Emphysema of the lungs: symptoms
Last reviewed: 23.04.2024
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The main complaint of patients with emphysema is shortness of breath. At the onset of the disease, it occurs only with considerable physical exertion, then with progression, emphysema acquires a permanent character. With the development of bronchial obstruction, dyspnea becomes expiratory.
Dyspnea with primary emphysema differs from dyspnea with secondary emphysema. With the primary emphysema of the lungs, the character of breathing changes: the breath becomes deep, and the exhalation is prolonged, through closed lips. Patients tend to increase during exhalation the pressure in the airways, so on exhalation they cover their mouths and inflate their cheeks, which reduces the expiratory collapse of small bronchi. This type of breathing resembles puffing.
Cough is a characteristic symptom of primarily chronic obstructive bronchitis. Naturally, he continues to bother the patient even when chronic obstructive bronchitis is complicated by pulmonary emphysema. The cough is of a superficial, unproductive nature. At the onset of the development of primary diffuse emphysema, cough does not bother the patients. But, as was mentioned above, as the primary emphysema progresses, chronic bronchitis develops and a cough appears.
Skin color and visible mucous membranes, severity of cyanosis. In patients with primary pulmonary emphysema, the violation of the ventilation-perfusion ratio is not as pronounced as in secondary emphysema; in rest arterial hypoxemia is not observed. The patients develop hyperventilation, which contributes to blood arterialization. In this regard, patients with primary emphysema of light hypercapnia for a long time there, the skin and visible mucous membranes are more pink than cyanotic. Patients with primary emphysema are referred to as "pink puffers". However, as the reserve capabilities of the respiratory system deplete, alveolar hypoventilation occurs with arterial hypoxemia and hypercapnia, and pronounced cyanosis may appear.
For patients with secondary emphysema of the lungs (as complications of chronic bronchitis), diffuse cyanosis is very common. First it is noted in the distal parts of the limbs, then as the disease progresses and the development of hypercapnia and hypoxemia spreads to the face and mucous membranes.
With severe hypercapnia, a bluish shade of the tongue ("heath" tongue) appears in patients with secondary emphysema.
Loss of body weight. In patients with emphysema, a significant loss of body weight is noted. Patients thin, subtle, can generally look cachectic and hesitate to undress for medical examination. Expressed weight loss is probably associated with high energy costs for exercising hard work of the respiratory muscles.
Participation of auxiliary respiratory muscles in the act of breathing. When examining patients, one can see hyperfunctioning of the auxiliary respiratory muscles, abdominal muscles, upper shoulder girdle and neck.
Evaluation of the work of the auxiliary respiratory muscles is performed in the supine and sitting position. As the lung emphysema progresses, respiratory muscle becomes fatigued, patients can not lie (horizontal position causes intense diaphragm work) and prefer to sleep sitting.
Chest examination. When examining patients, "classical emphysema breast" is revealed. The thorax becomes barrel-shaped; The ribs assume a horizontal position, their mobility is limited; intercostal spaces widened; epigastric angle blunt; The shoulder girdle rises and the neck seems shortened; supraclavicular areas bulge.
Percussion and auscultation of the lungs. Percutaneous signs of pulmonary emphysema are the lowering of the lower border of the lungs, the limitation or total absence of mobility of the lower pulmonary margin, the expansion of the Kernig fields, the reduction of the boundaries of cardiac dullness (hyper-airy lungs cover the heart region); boxed percussion sound over the lungs.
A characteristic auscultatory sign of emphysema is a sharp weakening of vesicular breathing ("cotton breath"). The appearance of wheezing is not characteristic for emphysema of the lungs and indicates the presence of chronic bronchitis.
The state of the cardiovascular system. Characterized by a tendency to arterial hypotension, resulting in dizziness and fainting when getting out of bed. Fainting may occur during a cough due to increased intrathoracic pressure and a violation of venous return of blood to the heart. Pulse in patients often low in filling, rhythmic, cardiac arrhythmias are rare. The boundaries of the heart are difficult to determine, seem to be reduced. The heart sounds are sharply muffled, they are better listened to in the epigastric region. With the development of pulmonary hypertension, the emphasis is on the second tone on the pulmonary artery. The formation of a chronic pulmonary heart is especially characteristic of chronic obstructive bronchitis. In patients with primary pulmonary emphysema, the chronic pulmonary heart develops much later (usually already in the terminal stage).
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