Pulmonary Emphysema - Symptoms

Cough is a characteristic symptom of chronic obstructive bronchitis, first of all. Naturally, it continues to bother the patient even when chronic obstructive bronchitis is complicated by pulmonary emphysema. The cough is of a straining, unproductive nature. At the beginning of the development of primary diffuse emphysema, cough does not bother patients. But, as was indicated above, as primary emphysema progresses, chronic bronchitis develops and cough appears.

Color of the skin and visible mucous membranes, severity of cyanosis. In patients with primary pulmonary emphysema, the ventilation-perfusion ratio is not as severely impaired as in secondary emphysema; arterial hypoxemia is not observed at rest. Patients develop hyperventilation, which promotes arterialization of the blood. In this regard, patients with primary pulmonary emphysema do not have hypercapnia for a long time, the skin and visible mucous membranes are pink rather than cyanotic. Patients with primary pulmonary emphysema are called "pink puffers". However, as the reserve capacity of the respiratory system is depleted, alveolar hypoventilation with arterial hypoxemia and hypercapnia occurs, and severe cyanosis may appear.

For patients with secondary pulmonary emphysema (as a complication of chronic bronchitis), diffuse cyanosis is very typical. At first, it is noted in the distal parts of the extremities, then, as the disease progresses and hypercapnia and hypoxemia develop, it spreads to the face and mucous membranes.

With severe hypercapnia in patients with secondary emphysema, a bluish tint to the tongue appears (“heather” tongue).

Weight loss. Patients with pulmonary emphysema experience significant weight loss. Patients are thin, frail, may even look cachectic and are embarrassed to undress for a medical examination. Significant weight loss is probably due to the high energy costs of performing the intense work of the respiratory muscles.

Participation of the accessory respiratory muscles in the act of breathing. When examining patients, hyperfunctioning of the accessory respiratory muscles, abdominal muscles, upper shoulder girdle and neck can be seen.

The work of the accessory respiratory muscles is assessed in the lying and sitting positions. As pulmonary emphysema progresses, the respiratory muscles become fatigued, patients cannot lie down (the horizontal position causes intense work of the diaphragm) and prefer to sleep sitting.

Examination of the chest. When examining patients, a "classic emphysematous chest" is revealed. The chest acquires a barrel-shaped form; the ribs assume a horizontal position, their mobility is limited; the intercostal spaces are widened; the epigastric angle is obtuse; the shoulder girdle is raised and the neck appears shortened; the supraclavicular areas bulge.

Percussion and auscultation of the lungs. Percussion signs of pulmonary emphysema are lowering of the lower border of the lungs, limitation or complete absence of mobility of the lower pulmonary edge, expansion of Kernig's fields, reduction of the borders of cardiac dullness (hyper-air lungs cover the heart area); box percussion sound over the lungs.

A characteristic auscultatory sign of pulmonary emphysema is a sharp weakening of vesicular breathing ("cotton-wool breathing"). The appearance of wheezing is not characteristic of pulmonary emphysema and indicates the presence of chronic bronchitis.

Condition of the cardiovascular system. A tendency to arterial hypotension is typical, as a result of which dizziness and fainting occur when getting out of bed. Fainting may occur during coughing due to increased intrathoracic pressure and impaired venous return of blood to the heart. The pulse in patients is often low in volume, rhythmic, heart rhythm disturbances are rare. The borders of the heart are difficult to determine, seem reduced. Heart sounds are sharply muffled, better heard in the epigastric region. With the development of pulmonary hypertension, an accent of the second tone is heard on the pulmonary artery. The formation of chronic pulmonary heart is especially characteristic of chronic obstructive bronchitis. In patients with primary pulmonary emphysema, chronic pulmonary heart develops much later (usually already in the terminal stage).

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