EMPHYSEMA

Emphysema

Introduction

Emphysema is characterized by abnormal enlargement of air spaces distal to terminal bronchioles, accompanied by destructive changes of alveolar walls which are one of the common forms of chronic nonspecific lung diseases. The primary (idiopathic) pulmonary emphysema develops without preceding bronchopulmonary disease and secondary (obstructive) emphysema is most often a complication of chronic obstructive bronchitis. It depends on the extent of emphysema which can be diffuse or focal. (Monsour & Savage, 1989)

Discussion

The first group consists of factors that violate the elasticity and strength of structural elements of the lung: pathological microcirculation, changes in the properties of surfactant, congenital deficiency of antitrypsin and gaseous substances (cadmium compounds, nitrogen oxides, etc.) as well as tobacco smoke, dust particles in the air inhaled. These causes can lead to the development of primary emphysema. The basis of its pathogenesis is pathological alteration of the respiratory department of lung; weakening of elastic properties of light leads to the fact that during exhalation it improves vnutrigrud-partial pressure of smaller bronchi which do not have a cartilaginous skeleton and devoid of elastic recoil of the lung, passively subsides increasing this bronchial resistance in expiration and pressure increase in the alveoli. Bronchial patency in inspiration during the primary emphysema cannot be violated.

The second group of factors contributes to increased pressure in the respiratory department of the lungs and increases the tension of the alveoli, alveolar passages and respiratory bronchioles. The highest value among them is airway obstruction that occurs in chronic obstructive bronchitis. This disease is the leading cause of secondary or obstructive emphysema, as it was when it created the conditions for forming the valve mechanism overdistension of the alveoli. (Amella, 2004)

Thus, the decrease in intrathoracic pressure during inspiration, causing a passive stretching of the bronchial lumen, reduces the degree of the existing bronchial obstruction, positive intrathoracic pressure during exhalation causes additional compression of the bronchial branches and exacerbating pre-existing bronchial obstruction, contributes to delay inspired air in the alveoli and the overdistension. Importance is the extension of the inflammatory process with the bronchioles into adjacent alveoli with the development of alveolitis and destruction interalveolar septa. (Abu-Omar & Catarino, 2002)

Focal causes of pulmonary emphysema may be incomplete obturation of the bronchus valvular inflammatory or tumorous genesis atelectasis or cirrhosis of the lung area and congenital abnormality (congenital lobar emphysema, congenital unilateral emphysema). Secondary emphysema is characterized by swelling of respiratory bronchioles and the change in the form mainly of the alveoli, which lie close to them (tsentroatsinarnaya emphysema). With the progression of the pathological process may include the whole acinus (lobule). Alveoli are flattened and the mouth of the expanded hypertrophic smooth muscle bundles, then dystrophic. The walls of respiratory bronchioles thinned the number of capillaries and cellular elements in them are reduced.

Treatment of symptomatic primary emphysema include breathing exercises which aimed at maximizing the inclusion of the diaphragm in the act of breathing rates of oxygen therapy, the exclusion of smoking and other harmful effects, including professional, restriction of physical ...