home Audience 5 What is bullous emphysema and how is it treated? Bullous emphysema of the lung (Alveolar cyst, Bullous disease, Bullous lung, False cyst, Vanishing lung syndrome)

What is bullous emphysema and how is it treated? Bullous emphysema of the lung (Alveolar cyst, Bullous disease, Bullous lung, False cyst, Vanishing lung syndrome)

Bullous disease is congenital pathology lungs, in which the terminal branches of the bronchial tree (bronchioles) expand. They form bullae - air bubbles. The lung itself becomes deformed and increases in size. A lot of air accumulates in the tissues. Gradually, destructive changes occur in the alveolar walls.

Causes of the disease

There are two directions of reasons that lead to the development of the disease - the influence of external factors and functional disorders pulmonary system.

The origin of morphological changes in the bronchial tree is due to the following physiological disorders:

Pathology of the communication of vessels that provide microcirculation. As a result, the transport of blood cells and lymph into the tissue cells of the organ is disrupted.
Changing the properties of pulmonary surfactant is a complex of surfactants that form the inner layer of the alveoli. Its function is to prevent the structures of the bronchi and lungs from sticking together during breathing.
Congenital deficiency of alpha-1-antitrypsin protein. It is produced by the liver and protects the lungs from the effects of its own enzymes (elastase) and autolysis (destruction of cells and tissues).

Factors environment, which provoke the development of bullae in the lungs:

smoking;
allergens;
air pollutants (pollutants);
dangerous and harmful conditions labor;
household and industrial dust;
air emissions;
long-term use of pharmacological drugs;
chronic respiratory diseases of infectious etiology– COPD, secondary emphysema, sarcoidosis, bronchial asthma, bronchitis, pneumosclerosis, tuberculosis, bronchiectasis.

Pathogenetic and functional changes in the pulmonary system

Bullae in the lungs are formations in the form of bubbles of different diameters and sizes. They consist of one layer or several. In diseases of the bronchi, the bullae are multiple in nature. The thin-walled bladder is filled with air, the diameter can reach from 1 to 15 cm. Neoplasms are localized under the visceral pleura, most often in the upper segments of the lungs. This is explained by the presence of perilobular layers of parenchyma.

The development mechanism is based on pathological restructuring of the acini - the structural and functional units of the lungs. The elasticity of the organ decreases, which leads to the fact that the bronchi collapse during exhalation. During the release of air it increases pulmonary pressure, the parenchyma presses on the bronchial tree, which does not have a cartilaginous frame.

Due to functional and structural changes in the respiratory tract, the bronchioles, alveoli and their passages are stretched. In the presence of chronic diseases of the pulmonary system, conditions are created for the formation of a valve mechanism in the alveoli. Systematic pressure failures in chest create additional compression of the bronchial tree. Holding exhalation contributes to strong stretching of the organ structures.

Bullae in the lungs are formed as a result of compression of the bronchial branches and difficult emptying of the alveoli. As a result, the interalveolar septa and parenchyma fibers are destroyed. This creates wide air spaces.

Blood circulation in the lungs and their gas exchange function are disrupted. As a result, chronic oxygen deficiency develops in the body and respiratory acidosis - accumulation carbon dioxide in the blood due to hypoventilation respiratory system.

Anatomical changes in bullous emphysema

Bullous emphysema is the destruction of the elastic framework of the parenchyma. Bronchioles are larger than normal in size. They alternate with fibrotic changes(replacement healthy tissue connecting fibers).

For diffuse and generalized forms of the disease structural changes occur in all segments of the lungs. The parenchyma exhibits a scarring process. The course of the pathology is very severe; spontaneous pneumothorax often occurs - accumulation of air in the pleural cavity.

Clinical picture of the disease

Signs of the disease progress as the disease gets worse pathological process. Main symptom– shortness of breath. In the primary bullous form it is very severe. In this case, there is no cough. A distinctive breathing sign is “puffing”; as you exhale, the mouth closes and the cheeks swell. This phenomenon is caused by the need to regulate intrabronchial pressure during breathing. It helps increase air ventilation in the lungs. Shortness of breath intensifies against the background of acute respiratory viral infections and influenza.

External signs of bullous disease:

the chest takes on the appearance of a barrel;
intercostal spaces widen;
chest mobility decreases;
subclavian and jugular veins protrude;
breathing weakens;
The mobility of the diaphragm decreases, it stands low.

Cough with bullae is mild or absent. Sputum is produced in small quantities. This is due to the fact that the disease is not associated with the introduction of infectious agents (bacteria, fungi).

Bullous disease greatly weakens a person. Appetite disappears, sleep is disturbed, a person experiences chronic fatigue . Patients rapidly lose weight. The muscles of the chest are in constant voltage and tone.

The bullae themselves are clinically asymptomatic. Severe respiratory failure occurs with multiple and voluminous bubbles, more than 10 cm in diameter. When they rupture, spontaneous pneumothorax occurs.

With bilateral lung damage, the symptoms are more pronounced. The presence of multiple blisters significantly deforms the bronchi and lungs. With unilateral pathology, the mediastinal organs are shifted to the healthy side.

With a long course of the disease, patients show signs of chronic respiratory failure and oxygen starvation:

the skin is pale, sometimes with a blue or gray tint;
rapid heartbeat and breathing;
decreased blood pressure;
abnormal movement of the chest;
chest pain;
drum fingers;
trembling in hands;
headache;
temporary cessation of breathing, the patient is afraid to fall asleep;
panic attacks.

Since in bullous disease the air circulation through the respiratory tract is constantly impaired, mucociliary clearance is sharply reduced - protective functions mucous membranes. Therefore, the lungs become a target for bacterial infection, which often turns into chronic form. To prevent the development of complications, patients are prescribed antibacterial drugs at the first symptoms of a cold - fever, runny nose, cough.

Methods for diagnosing the disease

Diagnosis of the disease includes physical and instrumental examination.

Particular attention is paid to data collection (history). They find out the patient’s age, place of work, main complaints, time of onset of the first symptoms, and their intensity.

On auscultation, weakened breathing is clearly recorded and wheezing is heard. When listening to breathing in horizontal position The patient exhibits forced expiration. Heart sounds are heard in the epigastric region.

During percussion, a box-shaped hue predominates over the entire surface of the chest. The lower borders of the affected lung are displaced downwards by a distance of 1-2 ribs. The mobility of the organ is limited.

X-ray images show displacement of the diaphragm. Its dome is dense and located abnormally low. Increased airiness of the parenchyma is observed. There is insufficiency of vascular shadows in the lung fields. With bullous emphysema, the organ pattern is enhanced.

Computed tomography confirms the signs of tissue damage found on x-rays - a sparse pattern of lung fields, a large amount of air in the bronchi. Using a three-dimensional projection, the exact location, number and size of the bullae are determined. On initial stage diseases the lungs are increased in volume. In heavy and advanced cases the pulmonary surface is reduced. Using CT, the mass and size of the organs of the respiratory system are determined.

All patients are required to undergo a test to evaluate their external respiratory function.. It includes a set of diagnostic measures:

spirometry;
peak flowmetry;
spirography;
determination of the gas composition of air during exhalation;
body plethysmography.

It is important to carry out the correct differential diagnosis to exclude pathologies such as cysts, abscesses.

Therapy for bullous pathology

Small bubbles in the lungs do not require specific treatment . At the initial stages of the disease, symptomatic treatment is prescribed:

mucolytic agents for producing a productive cough and removing phlegm from the bronchi;
antispasmodics to relieve chest pain;
non-steroidal anti-inflammatory drugs to reduce mucosal catarrh;
antibiotics in case of infection.

Collateral successful treatment and stopping the progression of the disease is complete failure from smoking.

For huge bullae with serious breathing problems, transthoracic drainage is performed with prolonged pumping of air. The disease is treated according to indications surgical method– removal of part of the lung, especially if spontaneous pneumothorax often recurs. The patient undergoes resection (cutting) of the lung together with pleurectomy (removal of part of the pleura).

Bullous pulmonary disease is often accompanied by infectious complications. The pathology cannot be completely cured, but with timely treatment medical care and constant monitoring can stop the progression of destructive processes. On late stages illness, the patient's condition is serious. A person loses his ability to work and acquires the status of a disabled person. Life expectancy depends on individual characteristics organism, survival rate is no more than 4 years. If the disease is detected early and treated, a person can live 20 years or more.

Emphysema – disease, in which swelling is noted lung tissue due to excess air content in it. Chronic emphysema is the most common disease in older people. Men get sick two to three times more often than women due to the prevalence of bronchitis, exposure to harmful occupational factors, and smoking tobacco. Today we will look at what pulmonary emphysema is, its symptoms, signs, treatment of chronic obstructive pulmonary disease (COPD) medicines, medications, folk remedies at home.

Remember that all given examples of drugs for the treatment of emphysema are provided for informational purposes and must be agreed with your doctor before use!

Bullous emphysema: types, photos

This form of the disease was first described in 1687 by the doctor S. Bartholinus. Bullous emphysema most often develops in men after 55 years of age and in infancy. It is characterized by excessive stretching of the alveoli with the destruction of their walls (the air bubbles that make up the lungs). At the same time, large accumulations of air larger than 1 cm (bullas) are formed, surrounded by healthy areas of the lungs. Subsequently, the undamaged parts are compressed by bullae, and atelectasis develops - collapse of part of the lung.

Bullous emphysema is classified according to the prevalence of bullae:

Solitary – single bulla;
one-sided local– bullae are localized in no more than two segments of one lung;
one-sided generalized– bullae are located in three or more segments of one lung;
bilateral - bullae are localized in both lungs.

Causes of emphysema

The main cause of pulmonary emphysema is bronchitis. All factors that contribute to the occurrence and development of chronic bronchitis are also important for emphysema.

Factors that contribute to the development of bullous emphysema:

Chronic diseases of the respiratory system: bronchial asthma, bronchiectasis, pneumosclerosis;
long-term tobacco smoking;
pulmonary circulatory disorders;
genetic, hereditary disorders;
polluted inhaled air containing microparticles of nitrogen oxides, dust, cadmium;
unfavorable working conditions: prolonged work in highly dusty air.

Emphysema can be the result of other lung diseases, such as suppurative processes, neoplasms, pleurisy. Deformations of the spine and chest, as well as profession (glassblowers, musicians), are important.

Emphysema: symptoms, signs

Bullous emphysema is accompanied by general and specific symptoms.

General signs:

sleep disorders,
fatigue,
loss of body weight,
constant feeling of weakness.

Characteristic symptoms:

The main complaints of patients are cough And dyspnea.

Cough is often accompanied by the release of mucopurulent sputum due to the presence of chronic bronchitis or bronchiectasis ( pathological expansion bronchi). Sometimes the cough can be dry.

Shortness of breath is initially observed during physical activity and is not always noticed by the patient. Subsequently, shortness of breath intensifies, begins to bother you even at rest, and becomes constant. With emphysema, it is usually difficult to exhale. The participation of auxiliary muscles in the act of breathing is noteworthy; they are tense and painful. The neck is shortened, you can often see swelling of the neck veins when exhaling, and cyanosis appears.

The chest is expanded, especially in the lower part, and has a barrel-shaped appearance. Kyphosis (forward curvature) is common thoracic spine. During breathing, retractions of the intercostal muscles are visible, and the mobility of the chest is limited.

Prevention of emphysema is associated, first of all, with the timely treatment of chronic diseases of the respiratory system, which cause the development of emphysema and, first of all, chronic bronchitis. Hard physical work is contraindicated for patients with emphysema, since the body is no longer able to adapt to the constant lack of oxygen. Increased physical activity leads to increased pulmonary insufficiency and pulmonary hypertension.

Emphysema: treatment

By means of official medicine

Treatment primary emphysema symptomatic:

breathing exercises aimed at maximizing the inclusion of the diaphragm in the act of breathing;
oxygen therapy courses,
avoiding smoking and other harmful effects, including professional ones;
limiting physical activity.

Therapy with 1-antitrypsin inhibitors is being developed. The addition of a bronchopulmonary infection requires the prescription of antibiotics.

At secondary emphysema They treat the underlying disease and therapy aimed at relieving respiratory and heart failure. There are attempts at surgical treatment of focal emphysema - resection of the affected areas of the lung.

Treatment should be primarily aimed at the diseases that cause the development of emphysema.
To improve bronchial conductivity, various bronchodilators are prescribed (Ephedrine, Atropine, Eufillin). These remedies are especially useful if you are prone to bronchospasms.
Use according to indications of mucolytics (Acetylcysteine), bronchodilators (long-acting theophyllines, inhaled beta-agonists and cholinergic blockers).
For allergic manifestations, corticosteroids are used.
For pulmonary emphysema, the administration of expectorants and thinners, which are given 4-5 times a day, is of great importance. Potassium iodide (2–3 g per day), ammonium chloride, ipecac, thermopsis preparations, alkaline and steam inhalations are effective.
In the presence of pulmonary and heart failure, oxygen inhalation, diuretics and cardiovascular drugs are used.
If an infection occurs - antibiotics, sulfonamides. Great importance with emphysema has physiotherapy. A special set of exercises has been developed for the development of lower thoracic, diaphragmatic breathing.

Traditional home remedies

Traditional medicine recommends such home treatment recipes.

Soapwort officinalis. Boil a teaspoon of crushed roots with 500 ml of water for 5 minutes. Strain. Drink 50 ml three times a day.

Coltsfoot. Included in the breast collection. The herb relieves bronchospasm well, dilutes bronchial secretions, and has an expectorant, anti-inflammatory and antispasmodic effect. Pour 400 ml of boiling water over a tablespoon of dry leaves, leave for 1 hour, strain. Drink 1 tablespoon 4-6 times a day.

centaury,
scolopendra foliage,
coltsfoot,
linden flowers.

In total, take 50 g. 2 tablespoons of the mixture, pour 500 ml of boiling water, add 1 teaspoon spoon of flaxseed, boil for 10 minutes in a tightly sealed container. Cool and strain. Take 1 tablespoon 4-6 times daily.

High mullein. The action of mullein is similar to that of coltsfoot. Pour 2 teaspoons of crushed leaves into 200 ml of boiling water, leave for 1 hour, strain. Drink a quarter glass 4 times a day.

Aloe leaf juice, kept for three days in the cold - 350 g, honey - 700 g, wine type " Cahors» – 1 bottle. Before preparing the medicine, heat the honey in a water bath to 40 °C. Mix all ingredients in an enamel bowl with a wooden spoon and transfer to a two-liter jar. Keep in the refrigerator for 2 days, stirring daily. Take 1 tablespoon three times daily before meals.

Boil 1 liter of water, add a tablespoon wild rosemary, close tightly. After 15–20 minutes, inhale steam. The same steam can be used three times by adding a teaspoon of wild rosemary to the water.

Eucalyptus. Inhalations 2–3 times a day. Per liter of boiling water 1 tablespoon of eucalyptus. Inhale the steam for 10-15 minutes 1-2 times a day.

Simmer 1 lemon over low heat for 10 minutes, cut in half, squeeze out the juice. Pour the juice into a glass, add two tablespoons of glycerin, mix well and fill the glass to the top honey. You can use lemon instead Apple vinegar . At severe cough take 1 teaspoon 5-6 times a day, for a moderate cough - 1 teaspoon 3-4 times a day.

To one teaspoon honey add two tablespoons of anise and two to three grams salt. Pour a glass of water, bring to a boil, strain and cool. Take 2 tablespoons every two hours.

Licorice root infusion. Pour 1 tablespoon of crushed root into an enamel bowl with 1 glass of boiling water, close the lid and leave in a water bath for 45 minutes. Strain and squeeze out the remaining raw materials. Add the resulting infusion boiled water up to 200 ml. Take 1 tablespoon 3-4 times a day. Store in the refrigerator for no more than two days.

Collection 2:

birch leaves – 10 g,
dandelion roots – 10 g,
juniper berries – 10 g.

Place 1 tablespoon of the mixture in an enamel bowl and pour 200 ml hot water. Boil in a water bath for 30 minutes, cool at room temperature for an hour, strain. Take 1 glass twice a day 30 minutes before meals.

Combine inhalation with fir oil (20–30 drops per 500 ml of boiling water) with rubbing fir oil in the chest area 1-2 times a day.

At viscous And thick purulent sputum prepare collection 3:

Pour two tablespoons of the mixture into 400 ml of boiling water and leave for 1 hour. Take 50 ml three to four times a day before meals.

1 teaspoon cyanosis roots blue pour 200 ml of boiling water, leave for 1 hour, boil for 3 minutes, cool, strain. 1 tablespoon 3-4 times a day.

A complete cure is possible if the cause of the disease is eliminated.
The primary measures in therapy are considered to be cessation of smoking tobacco and other bad habits.
Good healing effect performs chest massage.

Moderate physical activity restores the respiratory system. However, you need to remember that excessive exercise can be harmful to your health. Therefore, you need to follow the recommendations:

At the beginning of the course of treatment, the walking distance fresh air should not exceed 1 km;
take walks at a moderate pace;
when walking, maintain uniform breathing and lengthen the exhalation;
when the condition improves while maintaining uniformity of breathing, ascents to the 2nd-3rd floor are allowed.

Surgical treatment: surgery

When diagnosing bullous emphysema in a child, in advanced cases in adults, when drug therapy no effect, recommended surgery. The operation is performed with high-precision equipment through a small incision in the chest. The main purpose of the operation is to remove bullae, which contributes to:

decrease in lung volume,
straightening areas compressed by bullae,
facilitating the patient's breathing.

IN severe cases When many bullae are located in many areas of the lungs, removal or transplantation is required.

Life prognosis for pulmonary emphysema and prevention

Prevention of the disease consists of quitting smoking and avoiding harmful production or climatic factors. It is necessary to promptly diagnose and treat diseases of the respiratory system to avoid their chronicity.

In the absence of treatment for bullous pulmonary emphysema, complications such as:

spontaneous pneumothorax - rupture of a section of the lung with the release of air into the pleural cavity and its accumulation;
pulmonary hypertension - increased pressure in the vessels of the lungs, as a result - additional load on the right side of the heart;
right ventricular heart failure - develops against the background of progressive pulmonary hypertension, the heart cannot work fully and push blood towards high pressure;
ascites - accumulation of free fluid in abdominal cavity– manifestation of heart failure in the form of a significant increase in the size of the abdomen;
swelling in the legs in the evening, disappearing in the morning;
the addition of a secondary infection increases respiratory failure.

The most serious complication is heart failure. Loss of ability to work, and possible death if left untreated.

When the first symptoms of pulmonary emphysema (including the bullous form) appear, you should immediately consult a general practitioner or pulmonologist, because timely diagnosis and correct treatment will help avoid dangerous and severe consequences diseases.

Video on the topic

New method for treating emphysema

Bullous emphysema: surgical treatment

“Pulmonary emphysema” - this was the diagnosis given to capital resident Sergei Novikov. At any moment the man could die from suffocation. In just a few hours small punctures surgeons repaired the lungs and saved the man from the disease that had tormented him for many years.

What do doctors do? – first, the dangerous formation is removed with precision. A huge credit goes to the surgical assistants of all trades here. These are the very instruments that simultaneously cut and stop bleeding. In this case, they also fasten the lung tissue with special staples to maintain the tightness of the organ.

Bullous lung disease: thoracoscopic surgery

On the video channel of Irina Salnikova.

Pulmonary bullae - internal view: Bulla pulmonary

On the video channel of Stanislav Scriabin.

Photo and video pulmonary bull with bullous emphysema. Information for patients.

Removal of a lobe of the right lung: surgery

On Andrey Tim's video channel.

Removal of any lobe of the right and left lung can be done from the anterolateral or posterolateral approach, used to remove the entire lung. If the localization of the pathological process is not sufficiently determined before surgery, the intersection of the cartilage of the third rib is added to the intercostal incision to approach the apex of the lung, or the intersection of the V and VI ribs is added to access the lower lobe.

BULLA

(lat. bulla). 1) a wax or metal seal attached to any state paper, to papal charters. 2) the pope's decree on spiritual matters. - Golden Bull. Code of the Roman-German Emperor Charles IV.

, 1910 .

BULLA

Small Bukhara coin = 1/4 kopeck.

Dictionary foreign words, included in the Russian language. - Chudinov A.N., 1910 .

BULLA

lat. bulla, a wax or metal seal, especially on papal charters. Papal Decree on Spiritual Affairs. Golden Bull: Code of the Roman-German Emperor Charles IV.

Explanation of 25,000 foreign words that have come into use in the Russian language, with the meaning of their roots. - Mikhelson A.D., 1865 .

BULLA

a papal charter written (in Latin and on parchment) after consultation with the cardinals.

A complete dictionary of foreign words that have come into use in the Russian language. - Popov M., 1907 .

BULLA

the papal charter, drawn up in agreement with the council of cardinals, is announced to omniscience. Written in Latin on parchment.

Dictionary of foreign words included in the Russian language. - Pavlenkov F., 1907 .

Bulla

(lat. bulla)

1) in the Middle Ages - an imperial charter or decree;

2) message, order issued by the popes.

New dictionary of foreign words. - by EdwART,, 2009 .

Bulla

bulls, w. [ Latin bulla, lit. ball, circle] (special). Papal charter, message. [ From round stamp, suspended from the letter.]

Large dictionary of foreign words. - Publishing House "IDDK", 2007 .

Bulla

s, and. ( Middle-Lat. bulla seal, document with seal lat. bulla ball).
1. ist. In the Middle Ages Zap. Europe: imperial charter or decree.
2. An epistle, a decree issued by the Pope.
|| Wed. breve, decretal, encyclical.

Dictionary foreign words by L. P. Krysin. - M: Russian language, 1998 .

Synonyms:

See what "BULLA" is in other dictionaries:

Pope Urban VIII (1637) This term has other meanings, see Bulla (meanings). Bulla (from Latin bulla ... Wikipedia

- (foreign) letter, decree in general (especially the pope) from a lead seal attached to such resolutions, in the form of a round capsule. Wed. “Golden Bull” is an agreement between Emperor Charles IV and government officials, called this... ... Michelson's Large Explanatory and Phraseological Dictionary (original spelling)

- (lat. bulla ball; middle century lat. seal document with a seal), in the Middle Ages a round metal seal, usually sealing papal, imperial, royal acts, as well as the name of the acts themselves. See Golden Bull 1222, Golden Bull 1356... Big Encyclopedic Dictionary

BULLA- (Late Lat. bulla seal, document with a seal) 1) in the Middle Ages, a round metal seal, usually sealing papal, imperial, royal acts, etc. the name of the acts themselves (for example, Golden Bull of 1222, Golden Bull of 1356); 2)… … Legal encyclopedia

- (late Latin seal or document sealed with a seal) a round metal seal, which usually in the Middle Ages sealed a papal, imperial, royal act (document); the name of the act itself. The most important royal and imperial acts... ... Legal dictionary

Message, seal, letter Dictionary of Russian synonyms. bull noun, number of synonyms: 3 charter (14) seal ... Synonym dictionary

Bulla- Petersburg family. photographers; Karl Karlovich (1855/56 1929) founder of Russian. photo report. As a boy he came with his parents from Germany. He began his service at the Dunant company as a laboratory assistant. In 1886 he received a certificate for the right to take photographs. views of the capital... ... Russian humanitarian encyclopedic Dictionary

- (ball, seal, document with a seal) in the Middle Ages, a round metal seal, usually sealing papal, imperial, royal acts, as well as the name of the acts themselves... Historical Dictionary

BULLA, bulls, female. (lat. bulla, lit. ball, circle) (special). Papal charter, message. (From the round seal suspended from the letter.) Ushakov’s Explanatory Dictionary. D.N. Ushakov. 1935 1940 … Ushakov's Explanatory Dictionary

Female, lat. decree in a letter from the pope on matters of faith. Dahl's Explanatory Dictionary. IN AND. Dahl. 1863 1866 … Dahl's Explanatory Dictionary

Books

Bull Dynasty: Charles. Alexander. Victor. Yuri, Elbek V., Svetov Y., Byurganovsky D. (eds.). The photo monograph “Bulla Dynasty: Karl, Alexander, Victor, Yuri” is published in a series started in 2013, and is a direct continuation of the photo monograph “The First Photo Reporter of Russia Karl...

Bullae in the lungs are formations in the form of air bubbles in the lung tissue. The terms “bleb” and “cyst” are often used to refer to this phenomenon. They can be considered as variants of bullae. A bleb is a small formation with a diameter of up to 1 cm. The structure of a cyst differs from a bulla in the quality of its lining layer. Often even doctors are not able to correctly differentiate one from the other. Therefore, for the purposes of this article we will use the term “bulla” in its most general sense.

Bullae can be single or multiple, unilateral or multilateral. Occurs in adults, rarely in children.

In contact with

Why do bullae appear in the lung?

The appearance of bubbles in the lungs is influenced by a complex of reasons that are associated with external and internal factors.

External factors

Modern data suggest that external destructive influences play a dominant role in the occurrence of pulmonary diseases. This is, first of all:

Smoking;
air pollution;
pulmonary infections.

It has been proven that in people who smoke a pack of cigarettes or more per day, bullae formation of varying intensity is observed in 99%. The disease progresses unnoticed. In smokers with 20 years of experience, only 1% have no bullae in the lungs. Long-term passive smoking can increase the likelihood of pulmonary vesicles. But since secondhand smoke rarely occurs continuously over decades, the likelihood of this happening is small.

It should be emphasized that non-smokers even in the presence of predisposing factors, the disease progresses slightly.

Living in environmentally unfavorable places provokes destructive processes in the lungs. So do frequent lung infections. These factors in their impact significantly lag behind active smoking.

Men suffer from bullae more often. This is explained by lifestyle features:

Having bad habits,
unhealthy diet with a predominance of fats and sugars, deficiency of protein, vegetables, vitamins;
harmful working conditions;
frequent hypothermia, etc.

Internal reasons

If the destructive factor external environment superimposed on the existing predisposition, then the probability of the occurrence of bullae will tend to 100 percent. Among internal factors highlight:

Hereditary;
enzymatic;
mechanical impact;
lack of blood supply to the lung tissue;
inflammatory;
obstructive.

Genetic cases of bullae formation occur at any age, are often combined with liver diseases and are associated with a deficiency of the antitrypsin protein and accompanying enzymatic changes.

The mechanical method of occurrence of bullae is associated with anatomical feature the first two ribs, which are sometimes injured top part lungs. It has been proven that disproportionate growth of the chest (an increase in vertical plane more than horizontal) in adolescence is able to trigger processes leading to the formation of bullae.

Pulmonary vesicles can develop against the background of vascular ischemia of the lung. Frequent inflammatory processes create conditions for weakening the walls of the alveoli and deteriorating their nutrition. They lead to changes in pressure in certain parts of the bronchioles, which redirects air movement and contributes to thinning of the alveoli and changes in intra-alveolar pressure. All this leads to progression in the formation of air bubbles in the lungs. Obstructive disease in many cases is a harbinger of bullous formations.

The listed factors and reasons may be present in combination and have a complex effect. For example, the influence of poor blood supply to the lung tissue in combination with past illness respiratory tract exaggerated by smoking - all this significantly increases the likelihood of developing bullous disease.

What diseases does it occur in?

The appearance of bullae in the lungs accompanies the following diseases:

Emphysema of various types;
false cysts;
pulmonary dystrophy;
chronic obstructive pulmonary disease ();
other lung diseases.

Pulmonary vesicles arise as the main symptom, in which destructive changes occur in the structure of the alveolar walls, and pathological changes in the bronchioles develop.

In modern practice, the appearance of bullae is usually considered to be the main symptom.

Main manifestations of the disease

The course of bullous disease is often asymptomatic. IN neglected form symptoms manifest themselves in the form of complications:

(including bloody, liquid, purulent effusion-exudate);
pneumomediastinum;
rigid lung;
pleural fistula (fistula);
chronic respiratory failure;
hemoptysis.

All complications have the same clinical picture:

Additionally: with hemoptysis observed bleeding from the respiratory tract is scarlet in color, often in the form of foam.

In addition, the bulla can grow to gigantic sizes of several centimeters and put pressure on the heart and circulatory system, destabilizing their work.

Diagnostic methods

Diagnosis of bullous disease includes:

X-ray examination;
computed tomography;
physical methods for assessing respiratory function;
thorascopic examination with sampling of lung material.

How to treat

At the initial stage of the disease, physiotherapeutic treatment methods are indicated. You should pay attention to lifestyle and nutrition:

Avoid serious physical activity so as not to provoke rupture of the bubbles;
spend more time in the fresh air;
protect the respiratory tract from diseases, dress warmly;
enrich your diet with plant foods;
provide the body with vitamin support;
quit smoking.

When developing, treatment is traditional: puncture and drainage of the pleural cavity in order to restore the functionality of the lung.

With the progression of the disease - proliferation of bullae, ineffective drainage of the pleural cavity, repeated pneumothorax, persistent respiratory failure - there is a need for surgical intervention.

Is it necessary to have surgery?

There is no medical treatment for bullae. Depending on the rate of progression of bullous pulmonary emphysema and the severity of complications, the issue of surgery is decided. When resolving the issue, all factors are taken into account. Surgical intervention- always a last resort.

The operation to remove bullae on the lung in each specific case can be performed either openly or endoscopically. IN modern medicine Thoracic methods are preferred. However, the size and localization of bullae sometimes require an unconditional opening.

Conclusion

Bullous emphysema in most cases it is asymptomatic. Depending on the frequency and strength of the influence of external destructive factors - smoking, harmful production, poor ecology - a person with bullae lives without any problems for decades. The disease, having developed, sometimes stops progressing for a long time (for example, if a person abstains from smoking), and then the bubbles begin to increase again (for example, if a person returns to a bad habit). In most cases, the disease is acquired, takes a long time to develop and manifests itself with age. It is within the power of a person to prevent the destruction of his own respiratory system. It is of fundamental importance preventive actions, timely and complete treatment, giving up bad habits, normalizing lifestyle.

The video shows the process of formation of bullae in the lungs

To quickly cure cough, bronchitis, pneumonia and strengthen the immune system, you just need...

Bullous emphysema– a chronic disease characterized by local tissue changes, expressed by the destruction of the alveolar septa and the formation of air cysts-bulls with a diameter of more than 1 cm. That is, the walls of the alveoli are destroyed due to their stretching.

What are boules?

Emphysematous bulla- This is an area where air accumulates in the lungs. Lung bubbles compress healthy areas on all sides and part of the lung collapses. The disease is the direct cause of spontaneous pneumothorax in 80% of cases.

Diagnostic confirmation of the disease is made using MRI, radiography, CT, scintigraphy or thoracoscopy. In an uncomplicated course, symptoms may not appear even before spontaneous pneumothorax occurs.

In the asymptomatic form it is carried out dynamic observation; in case of complicated or progressive course of the disease, surgical treatment is performed.

Reasons for the development of the disease

There are several theories about the occurrence of the disease.

Mechanical theory suggests that the horizontal position of the first or second rib in some people injures the apex of the lung, which causes the development of bullous emphysema.
Vascular theory expresses the opinion that the bula appears as a result of pulmonary ischemia.
Infection theory suggests a connection between bullous emphysema and viral infections respiratory tract. Bulls may appear after obstructive bronchiolitis or tuberculosis. It has been noted that relapses of spontaneous pneumothorax occur during periods of epidemics adenovirus infection and flu.

Bullae in the lungs are either congenital or acquired in origin.

Congenital bullous changes are formed due to a lack of elastase inhibitor - a1-antitrypsin, resulting in enzymatic destruction of lung tissue.

Purchased develop against the background of existing emphysematous changes in the lungs. 90% of patients are long-term smokers, smoking more than 20 cigarettes per day for 10-20 years.

Passive smoking increases the likelihood of developing the disease to 43%.

Also risk factors are:

Chronic diseases of the respiratory system – Chronical bronchitis, asthma, bronchiectasis, pneumosclerosis, pneumoconiosis, sarcoidosis;
Tuberculosis;
Pathologies of blood circulation in the lungs;
Hereditary factor;
Bad ecology;
Long-term work in unventilated areas.

Classification

Bullae are of 3 types.

Bubbles are located:

On the surface of the organ on a narrow stalk;
On lung surface and are attached to it through a wide base;
Deep in the lung tissue.

Also, bullae can be multiple and single, single (in one lung) and bilateral (in two lungs), tense and non-tense.

The form of the disease can be localized in one or two segments or generalized.

The size of the bullae can be:

Small - up to 1 cm,
Medium - from 1 cm to 5 cm,
Large - from 5 cm to 10 cm,
Giant - 10 cm - 15 cm.

Bullous pulmonary emphysema is divided into:

Asymptomatic;
WITH clinical manifestations- with cough, shortness of breath and chest pain;
Complicated by spontaneous pneumothorax and other pathologies.

Symptoms

Most often, emphysematosis is diagnosed in people with an asthenic constitution, with VSD, with spinal curvature, and with chest deformation.

Common signs of the disease include: fatigue, loss of appetite, interruptions in sleep, weakness.

Specific symptoms include:

The appearance of shortness of breath even at rest;
Cough with sputum;
Chest pain;
Transformation of the chest towards its enlargement or curvature;
Change in skin color to bluish or gray.

The onset of the disease usually does not manifest itself with any symptoms. When emphysematous bullae reach enormous sizes, they begin to compress areas of the lung, which causes shortness of breath.

Most often, bulosis is determined only when complications are detected - for example, with the development of recurrent pneumothorax.

Bullous spontaneous pneumothorax is the complication of bullous disease in which it is detected. Usually the right lung is affected.

With physical stress, severe coughing or heavy lifting, the bulla ruptures, air escapes into the pleural cavity, and lung collapse develops. The patient notes sharp pains in the chest, radiating to the neck, collarbone or arm.

Shortness of breath, paroxysmal dry cough develops, the patient is forced to take more comfortable position and can't do deep breath. During the examination, tachycardia and widening of the intercostal spaces are revealed. With complicated pneumothorax, serous exudate is present in the pleural cavity of the lung.

If spontaneous pneumothorax continues to develop, the patient's condition deteriorates sharply. Complicated pneumothorax can lead to intrapleural bleeding. Rupture of the pleura can cause loss of consciousness. The patient's heart rate increases and pallor is observed.

Diagnostics

Diagnosis is based on clinical and radiological data.

Diagnostic methods help determine the presence of bullae and make a diagnosis:

Examination of the patient.
Percussion helps identify areas of increased airiness.
Auscultation reveals whistling dry rales.
A blood test helps determine the ratio of CO2 and O2.
Spirometry helps obtain data on tidal volumes.

X-rays are not always able to detect the disease. On high-resolution CT scans, bullae are visible as thin-walled cavities with smooth contours.

Lung scintigraphy helps to assess the ratio of functioning and pathological lung tissue, which is necessary when planning surgical treatment.

The patient is treated by a pulmonologist, and if complications develop, treatment is carried out by a thoracic surgeon.

Video

When diagnosing, it is important to differentiate bullous emphysema from diseases:

Bronchiectasis;
Chronic bronchitis;
Diffuse pulmonary emphysema;
Pneumothorax;
Pneumoconiosis.

Treatment and prevention

Patients whose disease was asymptomatic before the first episode of spontaneous pneumothorax are simply observed by a doctor. They are assigned physical rehabilitation, physical therapy, it is recommended to avoid physical activity and infectious diseases.

An effective treatment method is oxygen therapy, which involves inhalation of an oxygen-saturated gas-air mixture.

How to treat an uncomplicated disease?

Drug therapy is prescribed:

Bronchodilators;
Glucocorticosteroids;
Diuretics;
When a bacterial infection occurs, antibiotics are prescribed.

For spontaneous pneumothorax, pleural puncture or drainage is performed pleural cavity to straighten the lung. With increasing respiratory failure and an increase in the size of the cavity, the ineffectiveness of drainage procedures, and recurrent pneumothorax, surgery is performed to remove the bullae: bullectomy, segmentectomy, lobectomy, marginal resection.

Prevention of bullous disease is the same as prevention of emphysema.

It is necessary to quit smoking, including not being in the same room as smokers, eliminating contact with harmful production factors, and avoiding respiratory infections.

Forecast

When the root cause of the disease is eliminated and timely treatment the patient can be cured. Mild pulmonary pneumothorax can go unnoticed, which can have serious consequences. In case of relapse, the following complications may develop: hemothorax, reactive pleurisy, aspiration pneumonia.

If the cause of the disease is not treated and the cause of the disease is not eliminated, complications may develop that contribute to the development of respiratory failure and infection. The most dangerous complication is heart failure, which can be fatal.

Naturally, many patients come to mind the question: how long do they live with bullous emphysema?

The answer to this question depends on many factors: the severity of the disease, how timely treatment was prescribed, etc.

Life expectancy has the following statistics:

At mild form More than 80% of patients overcome the psychological milestone of 4 years;
At moderate form– about 70%;
In severe cases - up to 50%.