawing is depleted. Computed tomography confirms hyperemovitis, impoverishment of pulmonary fields with a coherent pattern and more clearly reveals the bull, their localization and size. With the help of radioisotopic methods in the lungs, ventilation and perfusion disturbances characteristic of emphysema are detected.
Patients with a chronic obstructive bronchitis during an x-ray examination of the structures of the thoracic cell draws attention to the high density of the walls of the bronchus, infiltration in their turn.
Functional examination
In establishing the diagnosis of chronic obstructive pulmonary disease, a large role is given to the study of the function of breathing. For emphysema, the most characteristic functional implications are: reduction of the elastic properties of the lungs, collapse of the main part of the inflammatory pathways, increase in the relative efficiency of the pathways, increase in the residual volume and the total capacity of the lungs detected by the total plethism,
A sharp decrease in the velocity indicators of the flow-volume curve is more characteristic for obstructive nylon. Inhalation test with protective equipment allows the evaluation of obstructive testing. In patients with emphysema, the obstruc- tion has a persistent, irreducible character, while in patients with an obstructive bombardment, a partial-bronchial dilatation response may be noted.
The diffusion capacity of the lungs is more severely affected by patients with emphysema, therefore, hypoxemia occurs earlier in them. Patients with obstructive bronchitis noted earlier a persistent increase in pressure in the pulmonary artery system, which leads to the appearance of characteristic blue cyanosis. In emphysema, the pressure in the pulmonary region is prolonged at the normal level or increased only during physical exercise.
Laboratory data
With the development of hypoxemia in patients with obstructive pulmonary diseases, the polycythemic syndrome develops, for which the increase in the number of erythrocytes, high hemoglobin, low rate of interaction of erythrocytes, and the resistance of the cytocytes, is observed, high hemoglobin, low velocity of the interaction of erythrocytes, and low erythrocytes, as well as high rates of hemoglobin.
Erythrocytosis and rheological disorders exacerbate respiratory failure, cyanosis acquires a characteristic violet hue.
These changes are more personalized in patients with bronchitis.
Patients with signs of respiratory failure need to monitor the gas composition of arterial blood in order to properly build a treatment program and determine the prognosis. When reducing the voltage of the acid below 60 mm ppm.st. long, more than 12–15 hours per day, oxygen therapy is shown. Hypercapnia (an increased voltage of CO2 in the arterial blood) is a serious problem, often accompanied by an exacerbation of respiratory deficiency and a syndrome of fatigue of the repulatory muscles.
It should be remembered that in patients with chronic obstructive pulmonary disease it is difficult to distinguish between the obstructive bronchitis and emphysema, and these pathological patterns develop in parallel.
Treatment
There is no specific treatment for pulmonary emphysema. More than 10 years ago, attempts were made to introduce a spectacular human therapy of a1-antitppsin, but the drug has not found wide application in clinical practice. For the correction of the proteolysis-antiprotheolysis system, mucolytic, antioxidant substances and vitamins are prescribed. Of the mucolytics, a prolonged use of acetylcystein is especially indicated, since it is able to counteract the damaging effects of free radicals.
In the treatment program of patients with emphysema of the lungs, the first step should be to remove events that increase the quality of life of the sick. Great importance is given to quitting smoking. The activity of doctors in helping smokers is extremely low: the formal question of stopping smoking is set in less than 50% of cases, and programs of treatment are offered in 5–8%. For successful treatment of emphysema patients, the position of the doctor plays a central role.
Drug treatment includes bronchodilators (B2-agonista, anticholinergics, theophyllines) and corictocteroids. The appointment of b2-agonists and anticholinergic agents is more indicated with obstructive bronchitis than with emphysema, although with a combination of these conditions in a patient, this approach is rather conventional.
In recent years, the emphasis has been placed on proliferated b2-agonistes (salmeterol, formoterol) and combinations of b2-agonists with M-holinoblokatorom (fenoterol + ipprtropium bromide). In elderly patients, the undesired cardiovascular effects of b2-agonists can manifest.
Preference should be given to prolonged theophyllines, which allow you to maintain a constant therapeutic concentration in the blood.
Theophylline acts simultaneously on impaired ventilation and perfusion, which are characteristic of patients with emphysema. In smokers, sensitivity to theophylline is reduced (its metabolism is accelerated), and in elderly people it is increased, they may develop its arrhythmogenic effect. The effectiveness of theophylline decreases when FVC1 drops below 1.5 liters.
Oppose the indications for the appointment of short-coteroids; more than 20% of patients with obstructive pulmonary diseases (and often smokers) do not respond positively to the therapy. It is necessary to take into account the myopathic action of the shorter horoscopes, which is extremely undesirable for patients with emphysema.
The indication is the rapid replication of the disease, which cannot be stopped by other means. It is usually recommended to prednisone at a dose of 15–20 mg with an assessment of the effectiveness in the next 3-4 days.