(Jrt)
Emphysema
In the proper sense, emphysema is a term of anatomopathologie designating the destruction of distal airways. By extension it also uses the term to designate the presence of gas in human tissues.
The pulmonary emphysema is literally the destruction of the distal airways (downstream of the terminal bronchioles). It is a tautology. Sometimes there is an excessive and continuous pressure of air in the lungs, can cause a breakdown in lungs. This excess is usually caused by a partial obstruction of bronchial embarrassing expiration.
The subcutaneous emphysema is the expression but unfit designating the presence of air in the deep areas of the body, causing a touch "crepitation snow." Located mostly in the region earlier neck, it is the result of an injury to the trachea, bronchi or plevres, leading to the passage of air into the subcutaneous tissue. On preferera the phrase "air parietal" or "air spaces in the deep."
Pulmonary emphysema
The pulmonary emphysema is a lung disease distal airways characterized by the destruction of the wall (septum) bronchioles downstream of the terminal bronchiole (level of secondary pulmonary lobe Miller). It is often associated with the category of COPD. A imaging, there are 4 types of emphysema:
* Central centrolobulaire or reaching the centre of lobules secondary
* Panlobulaire reaching the entire lobe secondary
* Paracicatriciel the décours of lung damage
* Paraseptal which is under pleural.
Etiology
The two biggest causes of pulmonary emphysema are:
* Smoking or enfumement homes heated with wood (vast majority of cases and giving centrolobulaire mainly emphysema and paraseptaux)
* Disability alpha-1 antitrypsin genetic in origin (very rare) giving panlobulaires emphysema.
Clinical
The effort dyspnea (difficulty breathing) is the only symptom. The pallor and fatigue are sometimes associated with dyspnea. The thorax is distended (barrel-shaped), rapid breathing and superficial, the expiration time.
A auscultation, the doctor can hear bronchial rails. There is a form where the patient has a bronchial pneumopatie chronic obstructive (COPD). It has often overweight and east cyanose.
Diagnostic examinations
* Tests of lung function
* Lung X-ray
* Gas arterial
* CT
Treatment
The emphysema is a definitive lesion (not cure), but symptomatic treatment exist:
* Stop smoking if there (the largest salary).
* Bronchodilators long-acting in case of trouble ventilatory obstructive confirmed.
* Antibiotics in case of respiratory tract infections.
* Anti-influenza vaccination and anti-pneumococcal.
* Treatment-based steroids and cortisones in the event of ignition.
* Physiotherapy breathing.
* Retraining for the effort.
* Sometimes surgery volume reduction in some respects or emphysema Bullous areas ventilatoires "recoverable".
* Sometimes lung transplant.
Pharmacological
Most of medication helps patients with emphysema to breathe easier when the practice of physical activity. The drugs help open the bronchial tubes, relieve shortness of breath, reduce inflammation, and make it easier to transport oxygen. There is a therapy to increase the alpha-antitrypsin called prolastine which is derived from human plasma and administered once a week by intravenous injection. This treatment is still under study and is very expensive but it seems to help patients be less essouffles during the year and also to slow the progression of the disease. The bronchodilator short-acting is used as needed for immediate relief, mainly β2-agonists. The anticholinergic and methylxanthines are less used because of side effects and drug interactions. The bronchodilators long-acting (formoterol, tiotropium) are used regularly.
Read also Emphysema
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