Adhesions in the lungs: what to do, how to treat?

The following methods can be used to eliminate adhesions:

• Drug therapy.
• A course of physiotherapy and other rehabilitation measures.
• Balneotherapy.
• Diet therapy and vitamin intake.
• Surgical treatment.
• Traditional methods.

Oxygen therapy is administered to relieve shortness of breath and other signs of respiratory failure. In case of multiple adhesions, plasmapheresis and hemosorption procedures are indicated. Surgical treatment of adhesions is used only in the most extreme cases when the patient's life is at risk. Particular attention is paid to preventive measures.

Medicines

Drug treatment of the adhesion process in the lungs depends on the etiology of the disease, the symptom complex and the presence of complications. In most cases, the use of drugs is symptomatic. Patients are prescribed drugs whose action is aimed at the respiratory system and maintaining blood oxygen saturation.

• If the adhesions are accompanied by inflammatory exacerbations (pneumonia, bronchitis, tonsillitis, pleurisy), then the patient is prescribed antibacterial, anti-inflammatory, mucolytic and bronchodilator drugs.
• In severe cases of the disease and its rapid progression, it is necessary to take glucocorticosteroids. Hormonal drugs stop inflammatory processes and suppress connective tissue growths.
• The therapy must be combined with immunosuppressive agents, anabolic and vitamin preparations.

Let's look at the main groups of drugs for the treatment of adhesions in the lungs:

Glucocorticosteroids

1. Prednisolone

Glucocorticosteroid, used for acute allergic reactions and bronchial asthma. The drug is effective in shock conditions, thyroid diseases, myocardial infarction, renal-hepatic and adrenal insufficiency, systemic lupus erythematosus. Prescribed for collagenoses (diffuse damage to connective tissue and blood vessels).

• Method of administration: intravenously or intramuscularly. The dosage is individual for each patient.
• Side effects: electrolyte imbalance, hyperglycemia, increased blood pressure, adrenal cortex suppression, ulceration of the gastrointestinal tract.
• Overdose: acute toxic effects. There is no specific antidote, symptomatic therapy is indicated.
• Contraindications: active tuberculosis, gastric ulcer and duodenal ulcer, mental illness, hypertension, decompensated diabetes mellitus, thrombophlebitis, heart failure, pregnancy and lactation.

Release form: 5 ml ampoules, 10 pieces per package, tablets, injection suspension.

2. Diprospan

Glucocorticoid with antiallergic, anti-inflammatory, anti-shock, immunosuppressive and desensitizing properties. Also has a mild mineralocorticoid effect.

• Indications for use: bronchial asthma, collagenoses, extra-articular rheumatism, post-traumatic osteoarthritis, osteochondrosis, lumbago, allergic rhinitis and gouty arthritis. Keloid scars, cerebral edema, psoriasis, anaphylactic and allergic reactions, shock conditions, dermatitis, malignant neoplasms.
• The method of administration and dosage depend on the severity of the disease. For intramuscular injections, the most commonly used dosage is 1-2 ml. The duration of treatment is individual for each patient.
• Side effects: sleep disturbances, irritability, digestive disorders, weight gain. Various edemas are also possible.
• Contraindications: hypersensitivity to the components of the drug, peptic ulcer, tuberculosis, viral and bacterial infections, ulcerative lesions of the stomach and duodenum, impaired renal and hepatic function. The drug is not used during pregnancy and lactation.
• Overdose: sleep and wakefulness disorder, adrenal dysfunction, nausea and vomiting, euphoria. Symptomatic therapy is indicated for treatment.

Diprospan is available as an injection solution in 1 ml ampoules.

3. Dexamethasone

A glucocorticosteroid hormone with pronounced anti-inflammatory and anti-allergic effects.

• Indications for use: sudden decrease in blood pressure, severe infectious lesions, vascular collapse, meningococcal infection, septicemia, diphtheria, eclampsia. Severe allergic reactions, asthma attacks, pyrogenic reactions.
• Method of application: in acute course of the disease condition high dosages are prescribed, which are gradually reduced. At the beginning of therapy 10-15 mg per day are used, maintenance dosage is 2-5 mg per day.
• Side effects: transient adrenal insufficiency, adrenal atrophy, menstrual irregularities, mental disorders, peptic ulcers, nausea and vomiting, increased intraocular pressure, arterial hypertension, muscle atrophy, allergic reactions. Overdose has similar signs, treatment is symptomatic.
• Contraindications: individual intolerance to the components of the drug, lactase deficiency. Gastric ulcer and duodenal ulcer, gastritis, peptic ulcer, history of myocardial infarction, endocrine disorders. Not used during pregnancy and lactation.

Release form: tablets of 0.5 mg of active substance and ampoules of 4 mg of dexamethasone.

Antifibrotic drugs

1. Colchicine

A medicinal product of alkaloid nature that reduces the movement of leukocytes to the inflammatory lesion. Inhibits the absorption of microcrystalline parts of uric acid by phagocytes. Stops the development of amyloidosis, reduces the intensity of formation of amyloid structure fibrils and does not allow protein to accumulate.

• Indications for use: phlebitis, scleroderma, amyloidosis, arthritis, inflammatory lesions in ENT practice and dentistry, chondrocalcinosis, gout.
• Method of administration: orally 1 tablet 2-3 times a day. In particularly severe cases, the dosage is selected individually for each patient. Duration of treatment is 4-12 weeks.
• Side effects: nausea, vomiting, diarrhea, malabsorption syndrome, neuropathy, renal dysfunction, leukopenia, urticaria, myopathy, epigastric pain, thrombocytopenia.
• Contraindications: hypersensitivity to the components of the drug, acute liver and kidney failure, severe gastrointestinal disorders, neutropenia, purulent infections, pregnancy and lactation, alcoholism.
• Overdose: severe diarrhea and vomiting, nausea, pain in the oral cavity, hypotension, convulsions, hemorrhagic gastroenteritis, hematuria. Burning of the skin, oliguria, renal failure, respiratory depression, ascending paralysis. There is no specific antidote, treatment is symptomatic with mandatory discontinuation of the drug.

Release form: tablets for oral administration, 10 and 100 pieces per package.

2. Veroshpiron

Competitive antagonist of the mineralocorticoid aldosterone. Reduces the rate of connective tissue formation. Has a pronounced diuretic effect. Does not affect renal circulation and renal tubular function.

• Indications for use: tissue edema due to cardiovascular insufficiency, ascites, paroxysmal myoplegia.
• Method of administration: orally 50-300 mg per day. After improvement of the painful condition, the dosage is reduced by half. The course of treatment is from 20 days to 4-5 months.
• Side effects: headaches and dizziness, increased drowsiness, skin diseases, low sodium/potassium levels in the blood.
• Contraindications: acute renal failure, intolerance to the components of the drug, pregnancy and lactation.

The drug is available in the form of tablets for oral administration of 25 mg, 100 pieces per package.

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Antitussives and expectorants

1. Euphyllin

Contains the active substance - theophylline. Increases antispasmodic activity. Relaxes the muscles of the bronchi, reduces the resistance of blood vessels and lowers the pressure in the pulmonary artery system. Has diuretic properties, increases renal blood flow. Inhibits platelet aggregation.

• Indications for use: bronchial asthma, bronchospasms, increased pressure in the pulmonary vessels, cardiac asthma, respiratory disorders. Improvement of cerebral circulation, reduction of intracranial pressure.
• Method of administration: the medicine is taken orally, injected into muscles and veins, used in the form of microclysters. The dosage for adults is 150 mg 1-3 times a day after meals. The course of treatment depends on the severity of the disease.
• Side effects: digestive disorders, decreased blood pressure, headaches and dizziness, increased heart rate, convulsions.
• Contraindications: sudden decrease in blood pressure, paroxysmal tachycardia, epilepsy, coronary insufficiency, cardiac arrhythmia.

Release form: tablets of 150 mg, ampoules of 10 ml of 2.4% solution and 1 ml of 24% solution.

2. Salbutamol

A drug that stimulates beta-adrenergic receptors in the bronchi. It has a bronchodilatory effect.

• Indications for use: bronchial asthma, bronchitis. The dosage and duration of use of the drug depend on the form of release of the drug and are selected by the doctor for each patient.
• Side effects: dilation of peripheral vessels, increased heart rate, muscle tremors.
• Contraindications: arterial hypertension, paroxysmal tachycardia, pregnancy and lactation, thyroid disease.

The medication is available in tablet form of 2, 4 and 8 mg, syrup, powder for inhalation, and injection solution.

3. Bromhexine

A phlegm thinner. Stimulates the formation of surfactant, which regulates the secretion of bronchopulmonary secretions and normalizes secretion. Reduces the viscosity of phlegm and promotes its removal from the bronchi. Low-toxic, does not affect blood circulation.

• Indications for use: acute and chronic diseases of the trachea, bronchi, lungs. Bronchiectasis, pneumoconiosis, bronchography.
• Method of administration: orally 4-8 mg 3-4 times a day. In particularly severe cases, the dosage may be increased to 16 mg per day. The duration of therapy is determined by the attending physician.
• Side effects: nausea, vomiting, digestive disorders, peptic ulcer, acute allergic reactions, increased levels of transaminases in the blood serum.
• Contraindications: hypersensitivity to the components of the drug, gastric bleeding, peptic ulcer, early pregnancy.

Release form: tablets of 80 and 40 mg, syrup and solutions for oral administration, inhalation and injection.

4. ACC

A medicinal product with the active component acetylcysteine. It has a mucolytic and expectorant effect. It reduces the viscosity of bronchial secretions, increases mucociliary clearance and improves expectoration. It has an antioxidant and pneumoprotective effect.

• Indications for use: diseases with accumulation of thick viscous sputum in the bronchial tree and upper respiratory tract. Prescribed for bronchitis, tracheitis, bronchiolitis, laryngitis, sinusitis, bronchial asthma, exudative otitis.
• Method of administration: for children over 14 years of age and adults, 400-600 mg per day. Duration of treatment is 5-7 days. The drug is taken after meals, dissolving the effervescent tablet or the contents of the sachet in a glass of water.
• Side effects: abdominal pain, diarrhea, heartburn, nausea and vomiting, headaches and tinnitus, increased heart rate, arterial hypotension. Allergic reactions in the form of bronchospasms are also possible.
• Contraindications: intolerance to the components of the drug, peptic ulcer, pulmonary hemorrhage or hemoptysis. Not used in pediatric practice for hepatitis and renal failure. With special caution, it is prescribed during pregnancy and lactation.
• Overdose: dyspeptic disorders. Symptomatic therapy is indicated for treatment.

Release form: effervescent tablets, powder for preparation of solution and hot drink for oral administration.

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Antibiotics

1. Streptomycin

Has a broad spectrum of antimicrobial action. Active against Mycobacterium tuberculosis, most gram-negative and gram-negative microorganisms. Less active against pneumococci and streptococci, does not act on anaerobes, viruses and rickettsia.

• Indications for use: treatment of tuberculosis of the lungs and other organs, purulent-inflammatory processes of various localizations, pneumonia, brucellosis, endocarditis.
• Method of administration: intramuscularly, intratracheally, intracavernously. Single dose for intramuscular administration is 500 mg-1 g, maximum daily dose is 2 g. Duration of treatment is from 7 days to 3 months.
• Side effects: allergic reactions, headaches and dizziness, increased heart rate, albuminuria, hematuria, diarrhea. In rare cases, vestibular disorders and hearing impairment are observed. Overdose has similar signs, treatment is symptomatic.

Release form: vials of 250 and 500 mg, 1 g.

2. Metronidazole

Antimicrobial and antiprotozoal drug. Its mechanism of action is based on the biochemical reduction of the 5-nitro group of metronidazole using intracellular transport proteins of anaerobic microorganisms and protozoa. It is active against a wide range of pathogenic microorganisms.

• Indications for use: protozoal infections and diseases caused by Bacteroides spp. Infections caused by Clostridium spp., Peptococcus and Peptostreptococcus. Pseudomembranous colitis, gastritis, duodenal ulcer. Prevention of postoperative complications, radiation therapy of patients with tumor resistance due to hypoxia in tumor cells.
• The method of administration and dosage depend on the form of the medication, and are therefore individual for each patient.
• Side effects: digestive system disorders, headaches and dizziness, impaired coordination of movements, weakness, increased irritability. Allergic reactions, cystitis, urinary incontinence, candidiasis, neutropenia, leukopenia. Pain, swelling or hyperthermia at the injection site.
• Contraindications: hypersensitivity to the components of the drug, history of leukopenia, liver failure, first trimester of pregnancy and lactation.

Metronidazole is available in the form of a gel and cream for external use, vaginal suppositories and tablets, powder for solution for intravenous administration, ready-made solution for infusions, oral suspension and in the form of enteric-coated tablets.

3. Fenoterol

Adrenomimetic drug, stimulator of beta-adrenoreceptors of bronchi and uterine tissues. Activates adenylate cyclase receptors, which stimulate the calcium pump, which redistributes calcium ions in muscle cells. Expands the lumen of the bronchi, relieves bronchospasms and asthma attacks of various origins.

• Indications for use: bronchial asthma, infectious lung diseases with difficulty exhaling, pulmonary emphysema.
• Method of application: 1-2 doses of aerosol inhalation. If inhalation does not relieve the asthma attack, the aerosol is used again. Treatment is carried out no more than 4 times a day with an interval of at least 2 hours.
• Side effects: tremors of the extremities, increased heart rate, increased fatigue and sweating, headaches. For treatment, it is necessary to reduce the dosage.
• Contraindications: hypersensitivity to the components of the drug, arrhythmia and atherosclerosis of the heart.

Fenoterol is produced in 15 ml aerosol cans - 300 doses of 0.2 mg and in the form of ampoules for injection of 0.5 mg.

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Cardiac glycosides

(to prevent heart failure)

1. Strophanthin

Cardiac glycoside, increases the speed and force of myocardial contractions, reduces the negative chronotropic effect. Increases the stroke and minute volume of the heart muscle, improves ventricular emptying.

• Indications for use: cardiac arrhythmia, chronic heart failure, atrial fibrillation, supraventricular tachycardia.
• Method of administration: intravenously as a 0.025% solution of 1 ml. The drug is diluted in 10-20 ml of glucose solution or isotonic sodium chloride solution. The drug is administered slowly, since rapid administration can cause shock. If intravenous administration is impossible, the drug is administered intramuscularly. The therapeutic effect develops 3-10 minutes after injection. The maximum therapeutic effect is achieved 30 minutes to 2 hours after saturation. The duration of action of the drug is 1-3 days.
• Side effects: heart rhythm disturbance, extrasystole, rhythm dissociation, nausea and vomiting attacks. For treatment, a reduction in dosage and an increase in the interval between injections are indicated. If the pulse slows down sharply, the administration is stopped.
• Contraindications: individual intolerance to the components of the drug, inflammatory lesions of the heart muscle, diseases of the internal cavities of the heart, cardiosclerosis. With special caution it is prescribed for diseases of the thyroid gland and atrial extrasystole.

The drug is available in the form of a 0.025% solution for injection in 1 ml ampoules.

2. Adoniside

A medicinal product with cardiotonic action. Strengthens systole and increases diastole, reduces the number of heart contractions.

• Indications for use: vegetative-vascular neuroses, circulatory and cardiac insufficiency.
• Method of administration: orally 30 minutes before meals. As a rule, the dosage is 20-40 drops 2-3 times a day. The highest single dose for adult patients is 40 drops, and the daily dose is 120 drops.
• Side effects: digestive disorders. To eliminate this reaction, the drug should be taken after meals.
• Contraindications: gastric ulcer and duodenal ulcer, gastritis and enterocolitis in the acute stage.

The drug is available in 15 ml bottles.

3. Corglicard

A medicinal product from the group of cardiac glycosides. Contains the active substance - corglycon. Reduces the level of potassium ions in cardiomyocytes and increases the level of sodium, improving the contractility of the heart muscle. Increases the stroke volume of blood, reducing the need for oxygen.

• Indications for use: acute and chronic heart failure. Prescribed when it is impossible to use digitalis preparations.
• Method of administration: the drug is used for intravenous administration. The solution is administered slowly by bolus, mixing with 20 ml of 0.9% sodium chloride. The daily dosage for adults is 0.5-1 ml of solution per 1 injection. The highest daily dose is 2 ml of solution. During treatment, it is necessary to monitor electrolyte balance and ECG.
• Side effects: heart rhythm disturbances, bowel disturbances, pain in the epigastric region, nausea and vomiting, dryness of the oral mucosa. Pain in the extremities, apathy, confusion, decreased visual acuity. Overdose has similar symptoms. There is no specific antidote.
• Contraindications: intolerance to the components of the drug or other cardiac glycosides. Not used in acute myocardial infarction, bradycardia, unstable angina, diastolic dysfunction. Contraindicated in water-electrolyte metabolism disorders, during pregnancy and lactation.

Release form: solution for parenteral administration in 1 ml ampoules.

4. Cytochrome C

An enzymatic agent with an active substance that is produced by extracting the tissues of cattle and pigs. Participates in tissue respiration of the body, accelerates oxidative processes.

• Indications for use: improvement of tissue respiration, asthmatic conditions, pneumonia, heart failure, ischemic heart disease, intoxication damage.
• The method of administration and dosage depend on the form of the medication and are selected individually for each patient.
• Side effects: fever, elevated body temperature. The drug is contraindicated in case of individual intolerance to its active components.

Cytochrome-C is available in ampoules of 0.25% solution of 4 ml and in the form of enteric-coated tablets.

In order for drug therapy to be as effective as possible, it is carried out in combination with therapeutic bronchoscopy. This allows for the delivery of drugs directly to the affected tissues of the lungs and bronchi, stopping inflammatory processes and removing stagnant contents of the organ.

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Vitamins

Various micro and macro elements have a beneficial effect on the immune system, increase its protective properties and speed up the recovery process. Vitamins are prescribed both in the early stages of adhesive disease and in the development of severe complications. Most often, patients are prescribed vitamins of group B, E, A, folic acid and aloe preparations. This complex of useful substances increases the elasticity of existing connective tissue adhesions and prevents the development of new ones.

Let's consider the effect of essential vitamins on the respiratory system:

• A – accelerates the regeneration processes of the epithelium of damaged respiratory tract and pleura of the lungs.
• C – activates oxidation-reduction processes in the body, improves overall well-being.
• Group B – thiamine and riboflavin are part of the respiratory coenzymes, so the body especially needs these substances in inflammatory diseases. Nicotinic acid stimulates metabolic processes at the cellular level. Folic acid is effective in severe forms of pneumonia.

To strengthen and restore the body, it is necessary not only to take vitamin supplements, but also to have a balanced diet.

• Fermented milk products are rich in organic calcium, which supports healthy functioning of the body.
• Particular attention should be paid to antioxidant products. For example, carrots nourish and strengthen lung tissue, broccoli enriches with plant proteins that participate in the construction of new pleural cells. Beets improve the drainage functions of the bronchi and activate gas exchange.
• Green leafy vegetables contain magnesium, which stabilizes the lungs and prevents their irritation. Garlic and onions contain phytoncides, which destroy pathogenic microorganisms.
• To clear phlegm, you need to add hawthorn and seaweed to your diet, as well as other foods with organic acids and iodine.
• Honey saturates the body with useful microelements, tones the bronchioles, accelerates the discharge of sputum, and prevents diseases of the respiratory system.
• Olive oil and other products with polyunsaturated fats support the normal functioning of the lungs and the entire body.

A balanced diet combined with regular intake of vitamins is an effective prevention of adhesive disease and any other disorders of the body.

Physiotherapy treatment

In addition to drug or surgical therapy, physiotherapy is used to combat adhesions in the lungs. Physiotherapeutic procedures have the following properties:

• Pronounced anti-inflammatory and anti-edematous effect.
• Improving blood circulation.
• Blood oxygen saturation.
• Activation of recovery processes in lung tissue.
• Resorption of inflammatory infiltrate.
• Restoration of the drainage function of the bronchi.
• Stretching of pleural adhesions.

Moulting is usually treated with the following physiotherapy methods:

• Paraffin and ozokerite applications.
• Electrophoresis with absorbable and analgesic drugs.
• Low frequency magnetic therapy.
• Enzyme therapy.
• Massage (vibration, manual).
• Sanatorium and resort treatment.

Physiotherapeutic procedures are contraindicated in oncological processes, the presence of effusion in the pleural cavity, purulent processes in the lungs, bronchial asthma, pneumothorax, emphysema. As well as in severe cardiovascular, renal and hepatic diseases.

Exercises for lung adhesions

To relieve painful symptoms of lung congestion, patients are prescribed special exercises. Physical exercise in combination with breathing exercises has the following properties:

• Decrease in body temperature.
• Increasing the elasticity of connective tissue adhesions.
• Reduction of exudate.
• Improving overall well-being.

The main goal of therapeutic gymnastics: improving blood and lymph circulation. This promotes the resorption and stretching of the moorings, eliminates the inflammatory process. Normal lung mobility and breathing are restored, the overall tone of the body increases.

Effective exercises for lung adhesions:

• Tilts of the body in different directions and circular rotations.
• Extension movements of the torso with raising of the arms.
• Swinging movements of the arms.
• Pull-ups and hanging on the horizontal bar.
• Raising arms to lung level with backward bends.

The therapeutic exercise complex is performed with breathing exercises that increase the mobility of the diaphragm, lungs and chest. Gymnastics promotes the divergence of fused pleural sheets and prevents adhesions.

Breathing exercises:

• Lying on your back, take a deep breath and use your hands to pull your right knee to your chest. Exhale slowly, returning your leg to its original position. Repeat with the other leg.
• In a standing position, place your hands on your shoulders. Take a deep breath and raise your hands up, and as you exhale, lower them onto your shoulders.
• In a sitting position, inhale and raise your arms to the sides, bending your back backwards as much as possible.
• Sitting on a chair, stretch your arms out in front of you. As you inhale, turn your body toward the healthy side, and as you exhale, return to the starting position.

Exercise therapy for adhesions in the lungs is not performed if there is severe pain. The duration and frequency of this therapy are individual for each patient.

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Folk remedies

Treatment of pulmonary adhesions by non-traditional methods has questionable effectiveness. Traditional treatment involves the use of herbal decoctions and infusions for oral administration and rubbing the chest. Special ointments and lotions can also be used.

Popular folk recipes:

• Combine two tablespoons of rose hips and dry nettle, add one spoon of lingonberry. Mix all ingredients thoroughly and pour 500 ml of boiling water. Let it brew for 2-3 hours, strain. Take ½ glass in the morning and before bed.
• Place a couple of tablespoons of flax seeds in a cloth handkerchief and dip it in boiling water. As soon as the water cools, take out the bag and apply it to your chest at night.
• Pour a glass of boiling water over a tablespoon of St. John's wort and simmer for 10-15 minutes. Strain and take ¼ glass 2-3 times a day.
• Take equal proportions of centaury, sweet clover, and coltsfoot. Mix thoroughly and pour a glass of boiling water over it. The drink should be infused in a thermos for 1-2 hours. It is recommended to take the medicine for 20-30 days, ¼ glass 3-5 times a day.

Before using the above recipes, you should consult with your doctor. It is also necessary to take into account that folk methods cannot act as a monotherapy for adhesive disease.

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Herbal treatment

One of the effective methods of treating connective tissue adhesions in the lungs is the use of medicinal plants. Herbs have a soft but persistent healing effect, have a minimum of contraindications and side effects.

Medicinal recipes:

• Take equal proportions of rose hips, raspberries and currants. Pour 500 ml of boiling water over the plant material and let it brew until it cools completely. Strain and take ½ cup 3-4 times a day.
• Chop one onion and boil it in sugar or honey syrup until transparent. Strain carefully and take a tablespoon throughout the day.
• Wash a couple of aloe leaves and grind them together with the skin until you get a mass of uniform consistency. Add 2-3 tablespoons of honey and 250 ml of the red kind to the aloe. Mix everything well and take 2-3 times a day, one tablespoon before meals.

Herbal treatment should be part of a comprehensive treatment for adhesive disease. Herbal treatment is contraindicated in the presence of multiple adhesions.

Homeopathy

Today, there are several effective methods for treating adhesive disease, but some patients with this diagnosis resort to using homeopathic medicines. Homeopathy for connective tissue adhesions in the lungs suggests using the following types of medicines:

• Bryonia – pain in the pleural cavity and shortness of breath. The drug is used orally, as well as in the form of an ointment for applications to the sternum.
• Apis is a complicated adhesive process with accumulation of exudate.
• Cantaria - severe respiratory failure, general weakness, shortness of breath, increased sweating.
• Ranunculus – sharp pains during breathing and active movements, general weakness.
• Silicea - cords resulting from pleurisy or pneumosclerosis, oxygen starvation.

All of the above medications should be taken only as prescribed by a doctor. A homeopath will prescribe the recommended dosage and introduce other features of using the medication.

Surgical treatment

If the adhesive disease is in the acute stage or has caused life-threatening complications, then surgical intervention may be prescribed. The type of surgery depends on the volume of connective tissue growths.

Separation of the adhesions from the pleura is decortication. The main indications for its implementation are:

• Hemothorax (spontaneous, traumatic).
• Formation of pleural pockets.
• Acute respiratory failure.
• Exudate and purulent processes.

When removing wide adhesions that occur after diffuse inflammatory processes, the thoracotomy method is used. In particularly severe cases, atypical access is used. Parietal adhesions narrow the intercostal space, so the surgical intervention is carried out using combined methods. The most difficult is the removal of adhesions around pleurobronchial fistulas.

The situation is much worse with the treatment of old pleural adhesions:

• The moorings support the lung in a state of collapse, which causes irreversible changes – deformation of large vessels and bronchi.
• With multiple adhesions or their deep growth into the lung tissue, prolonged air release from the damaged area is possible. Because of this, the organ does not straighten out, and the operated pleural cavity is exposed to infection and the formation of new scars.

In case of extensive lesions, pleuropneumonectomy is performed instead of decortication. The effectiveness of the surgical method becomes apparent at the time of the operation. The lung, freed from scars, straightens out and fills the free space in the chest cavity. Decortication has a high risk of life-threatening blood loss, so it is necessary to ensure continuous hemostasis and blood replacement.

In particularly severe cases, a lung transplant is performed. The operation is aimed at increasing the patient's life expectancy and improving its quality. Transplantation is performed in cases of acute respiratory failure, decreased diffusive capacity of the lungs and their vital capacity. During transplantation, either one or both organs can be replaced. After such treatment, the patient must take immunosuppressive drugs for life to eliminate the risk of implant rejection.