Emphysema of the lungs - what are the symptoms of treatment. Medicine man's advice: treatment of emphysema

Pulmonary emphysema is a chronic disease that develops against the background of an obstructive lesion of the bronchial tree and is characterized by an irreversible expansion of the alveolar sacs with the destruction of their wall. Patients report shortness of breath and cough that is not treatable. Pathology is observed in 4% of the world's population. The main contingent of people suffering from emphysema is long-term smoking middle-aged men (30-60 years). Such a lung disease causes dangerous complications and disability, so it is very important to consult a doctor at the first symptoms for timely diagnosis and therapy.

The occurrence of pathology occurs due to the influence of 2 main reasons, presented:

1. Impaired elasticity and strength of the lung tissue:

• Congenital deficiency of alpha-1-antitrypsin (a substance that prevents the destruction of the walls of the alveoli by proteolytic enzymes).
• Congenital anomalies of the structure of the lungs.
• Inhalation of polluted air (toxic substances damage the vasculature and epithelium, causing inflammation and activating proteolytic enzymes).
• Dishormonal conditions (impaired estrogen-androgen balance leads to a decrease in the elasticity of small bronchi, which causes overstretching of their walls and leads to the formation of bronchiectasis).
• Infectious diseases (accumulated sputum stretches the alveoli, and the released enzymes contribute to the destruction of the walls).
• Degenerative changes (associated with poor blood supply).

2. Increased pulmonary pressure:

• Chronic obstructive pulmonary disease (COPD) develops due to incomplete ventilation of the alveoli.
• Occupational hazard is associated with a decrease in the elasticity of the alveoli and bronchi and a deterioration in their blood circulation.
• Obstruction of the pulmonary tree (foreign body, mucus). The air that has accumulated in the alveoli cannot escape. This phenomenon leads to acute emphysema.

According to doctors, it is impossible to determine the exact cause of emphysema. The development of this anomaly combines several provocative factors acting simultaneously.

Symptoms of pathology

The disease is characterized by polymorphism of manifestations, which can be described as follows:

1. Bluish or cyanotic color of the earlobes, nail phalanges, tip of the nose. Over time, due to hypoxia, blanching of the skin occurs.
2. Expiratory (on exhalation) shortness of breath. Characterized by a short inhalation and a stepped long exhalation. In the supine position, the symptom does not increase, in contrast to shortness of breath on the background of cardiovascular disorders.
3. Increasing the intensity of the auxiliary respiratory muscles (intercostal, diaphragm).
4. Overfilling of the veins of the neck (when coughing or exhaling, intrathoracic pressure increases).
5. At the time of coughing fits, the face becomes red, little sputum is separated. Such patients are called pink puffers.
6. Weight loss.
7. Hepatomegaly (enlarged liver) with prolapse. The reason is that the blood stagnates in the hepatic vasculature and the diaphragm descends for better ventilation of the lungs.
8. Changed appearance of the patient (with a chronic course). A short neck, a barrel-shaped chest, convex supraclavicular regions, fingers and nails in the form of drumsticks and watch glasses, respectively, are noted.

Disease classification

Depending on the time of occurrence, emphysema is divided into primary (it is an independent disease) and secondary (occurs with existing pathologies in the lung, which include COPD).

According to the prevalence of the process, there is localized and diffuse emphysema of the lungs.

Given the degree of violation of the acini (lungs), the following forms of the disease are called:

1. Panlobular (panacinar). The entire acinus is affected.
2. Centrilobular (centroacinar). Affected centers of acini and respiratory alveoli.
3. Perilobular (periacinar). The periphery of the acini is destroyed.
4. Peri-scarring (irregular / uneven).
5. Bullous (bullous formations are detected).

Vicarious emphysema of the lungs (observed in the organ preserved after removal, is a normal reaction of the body) belongs to a separate group.

Diagnostics

The algorithm for examining a patient for the presence of pulmonary emphysema is represented by the following steps:

• History of the disease (complaints, their onset, under what circumstances they arise, the presence of bad habits).
• Physical methods: percussion: by tapping the organ, changes in the pulmonary sound and a downward displacement of the lower border are determined; auscultatory: listening to the lungs, note weakened rapid breathing, the presence of dry rales and tachycardia.
• X-ray diagnostics. The method allows to identify the localization, prevalence and stage of the disease.
• MRI of the chest. With the help of this study, fluid, pathological foci and the condition of the bronchial tree are detected.
• CT of the lungs. This type of diagnosis makes it possible to determine the size, boundaries of pathological foci, dilated sections of the bronchi and blood vessels, airiness.
• The method of scintigraphy is carried out as a preoperative preparation, to exclude a tumor and determine vascular changes in the lung parenchyma.
• Spirogram. The study helps to identify violations of external respiration (the content of inhaled and exhaled air).
• Peakflowmetric diagnostics is used to determine the obstructive lesion of the bronchial tree.
• The gas composition of the blood is prescribed to detect hypoxia (lack of oxygen) and hypercapnia (increased carbon dioxide content).
• KLA (general blood test). With emphysema, there is an increase in red blood cells, hemoglobin, blood viscosity, but the ESR is reduced.

Treatment Methods

Medicines

To effectively combat emphysema, treatment with the following drugs is mandatory:

1. Bronchodilators (Atrovent, Salbutamol, Theophylline, Teopek). They are prescribed both in tablet forms and in the form of inhalers (severe stage of the disease).
2. Glucocorticosteroids ("Triamcinolone", "Prednisolone"). They have an anti-inflammatory effect, reduce the viscosity of mucus, relieve swelling of the bronchial mucosa.
3. Mucolytics ("Bromhexine", "ACC"). Provide liquefaction of sputum and facilitate its discharge.
4. Antitussives ("Tusuprex", "Libeksin").
5. Antibiotics ("Azithromycin", "Amoxicillin"). The use of these drugs is necessary in case of emphysema against the background of inflammatory lung diseases (pneumonia, bronchitis).
6. Multivitamin complexes ("Duovit", "Supradin").

Therapy with drugs should be carried out for at least 3-4 weeks without interruption.

Sulfur is used as homeopathy in various dilutions.

To enhance the effect of ongoing therapy, it is possible to use alternative methods.

Alternative Medicine Recipes

To treat emphysema at home, there are numerous remedies, the most effective of which are:

1. Honey-garlic infusion. Garlic (10 peeled and chopped heads) with honey (1 kilogram) and lemon (squeeze juice from 10 pieces) are mixed until a homogeneous consistency. Glassware and a dark place are necessary to store the mixture. After 7 days, the drug is taken orally 4 tablespoons a day.
2. Inhalations with honey-garlic infusion. Dilute soda in water and add the healing mixture. Pairs of garlic with honey improve sputum discharge, you can use propolis.
3. Juice of potato leaves. It is necessary to drink the drug on the first day, 0.5 tsp, with a daily increase in the dose by half a teaspoon. After 7 days, the total amount of the substance taken at a time should be 0.5 cups.
4. An infusion containing cumin and fennel - 1 tbsp. l. and field horsetail - 2 tbsp. l. Herbs insist on a glass of boiled water. You need to take the drug 3 times a day, 75 ml.
   Buckwheat (3 tablespoons) per 0.5 liters of boiled water. Warm infusion take half a glass 4 times a day.
5. Juniper fruits, dandelion root - 1 tbsp. l. and birch leaves -2 tbsp. l. for 200 ml of boiling water. The therapy is carried out 3 times a day for half a cup for 3 months.
6. Meadow sivets (20 g) and dried lemon balm (50 g) per 1000 ml of dry white wine. The mixture is infused for a day, shaking occasionally. You need to take the drug 2 times a day, 100 ml. Effective in exacerbations.
7. Collection of licorice rhizomes, sage leaves, pine buds, anise fruits and marshmallow root insist on a glass of boiling water and take 50 ml 4 times a day before meals.
8. Potato flowers (1 tablespoon) per 200 g of boiled water. Such an infusion should be drunk three times a day, 100 ml for a month and with attacks of shortness of breath.
9. Peppermint, eucalyptus, sage, elecampane, thyme (1 tablespoon of all components) pour a glass of boiled water and drink 3 times a day.

Treatment of emphysema with folk remedies is possible only after consulting a doctor.

Surgery

In the absence of the effect of conservative therapy, severe disease and massive damage to the lung tissue, surgical methods are used. Carry out the following operations:

1. Lung transplant (lobar or including heart). The procedure is indicated for patients with massive impairment and multiple bullae.
2. Excision of the affected area of ​​the lungs with the imposition of sealing sutures.
3. Thoracoscopic removal (minimally invasive: the ribs are not dissected) of a part of the lung.
4. Bronchoscopy. The method is the least invasive, possible when the affected areas are located near the large bronchi.

After surgical treatment, pulmonary ventilation is restored due to the lack of compression by the pathologically enlarged area. The period of postoperative rehabilitation lasts about 3 months.

Breathing exercises are also effective in the fight against emphysema. It helps to fight hypoxia at an early stage of the disease.

A patient with pulmonary emphysema should adhere to a special general strengthening and detoxifying diet, consisting of the following principles:

• you need to eat up to 6 times a day in small portions;
• per day it is recommended to consume up to 90 g of vegetable or animal (high-fat milk) fats;
• proteins in the daily diet should be at least 120 grams, half of which are of animal origin;
• the carbohydrate content should be 350-400 grams;
• fruits, vegetables and bran are also a necessary component of the diet;
• drink at least 2 liters of fluid per day;
• observe the salt regime (limit the amount of salt to 6 grams per day);
• it is necessary to exclude alcohol, fried meat, cooking fats, confectionery from consumption.

Prognosis of the disease and possible consequences

In the case of a stable uncomplicated course of emphysema, the outcome is favorable.

With severe lesions and the development of complications, the prognosis of the disease is less optimistic.

To determine life expectancy, it is necessary to take into account the patient's age, the presence of concomitant pathology and the degree of compensation of emphysematous lesions.

If the disease enters the stage of decompensation, then the following life-threatening complications may develop:

1. Pneumothorax (accumulation of air in the pleural cavity).
2. Bacterial infections (due to reduced immunity).
3. Right ventricular failure (with increased pulmonary pressure and the development of pneumosclerosis).

is a disease characterized by the expansion of the chest. The name of this chronic disease comes from the word emphysao - to inflate (Greek). As a result of the disease, the partitions between the alveoli are destroyed and the terminal branches of the bronchi expand. The lungs swell, their volume increases, air voids form in the tissue of the organ. This leads to the expansion of the chest, acquiring a characteristic barrel shape.

Mechanism of lung damage in emphysema:

Alveoli and bronchioles stretch, increase by 2 times.

The walls of blood vessels become thinner, stretching of smooth muscles occurs. Due to the desolation of the capillaries, nutrition in the acinus is disturbed.

Excess air in the alveolar lumen is not represented by oxygen, but by an exhaust gas mixture with a high content of carbon dioxide. Due to the decrease in the area of ​​formation of gas exchange between the blood and oxygen in the air, there is a lack of oxygen;

Healthy lung tissue is subjected to pressure from the expanded areas, the ventilation of this organ is disturbed with the appearance of shortness of breath and other symptoms of the disease.

Respiratory tract infections. When it occurs, or immunity stimulates the activity of protective cells: macrophages and lymphocytes. A side effect of this process is the dissolution of the protein in the walls of the alveoli. Additionally, sputum clots do not allow air to pass from the alveoli to the exit, which leads to tissue stretching and overflow of the alveolar sacs.

Increased pressure in the lungs:

• Occupational hazards. The costs of the profession of musicians of wind instruments, glassblowers - increased air pressure in the lungs. Prolonged exposure to these hazards leads to impaired blood circulation in the walls of the bronchi. Due to the weakness of smooth muscles, part of the air remains in the bronchi, the next portion is added to it when inhaling. This results in cavities.

  Chronic obstructive bronchitis. With this pathology, the patency of the bronchioles is impaired. When you exhale, the air is not completely expelled from the lungs. Because of this, both the alveoli and small bronchi are stretched, and over time, cavities appear in the tissues of the lung.

  Blockage of a foreign body in the lumen of the bronchi. Causes an acute form of emphysema, since the air from this segment of the lung cannot escape.

The exact cause of the appearance and development of this pathology has not yet been established. According to scientists, the appearance of emphysema is influenced by several factors.

Cyanosis - the tip of the nose, earlobes, nails become bluish. As the disease progresses, the skin and mucous membranes become pale. The reason is that small capillaries are not filled with blood, oxygen starvation is fixed.

Shortness of breath of an expiratory nature (with difficulty exhaling). Insignificant and imperceptible at the beginning of the disease, it progresses in the future. It is characterized by difficult, stepped exhalation and meek inhalation. Due to the accumulation of mucus, the exhalation is elongated and puffy. Differentiation from shortness of breath with - does not increase in the supine position.

Intensive work of the muscles that provide breathing. To ensure the work of the lungs during inhalation, the muscles that lower the diaphragm and raise the ribs are intensively tightened. On exhalation, the patient strains the abdominal muscles, raising the diaphragm.

Swelling of the neck veins. It occurs due to an increase in intrathoracic pressure during and exhalation. With emphysema complicated by heart failure, the jugular veins swell even when inhaled.

pinking complexion during a coughing fit. Due to this symptom, patients with emphysema have received the nickname "pink puffers". The amount of cough discharge is small.

Weight loss . The symptom is associated with excessive activity of the muscles that provide breathing.

An increase in the size of the liver, its omission. Occurs due to stagnation of blood in the vessels of the liver and omission of the diaphragm.

Appearance changes. Appear in patients with chronic emphysema of a long course. Signs: short neck, protruding supraclavicular fossae, barrel-shaped chest, sagging abdomen, intercostal spaces retracted during inspiration.

Types of emphysema

Emphysema is classified into several categories.

By the nature of the flow:

Acute. It can be caused by significant physical exertion, an attack of bronchial asthma, or the ingress of a foreign object into the bronchial network. There is swelling of the lung and hyperextension of the alveoli. The condition of acute emphysema is reversible, but requires emergency treatment.

Chronic. Changes in the lungs occur gradually, at an early stage, a complete cure can be achieved. Left untreated, it leads to disability.

Origin:

Primary emphysema. The origin is associated with the innate characteristics of the organism. It is an independent disease, diagnosed even in newborns and infants. Poorly treatable, progresses at an accelerated pace.

Secondary emphysema. The origin is associated with the presence of chronic obstructive pulmonary diseases. The appearance of the disease may go unnoticed, the intensification of symptoms leads to disability. If the disease is not treated, the size of the emerging cavities can be significant, occupying entire lobes of the lungs.

By prevalence:

diffuse form. Tissue damage and destruction of the alveoli occurs throughout the lung tissue. Severe forms of the disease can result in transplantation of a donor organ.

focal form. Changes in the parenchyma are diagnosed around the foci of tuberculosis, scars, the site of blockage of the bronchus. Symptoms of emphysema are less pronounced.

According to anatomical features, in relation to the acinus:

Panacinar (vesicular, hypertrophic) form. It is diagnosed in patients with severe emphysema. There is no inflammation, there is respiratory failure. There is no healthy tissue between damaged and swollen acini.

Centrilobular the form. Destructive processes affect the central part of the acinus. Due to the expansion of the lumen of the bronchi and alveoli, an inflammatory process develops, mucus is secreted in large quantities. Fibrous degeneration of the walls of damaged acini occurs. Intact parenchyma of the lungs between the areas that have undergone destruction, performs its functions without changes.

Periacinar (parasepital, distal, perilobular) form. It develops when, with this form, the extreme sections of the acinus near the pleura are affected. It can result in a complication - rupture of the affected area of ​​the lung (pneumothorax).

Peripheral form. It is characterized by minor symptoms, manifests itself near fibrous foci and scars in the lungs.

Near the pleura or throughout the parenchyma, bullae (bubbles) with a diameter of 0.5-20 cm are formed. They occur at the site of damaged alveoli. They can rupture, become infected, and compress surrounding tissues.

INSTRATIONAL(subcutaneous) form. Due to the rupture of the alveoli, air bubbles form under the skin. Through the lymphatic pathways and gaps between the tissues, they move under the skin of the head and neck. Due to the rupture of the bubbles remaining in the lungs, spontaneous pneumothorax can occur.

Due to occurrence:

Senile emphysema. It occurs due to age-related changes in the vessels, violations of the elasticity of the walls of the alveoli.

Lobar emphysema. It is observed in newborns, appears due to obstruction of one of their bronchi.

Bullous emphysema

Bullous emphysema is understood as a critical violation of the structure of the lung tissue, in which the destruction of the interalveolar septa occurs. In this case, one large cavity filled with air is formed. Bullous emphysema can occur against the background of general emphysema of the lungs, as one of the extreme degrees of its development, and can also develop against the background of healthy surrounding lung tissue. Such a bullous transformation is facilitated by the transferred inflammatory and suppurative processes in the lungs, especially with a chronic course (chronic, bronchiectasis, tuberculous foci). The mechanism of its appearance initially has a vicarious character of emphysema, which over time transforms into a bulla.

If bullous emphysema is represented by single bullae on the surface of the lungs, the person is usually unaware of its existence. It is not available for diagnosis even with x-ray examination. The situation is quite different with multiple bullae over the entire surface of the lung tissue. Such patients have all the symptoms of emphysema, including signs of respiratory failure of varying degrees.

The danger of bullous emphysema arises with a strong thinning of the surface shell of the bulla. In this case, the risk of its rupture is extremely high. This is possible with sudden changes in pressure in the chest (cough, physical stress). When a bulla ruptures, air from the lungs rapidly enters the pleural cavity. There is a dangerous condition called pneumothorax. In this case, the air accumulated in the pleural cavity creates high pressure, which compresses the affected lung. If the defect in the lung tissue is large enough, it is not able to close on its own, which leads to a continuous flow of air into the pleural cavity. When its level becomes critical, it begins to enter the mediastinum and subcutaneous tissue, which causes the development of subcutaneous and mediastinal emphysema. This is very dangerous, as it can result in decompensated respiratory failure and cardiac arrest.

Examination by a doctor

At the first symptoms or suspicion of emphysema, the patient is examined by a pulmonologist or therapist.

The examination is carried out according to the following scheme:

The first stage is the collection of anamnesis. Sample topics for questions to the patient:

• How long does the cough last?

  Does the patient smoke? If yes, how long, how many cigarettes does he use per day?

  Is there shortness of breath?

  How does the patient feel during increased physical activity;

Percussion - a special technique for tapping the chest with the fingers of the right hand through the palm of the left placed on the chest. Possible symptoms:

• Limited mobility of the lungs;

  "box" sound over areas of high airiness;

  Omission of the lower edge of the lungs;

  Difficulty in determining the boundaries of the heart.

Auscultation - listening to the chest with a phonendoscope. Possible manifestations of the disease:

• Strengthening exhalation;

  Muffled heart sounds due to absorption of sound by air-filled lung parenchyma;

  Weakened breathing;

  When bronchitis is attached - dry rales;

Emphysema symptoms:

Identification of the area of ​​expanded areas;

Fixing the size and location of bullae;

Vasodilation at the root of the lung;

The appearance of airborne areas.



A method for examining the lungs by introducing radioactive isotopes (technetium-99M) into them. The gamma camera, rotating around the patient, takes pictures of the organ.

Indications:

• Diagnosis of vessels at an early stage of development of emphysema;

  Preparation for surgery - assessment of the state of the surgical field;

  Suspicion of oncological lesions of the lung;

  Monitoring the effectiveness of conservative therapy.

Pregnancy is an absolute contraindication to the examination.

Emphysema symptoms:

blood flow disorders;

The appearance of areas of compression of the lung tissue.

Spirometry. A research method for studying the volume of external respiration, carried out using a spirometer. The device records the amount of air inhaled and exhaled by the patient.

Indications:

• Prolonged cough;

  respiratory pathology;

  Long experience as a smoker;

  Exposure to occupational hazards;

  Respiratory tract diseases (asthma, obstructive bronchitis, pneumosclerosis).

Contraindications:

Condition after a stroke and heart attack, operations on the chest and peritoneum;

Bloody sputum.

Symptoms of the disease:

Changes in vital and residual lung capacity;

Reduced ventilation and speed performance;

Increased airway resistance;

Decreased compliance of the lung parenchyma.

Peakflowmetry- measurement of maximum expiratory flow to determine bronchial obstruction. Method for determining bronchial obstruction. With the help of a peak flow meter, the expiratory rate is measured for 3 times before taking the medication. The disadvantage of the method is the impossibility of establishing a diagnosis of emphysema. The method determines diseases accompanied by obstruction of the lungs. There are no contraindications.

Determination of the gas composition of the blood. A method for studying the ratio of oxygen and carbon dioxide in the blood, for assessing the enrichment of arterial blood with oxygen and its purification from carbon dioxide. Blood taken from the cubital vein is placed in a syringe with heparin to prevent premature clotting.

Indications:

• Signs of lack of oxygen (cyanosis);

  Respiratory disorders in lung diseases.

Symptoms:

Blood oxygen less than 15%;

Oxygen tension less than 60-80 mm Hg;

Carbon dioxide voltage over 50 mm Hg.

ineffectiveness of outpatient treatment (deterioration of peak flow measurements).

Nutrition for emphysema (diet)

Diet No. 11 and No. 15 is aimed at strengthening the immune system, detoxifying the body and replenishing the patient's energy reserve.

Principles of dietary nutrition:

The caloric content of the daily diet is not less than 3500 kcal. Diet - 4-6 times a day a little.

The intake of fats is at least 80-90 g. It can be vegetable and butter, dairy products with a high fat content. The ratio of the proportion of animal fats to vegetable fats is 2:1.

Proteins are consumed in amounts up to 120 g per day. There must be at least half of animal products (eggs, meat of all varieties, sausages, sea and river fish, seafood, liver). Fried meat is excluded.

The amount of carbohydrates in the diet is from 350 to 400 g. These are cereals, bread, jam, honey, pasta.

Providing vitamins through the use of fresh fruits and vegetables, the introduction of bran into food.

Any drinks are allowed: juices, koumiss, rosehip compote.

Restriction of salt to 6 g for the prevention of edema and complications of cardiac activity.

The diet of patients with emphysema should not contain alcohol, cooking fats, confectionery products with a high fat content.

Emphysema is a complication of bronchopulmonary diseases. This means that the changes in the lung tissue that have arisen in this case are irreversible. All that remains is to slow the progression of the disease and reduce signs of respiratory failure by improving bronchial patency.

Therefore, the prognosis for emphysema depends on:

Timeliness and adequacy of treatment of the underlying disease;

An early and correct therapeutic approach to the treatment of emphysema;

duration of the disease.

In any case, it will not be possible to completely get rid of emphysema under any circumstances. But it is possible to influence the progression of the disease. If the underlying disease of the bronchopulmonary system that caused pulmonary emphysema is characterized by a relatively stable course, then the prognosis for maintaining emphysema at its minimum level is quite favorable. If you follow all the recommendations of specialists, then the signs of respiratory failure will be insignificant and a person will be able to live in his usual rhythm.

The prognosis in the case of decompensated bronchial diseases with severe emphysema is in any case unfavorable. Such people are forced to take expensive medications for life, which can only support the basic vital parameters of breathing. Significant improvements in quality of life are extremely rare. Life expectancy depends on the degree of compensation of the pathological process, age and regenerative resources of the body.

The consequences of emphysema

Complications of this disease can be fatal. Any symptoms indicating the appearance of complications are a signal for immediate medical attention.

Pneumothorax. In this case, the pleura sheet that protects the lung is torn. Air enters the pleural cavity, the lung collapses and can no longer expand. Fluid appears in the pleural cavity. The main ones are severe retrosternal pain, aggravated by inspiration, tachycardia, a feeling of panic. If you do not take immediate action within 4-5 days, surgery will be required to straighten the lung.

Development of bacterial infections. Due to reduced local immunity, the resistance of the lungs to infection decreases. Inflammation of the lungs and severe bronchitis become chronic. Symptoms: hyperthermia, cough with purulent discharge, weakness.

Right ventricular heart failure. The destruction of small capillaries leads to pulmonary hypertension - an increase in blood pressure. The increased load on the right parts of the heart leads to their rapid aging and deterioration. Death due to heart failure is one of the leading causes of death in emphysema. Symptoms such as the appearance of edema, swelling of the veins in the neck, pain in the heart and liver are a reason to immediately seek emergency help.

Emphysema has a favorable prognosis under the following conditions:

Prevention of lung infections;

Refusal of bad habits (smoking);

Ensuring a balanced diet;

Life in a clean air environment;

Sensitivity to drugs from the group of bronchodilators.

Education: Moscow Medical Institute. I. M. Sechenov, specialty - "Medicine" in 1991, in 1993 "Occupational diseases", in 1996 "Therapy".

Pulmonary emphysema is a disease that affects the respiratory tract, which is characterized by a pathological increase in the air space of the bronchioles, accompanied by changes in the walls of the alveoli of a destructive-morphological nature. Emphysema is one of the most common form of non-specific and chronic lung disease.

Factors that are responsible for the occurrence of emphysema are divided into 2 groups:

• Factors that violate the strength and elasticity of the lungs (deficiency of alpha-1-antitrypsin of an innate nature, tobacco smoke, nitrogen oxides, cadmium, dust particles in space). These factors cause primary emphysema, during which the pathological restructuring of the work of the respiratory section of the lungs begins. Due to these changes, during exhalation, the pressure on the small bronchi increases, which, under its influence, passively subside (merge and form bullae), thereby increasing the pressure in the alveoli. Increased pressure in the alveoli occurs due to increased bronchial resistance during exhalation. It should be noted that after such changes, the patency of the bronchi during inhalation of air is not impaired in any way.
• Factors that increase the stretching of the alveolar passages, alveoli and respiratory bronchioles (cause secondary emphysema). The most dangerous factor of occurrence is the presence of chronic obstructive bronchitis (bronchitis and asthma), even tuberculosis, which can develop due to long-term smoking, polluted air, the specifics of professional activity (this category includes builders, miners, workers in the metallurgical, pulp industry, coal miners, railroad workers, people involved in the processing of cotton and grain), adenoviruses and lack of vitamin C in the body.

Forms of emphysema:

1. 1 diffuse - there is complete damage to lung tissues;
2. 2 bullous - diseased (swollen) areas are located close to the healthy parts of the lungs.

Symptoms of emphysema:

• shortness of breath, suffocation;
• the chest takes the shape of a barrel;
• widened spaces between ribs;
• protrusion of the clavicles;
• swollen face (especially under the eyes and in the area of ​​​​the nose);
• cough with hard sputum, the strength of which increases with physical exertion;
• to facilitate breathing, the patient raises his shoulders, which gives the impression that he has a short neck;
• "pant";
• during the passage of the x-ray, the lung fields in the picture will be excessively transparent;
• weak, quiet breathing;
• inactive diaphragm;
• bluish nails, lips;
• thickening of the nail plate (nails eventually become like drumsticks);
• heart failure may occur.

With emphysema, you should be wary of any infectious diseases. So, because of the weakened broncho-pulmonary system, they can quickly develop into chronic ones. At the first symptoms of an infectious disease that appear, treatment should be started immediately.

Useful products for emphysema

1. 1 cereal crops;
2. 2 raw vegetables and fruits (especially seasonal) - zucchini, carrots, broccoli, pumpkin, tomatoes, sweet peppers, all leafy vegetables and citrus fruits;
3. 3 sugar and sweets must be replaced with dried fruits (prunes, figs, raisins, dried apricots);
4. 4 marine products;
5. 5 seriously ill patients need to adhere to a protein diet and focus on cottage cheese, legumes, lean meats and fish;
6. 6 herbal teas from currant, linden, dog rose, hawthorn.

Portions should not be large, it is better to eat less at a time, but more often. This is due to the fact that with an increase in lung volume, the volume of the stomach becomes smaller (therefore, eating a large amount of food will create discomfort in the abdomen).

Traditional medicine:

• Physiotherapy which improves lung function.
  Exercise 1- stand straight, put your feet shoulder-width apart, blow out your stomach and at the same time inhale. Put your hands in front of you, bend over and at the same time draw in your stomach and exhale.
  Exercise 2- lying on your back, put your hands on your stomach and inhale, hold your breath for a few seconds, then exhale deeply, while massaging your stomach.
  Exercise 3- rise, spread your legs shoulder-width apart, put your hands on your belt, take short, jerky exhalations.
  The duration of each exercise should be at least 5 minutes, the frequency of repetition should be 3 times a day.
• good respiratory trainer are hiking, skiing, swimming.
• Every morning you need rinse your nose cool water. It is very important to constantly breathe through the nose (it is strictly forbidden to switch to breathing through the mouth - heart failure may develop due to such actions).
• Oxygen therapy- inhalations with a high oxygen content, which can be done at home. You can use a simple substitute for these inhalations - the "grandmother's" method - boil potatoes in their skins and inhale its steam (you should be extremely careful not to get facial burns from hot steam).
• aromatherapy. Add a couple of drops of essential oil to water and heat in an aroma lamp. The steam that will appear must be inhaled by the patient. You can use oils of chamomile, lavender, eucalyptus, bergamot, frankincense. Repeat this procedure three times a day until the disease disappears.
• Drink decoctions and infusions from chamomile, coltsfoot, centaury, centipede leaf, from buckwheat and linden flowers, marshmallow and licorice roots, sage leaves, mint, anise fruits, flax seeds.
• Massage- helps to separate and expel mucus. The most effective is acupressure.

Before proceeding with treatment, the first step is to quit smoking!

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

One of the most insidious diseases of the respiratory system is emphysema, the prognosis of life in which is determined by the causes, nature and course of the pathology.

This disease is a chronic disease in which the alveoli cease to contract normally. Often harbingers of emphysema are diseases such as pneumonia and bronchitis.

The danger of pathology lies in the fact that it can develop for a long time without clear manifestations, both in an elderly person and in a newborn.

What is pulmonary emphysema?

Emphysema refers to COPD (chronic obstructive pulmonary disease). It is characterized by damage to the alveoli located in the cavity of the lungs and the endings of the bronchi involved in the process of breathing. When you inhale, the alveoli fill and swell, when you exhale, they return to their original position.

With emphysema, this process is disrupted, the air pressure in the alveoli increases, and the bubble-like formations are stretched.

When the alveoli cease to take part in the process of breathing, the entire respiratory system begins to suffer. Due to impaired gas exchange, the amount of air in the lungs increases, which leads to improper functioning of the organ.

Here it is important to see a doctor as soon as possible in order to prevent the development of complications and improve the prognosis of life.

Types of emphysema

There are two types of emphysema:

• diffuse. It is a lesion of the entire lung tissue. May be caused by allergic or obstructive bronchitis.
• Localized. It is characterized by damage not to all lungs, but to their individual sections. Often occurs against the background of congenital disorders.

There are also the following forms of emphysema:

Causes of emphysema

The disease can develop for the following reasons:

• Violation of microcirculation in the tissues of the lungs;
• The presence in the bronchi or alveoli of the inflammatory process;
• Bronchial asthma and other chronic obstructive pulmonary pathologies;
• Congenital deficiency of α-1 antitrypsin, due to which alveolar tissues begin to be destroyed by proteolytic enzymes;
• Smoking, including passive;
• The entry of toxic compounds into the lungs, for example, when working in industrial production.

These factors contribute to damage to the elastic tissue of the lungs, disruption of its ability to stretch and contract normally during breathing. With emphysema, small bronchial branches stick together, the lung tissue becomes stretched and swollen, bullae or air cysts form. Emphysematous lungs are enlarged and look like a porous sponge.

Signs of emphysema

Patients with diffuse emphysema may experience the following symptoms:

• Sudden weight loss;
• Protrusion of the supraclavicular fossae;
• Slouch;
• The presence of weakened, and in some places even absent breathing (detected when listening with a phonendoscope);
• The appearance of shortness of breath with any physical exertion;
• Sticky lungs (if the patient has swelling of the lung, it is customary to say that "the lung stuck together");
• Widened spaces between ribs;
• Barrel-shaped chest;
• The presence of air traps in the lungs.

In people with diffuse eczema, x-rays show a low-lying diaphragm and increased transparency of the lung area. Respiratory failure increases, the heart takes a more vertical position. In a localized type of disease, affected areas put pressure on healthy areas of the lungs. The result is the development of pronounced disorders, up to suffocation, and the prognosis of life deteriorates sharply.

When can you expect a favorable outcome?

With emphysema, the prognosis of life depends on the form of the pathology, the person's lifestyle.

Factors that prolong life with the disease:

• Timely diagnosis, early treatment;
• The course of emphysema in mild and moderate forms;
• To give up smoking;
• Compliance with a special diet.

If emphysema is bullous, life expectancy is short. If a patient with this disease manages to live more than four years from the moment the diagnosis was made, the outcome is considered favorable.

When is an unfavorable outcome possible?

The process of lung tissue change is irreversible and continuous. Eventually the disease affects the lungs completely. However, even in the most severe cases, patients with emphysema manage to live for more than a year.

To answer the question of how many people live with emphysema, you need to pay attention to the nature, course and causes of the disease. The most unfavorable outcome is primary pulmonary emphysema, which develops with congenital defects of the enzyme system.

Aggravating factors are cell damage from cigarette smoke, inhalation of industrial dust and toxic substances, especially if this occurs over several years and does not stop after diagnosis.

Early diagnosis of the disease and adequate therapy helps to delay death from emphysema. The situation is complicated by the fact that the disease does not manifest itself in any way for a long time, so its diagnosis occurs with significant damage to the lung tissue. The first signs of pathology (shortness of breath, cough) appear when the disease progresses.

Simply put, an unfavorable outcome is possible in the cases described below:

• With untimely treatment of emphysema;
• In people with congenital enzyme defects;
• If you have bad habits (smoking);
• If the patient is under the influence of dust and toxic substances.

Life expectancy for emphysema

Some people ask the question "What is this - mortality?". Mortality from emphysema or any other pathology is understood as the number of deaths caused by this disease.

Data on life expectancy and mortality in patients with emphysema are obtained from medical statistics, but they are limited. However, doctors do not advise drawing conclusions based on this information. The fact is that the dynamics of the development of emphysema is individual for each patient.

Life span depends on:

• General physical condition of the patient;
• Lifestyle;
• heredity;
• age;
• The presence of other systemic diseases, such as bronchial asthma, tuberculosis, chronic bronchitis.

If a person has several factors from the above list at once, it is possible to give an accurate and correct forecast of life expectancy only after a detailed examination.

At the same time, evaluation criteria cannot be dispensed with. To make a diagnosis, it is necessary to determine the severity of the pathological process. For this, attempts were made to standardize the stages of the disease. To do this, tests are used that evaluate a set of indicators: body mass index, exercise tolerance, the presence of shortness of breath, as well as the volume of air exhaled for a specific period of time.

• Very heavy;
• heavy;
• moderate;
• Light.

The more severe the form of pathology, the worse the prognosis of life.

If we consider a life expectancy of more than 4 years from the date of diagnosis as a relatively favorable diagnosis, the averaged and generalizing conclusions look like this:

• With a mild form of the disease, more than 80% of patients manage to live for more than 4 years;
• With moderate - up to 70%;
• In severe - up to 50%.

Treatment of emphysema

If you are wondering how to treat emphysema, it will be useful for you to know that the pathology is treated by giving up bad habits, following a special diet, oxygen therapy, massage and exercise therapy. Inhalation is also possible. The main thing in this case is to choose the right inhaler (this issue should be discussed with your doctor).

Medical treatment of emphysema is also practiced. The task of a specialist is to conduct a thorough examination and choose drugs that will help eliminate the symptoms of the disease.

When answering the question “How is emphysema treated?”, Do not forget about the possibility of using folk remedies. It is not worth practicing self-medication. Before taking any medication, you should consult with a pulmonologist and a therapist.

Complications of emphysema

In both adults and children, emphysema can lead to negative consequences in the form of:

• Pulmonary hypertension;
• failure;
• Oncology (cancer);
• Right heart failure and its consequences, such as hepatomegaly, edema of the lower extremities, ascites.

The most dangerous complication is spontaneous pneumothorax, which requires drainage of the pleural cavity and air aspiration.

Improving the prognosis of life in emphysema

To stop the development of the disease and stabilize the human condition, you should:

• Balance nutrition (include more vegetables, boiled fish and meat in food, reduce salt intake);
• Give up bad habits, such as alcohol abuse and smoking (tobacco smoke is the main destructive factor that destroys the lungs);
• Take daily walks in the fresh air;
• Avoid hypothermia, cold air and respiratory infections;
• Train the respiratory muscles 4 to 5 times a day for 15 minutes. (there is a special gymnastics for this).

Emphysema is a chronic and progressive disease. Prolonged inflammation and narrowing of the lumen of the respiratory tract leads to a decrease in the elasticity of the lung tissue. As for the prognosis of life with a disease, it depends on the form of the disease, the severity of its course and some other factors.

According to WHO, up to 4% of the population, mainly older men, suffer from emphysema (emphysao - “inflate”) - a pathological increase in lung volume. There are acute and chronic forms of pathology, as well as vicarious (focal, local) and diffuse emphysema. The disease occurs with impaired pulmonary ventilation and blood circulation in the respiratory system. Let's take a closer look at why emphysema appears, what it is and how to treat it.

What is pulmonary emphysema?

Emphysema (from the Greek emphysema - swelling) is a pathological change in the lung tissue, characterized by its increased airiness, due to the expansion of the alveoli and the destruction of the alveolar walls.

Pulmonary emphysema is a pathological condition that often develops in a variety of bronchopulmonary processes and is extremely important in pulmonology. The risk of developing the disease in some categories is higher than in other people:

• Congenital forms of pulmonary emphysema associated with a deficiency of whey protein are more often detected in residents of Northern Europe.
• Men get sick more often. Emphysema is found at autopsy in 60% of men and 30% of women.
• People who smoke are 15 times more likely to develop emphysema. Passive smoking is also dangerous.

Without treatment, changes in the lungs with emphysema can lead to disability and disability.

Causes leading to the development of emphysema

The likelihood of developing emphysema increases with the presence of the following factors:

• congenital deficiency of α-1 antitrypsin, leading to the destruction of alveolar lung tissue by proteolytic enzymes;
• inhalation of tobacco smoke, toxic substances and pollutants;
• violations of microcirculation in the tissues of the lungs;
• bronchial asthma and chronic obstructive pulmonary diseases;
• inflammatory processes in the respiratory bronchi and alveoli;
• features of professional activity associated with a constant increase in air pressure in the bronchi and alveolar tissue.

Under the influence of these factors, there is damage to the elastic tissue of the lungs, a decrease and loss of its ability to fill and collapse.

Emphysema can be considered as a professionally conditioned pathology. Often it is diagnosed in people who inhale various aerosols. The role of the etiological factor can be pulmonectomy (removal of one lung) or trauma. In children, the cause may lie in frequent inflammatory diseases of the lung tissue (pneumonia).

Mechanism of lung damage in emphysema:

1. Stretching of the bronchioles and alveoli - their size doubles.
2. Smooth muscles are stretched, and the walls of blood vessels become thinner. The capillaries become empty and nutrition in the acinus is disturbed.
3. Elastic fibers degenerate. In this case, the walls between the alveoli are destroyed and cavities are formed.
4. The area in which gas exchange between air and blood is reduced. The body is deficient in oxygen.
5. Expanded areas squeeze healthy lung tissue, which further disrupts the ventilation function of the lungs. Shortness of breath and other symptoms of emphysema appear.
6. To compensate and improve the respiratory function of the lungs, the respiratory muscles are actively involved.
7. The load on the pulmonary circulation increases - the vessels of the lungs overflow with blood. This causes disturbances in the work of the right heart.

Types of disease

There are the following types of emphysema:

1. Alveolar - caused by an increase in the volume of the alveoli;
2. Interstitial - develops as a result of the penetration of air particles into the interlobular connective tissue - interstitium;
3. Idiopathic or primary emphysema occurs without previous respiratory disease;
4. Obstructive or secondary emphysema is a complication of chronic obstructive bronchitis.

By the nature of the flow:

• Acute. It can be caused by significant physical exertion, an attack of bronchial asthma, or the ingress of a foreign object into the bronchial network. There is swelling of the lung and hyperextension of the alveoli. The condition of acute emphysema is reversible, but requires emergency treatment.
• Chronic emphysema. Changes in the lungs occur gradually, at an early stage, a complete cure can be achieved. Left untreated, it leads to disability.

According to anatomical features, there are:

• Panacinar (vesicular, hypertrophic) form. It is diagnosed in patients with severe emphysema. There is no inflammation, there is respiratory failure.
• Centrilobular shape. Due to the expansion of the lumen of the bronchi and alveoli, an inflammatory process develops, mucus is secreted in large quantities.
• Periacinar (parasepital, distal, perilobular) form. Develops with tuberculosis. It can result in a complication - rupture of the affected area of ​​the lung (pneumothorax).
• Peripheral form. It is characterized by minor symptoms, manifests itself near fibrous foci and scars in the lungs.
• Instantional (subcutaneous) form. Due to the rupture of the alveoli, air bubbles form under the skin.
• Bullous (bubbly) form. Near the pleura or throughout the parenchyma, bullae (bubbles) with a diameter of 0.5-20 cm are formed. They occur at the site of damaged alveoli. They can rupture, become infected, and compress surrounding tissues. Bullous emphysema, as a rule, develops as a result of loss of tissue elasticity. Treatment of emphysema begins with the elimination of the causes that provoke the disease.

Symptoms of emphysema

The symptoms of emphysema are numerous. Most of them are not specific and can be observed in other pathologies of the respiratory system. Subjective signs of emphysema include:

• unproductive cough;
• expiratory dyspnea;
• the appearance of dry wheezing;
• feeling of lack of air;
• weight loss
• a person has a strong and sudden pain syndrome in one of the halves of the chest or behind the sternum;
• tachycardia is observed when the rhythm of the heart muscle is disturbed with a lack of air.

Patients with emphysema mainly complain of shortness of breath and cough. Shortness of breath, gradually increasing, reflects the degree of respiratory failure. At first, it happens only with physical exertion, then it appears while walking, especially in cold, damp weather, and sharply increases after coughing attacks - the patient cannot "breathe". Shortness of breath with emphysema is unstable, changeable (“it doesn’t happen day after day”) - today it’s stronger, tomorrow it’s weaker.

A characteristic sign of emphysema is weight loss. This is due to the fatigue of the respiratory muscles, which work at full strength to facilitate exhalation. A pronounced decrease in body weight is an unfavorable sign of the development of the disease.

Noteworthy is the cyanotic color of the skin and mucous membranes, as well as a characteristic change in the fingers of the type of drumsticks.

People with chronic long-term emphysema of the lung develop external signs of the disease:

• short neck;
• expanded in the anteroposterior size (barrel-shaped) chest;
• supraclavicular fossae protrude;
• on inspiration, the intercostal spaces are drawn in due to the tension of the respiratory muscles;
• the abdomen is somewhat saggy as a result of the omission of the diaphragm.

Complications

The lack of oxygen in the blood and the unproductive increase in lung volume affect the entire body, but above all, the heart and nervous system.

1. An increased load on the heart is also a compensation reaction - the desire of the body to pump more blood due to tissue hypoxia.
2. Perhaps the occurrence of arrhythmias, acquired heart defects, ischemic disease - a symptom complex, known under the general name "cardiopulmonary insufficiency".
3. At the extreme stages of the disease, a lack of oxygen causes damage to nerve cells in the brain, which is manifested by a decrease in intelligence, sleep disturbance, and mental pathologies.

Diagnosis of the disease

At the first symptoms or suspicion of emphysema, the patient is examined by a pulmonologist or therapist. It is difficult to determine the presence of emphysema in the early stages. Often, patients go to the doctor already in the running process.

Diagnostics includes:

• blood test to diagnose emphysema
• detailed interview with the patient;
• examination of the skin and chest;
• percussion and auscultation of the lungs;
• determination of the boundaries of the heart;
• spirometry;
• survey radiography;
• CT or MRI;
• assessment of the gas composition of the blood.

X-ray examination of the chest organs is of great importance for the diagnosis of pulmonary emphysema. At the same time, expanded cavities are detected in various parts of the lungs. In addition, an increase in lung volume is determined, indirect evidence of which is the low position of the dome of the diaphragm and its flattening. Computed tomography also allows you to diagnose cavities in the lungs, as well as their increased airiness.

How to treat emphysema

There are no specific treatment programs for pulmonary emphysema, and those carried out do not differ significantly from those recommended in the group of patients with chronic obstructive pulmonary diseases.

In the treatment program for patients with emphysema, general measures that improve the quality of life of patients should come first.

The treatment of pulmonary emphysema pursues the following tasks:

• elimination of the main symptoms of the disease;
• improvement of the work of the heart;
• improvement of bronchial patency;
• ensuring normal blood oxygen saturation.

To alleviate acute conditions, drug therapy is used:

1. Eufillin to relieve an attack of shortness of breath. The drug is administered intravenously and relieves shortness of breath within a few minutes.
2. Prednisolone as a strong anti-inflammatory agent.
3. With mild or moderate respiratory failure, oxygen inhalations are used. However, here it is necessary to carefully select the concentration of oxygen, because this can both be beneficial and harmful.

All patients with emphysema are shown physical programs, especially chest massage, breathing exercises and teaching the patient kinesitherapy.

Is hospitalization required to treat emphysema? In most cases, patients with emphysema are treated at home. It is enough to take medication according to the scheme, stick to a diet and follow the doctor's recommendations.

Indications for hospitalization:

• a sharp increase in symptoms (shortness of breath at rest, severe weakness)
• the appearance of new signs of the disease (cyanosis, hemoptysis)
• ineffectiveness of the prescribed treatment (symptoms do not decrease, peak flow measurements worsen)
• severe comorbidities
• newly developed arrhythmias difficulty in establishing a diagnosis.

Emphysema has a favorable prognosis under the following conditions:

• Prevention of lung infections;
• Refusal of bad habits (smoking);
• Ensuring a balanced diet;
• Life in a clean air environment;
• Sensitivity to drugs from the group of bronchodilators.

Breathing exercises

In the treatment of emphysema, it is recommended to regularly carry out various breathing exercises in order to improve the exchange of oxygen in the lung cavity. The patient follows for 10 - 15 minutes. inhale the air deeply, then try to hold it as long as possible while exhaling with a gradual exhalation. This procedure is recommended to be carried out daily, at least 3 - 4 r. per day, in small sessions.

Massage for emphysema

Massage promotes sputum discharge and expansion of the bronchi. Classical, segmental and acupressure massage is used. It is believed that acupressure has the most pronounced bronchodilatory effect. Massage objective:

• prevent further development of the process;
• normalize respiratory function;
• reduce (eliminate) tissue hypoxia, cough;
• improve local ventilation of the lungs, metabolism and sleep of the patient.

exercise therapy

With emphysema, the respiratory muscles are in constant tone, so they quickly get tired. To prevent muscle strain, physiotherapy exercises have a good effect.

Oxygen inhalations

A long procedure (up to 18 hours in a row) of breathing through an oxygen mask. In severe cases, oxygen-helium mixtures are used.

Surgical treatment of emphysema

Surgical treatment of emphysema is not often required. It is necessary in the case when the lesions are significant and drug treatment does not reduce the symptoms of the disease. Indications for surgery:

• Multiple bullae (more than a third of the chest area);
• severe shortness of breath;
• Complications of the disease: oncological process, bloody sputum, infection.
• Frequent hospitalizations;
• The transition of the disease to a severe form.

A contraindication to the operation may be severe exhaustion, old age, chest deformity, asthma, pneumonia, in severe form.

Food

Compliance with the rational use of food in the treatment of emphysema plays an important role. It is recommended to eat as many fresh fruits and vegetables as possible, which contain a large amount of vitamins and trace elements useful for the body. Patients need to adhere to the use of low-calorie foods so as not to provoke a significant load on the functioning of the respiratory system.

Daily daily calorie content should not exceed more than 800 - 1000 kcal.

Fried and fatty foods that negatively affect the functioning of internal organs and systems should be excluded from the daily diet. It is recommended to increase the amount of fluid consumed to 1-1.5 liters. in a day.

In any case, you can not treat the disease yourself. If you suspect that you or your relative has pulmonary emphysema, you should immediately contact a specialist for timely diagnosis and treatment.

Forecast of life with emphysema

A complete cure for emphysema is impossible. A feature of the disease is its constant progression, even during treatment. With timely access to medical care and compliance with therapeutic measures, the disease can be somewhat slowed down, improve the quality of life, and also delay disability. With the development of emphysema against the background of a congenital defect of the enzyme system, the prognosis is usually unfavorable.

Even if the patient is given the most unfavorable prognosis due to the severity of the disease, he will still be able to live at least 12 months from the moment of diagnosis.

The duration of the patient's existence after diagnosing the disease is largely influenced by the following factors:

1. The general condition of the patient's body.
2. The emergence and development of such systemic ailments as bronchial asthma, chronic bronchitis, tuberculosis.
3. How the patient lives plays a big role. He leads an active mode of existence or he has low mobility. He observes a rational diet or eats food haphazardly.
4. An important role is given to the age of the patient: young people live longer after diagnosis than older people with the same severity of the disease.
5. If the disease has genetic roots, then the prognosis of life expectancy with pulmonary emphysema is determined by heredity.

Despite the fact that with emphysema, irreversible processes occur, the quality of life of patients can be improved by constantly using inhaled drugs.

Prevention

1. Anti-tobacco programs aimed at preventing children and adolescents from smoking, as well as at stopping smoking of people of any age, are of great preventive importance.
2. It is also necessary to treat lung diseases in time so that they do not become chronic.
3. It is important to observe patients with chronic respiratory diseases by a pulmonologist, conduct vaccines among the population, etc.