Emphysema

As emphysema, an irreversible hyperinflation of the smallest air-filled structures ( alveoli, alveoli) is called the lung. It represents the common end point of a number of chronic lung diseases

Physiology of the lung

The lung is for gas exchange: first, oxygen in the air is absorbed, the other carbon dioxide discharged from the blood. In order to perform this gas exchange efficiently, there is a lung from 300 million smallest subunits, the air sacs (alveoli ). The walls of the alveoli that make up the actual lung tissue, also known as interstitial tissue.

Pathogenesis

One theory is that it comes to inflammatory changes in the lung tissue ( the alpha-1 antitrypsin deficiency ) by various pollutants (tobacco smoke, silicates, and quartz fine dust) or by endogenous proteases. The following accumulation of leukocytes releases proteases, including elastase. These destroy the elastic fibers of the lung. Further oxygen radicals inactivate α -1-antitrypsin, which is normally inactivated elastase and other proteases. In addition, the external pressure is increased to the bronchioles (small bronchi), which then collapse during exhalation, so that the air in the alveoli remains trapped ( trapped air). The result is hyperinflation of the lungs. There are also other assumptions.

This may be less stale air being exhaled, less fresh air can flow. In extreme cases, are then calculated from previously functional alveoli large functionless " emphysema ". Endogenous can also be a persistent bronchial asthma lead to emphysema.

Finally, the lung loses its elasticity, and the air present can not escape completely.

Symptoms

Generally located in pulmonary emphysema, due to the reduced gas exchange surface, a chronic shortness of breath before, initially only during exercise, in the later stages even at rest ( dyspnea at rest ). The reduced oxygen content of the blood may be seen by bluish-red discoloration ( cyanosis) of the lips, fingertips and toes. In severe stage, a candle from about 15 cm distance no longer be blown out. The chest circumference increases ( barrel chest ). In the late stage, there is a (legal) workload.

Radiologically shows emphysema in a decreased density of the lung. Also may be formed a drop heart.

Classification

Anatomically, the airways branch out further and further, until they end in the so-called alveoli, in which then ultimately the gas exchange takes place (figuratively largely present as a grape ). The alveoli depend on a small bronchus (several respiratory bronchioles run to a terminal bronchiole together). The emphysema largely takes in this area, so the endings of the airways from.

One can divide the pulmonary emphysema as follows:

• Primary atrophic emphysema (normal Altersemphysem ).
• Secondary emphysema, that is, as a result of an underlying disorder: Centrilobular ( zentroazinäres ) emphysema: it typically results from a chronic obstructive pulmonary disease (COPD). This type is found mainly in the upper lobes of the lungs. It later also the terminal bronchioles ( alveolar duct ) and the acini ( alveoli and alveolar ducts consisting of ) themselves are the first respiratory bronchioles ( the fine branches of the bronchial tubes that lead from the terminal bronchioles virtually directly to the alveoli ), affected. Anatomy of the bronchus A: alveoli, BT: terminal bronchiole, BR: respiratory bronchioles, DA: alveolar duct
• Panlobuläres ( panazinäres ) Emphysema: This form typically affects the acini ( alveoli and alveolar ducts consisting of ) and later the respiratory bronchioles and terminal bronchioles. Main reason for the development is the inherited deficiency of the enzyme alpha -1 -antitrypsin. This enzyme protects the lungs from proteases that attack the tissues now. If the alveolar walls to tear down the emphysema may coalesce. It forms when further growth bullous emphysema from.
• Narbenemphysem: it does not involve an expansion of lung tissue in the vicinity of shrinking areas of the lung.
• Überdehnungsemphysem: , it may, for example, after a partial resection of the lung come through expansion of the residual lung.