Emphysema - a disease of the airways characterized by high content of air.
There are vesicular (true) and other forms of (interstitial, vicar, senile, congenital localized E. l. Syndrome Mc Lauda, acute swelling of the lungs).
The prevalence of emphysema is more than 4%, it registers with the dead men in 6o%, women - in the band% of cases. The frequency of pulmonary emphysema significantly increased after 6o years. Emphysema is a chronic disease of the lungs.
On the origin of differentiated primary emphysema, in which bronchial obstruction is a complication, and the secondary (obstructive) emphysema, which complicates the course of chronic bronchitis.
Primary diffuse pulmonary emphysema
Etiology and pathogenesis of primary pulmonary emphysema
The cause of the disease is genetically based deficit alfa-t-antitrypsin and its deficiency caused by smoking, aggressive etiological factors, occupational hazard.
Smoking is one of the most aggressive factors in the development of chronic obstructive pulmonary disease in general and emphysema in particular. The development of emphysema in smokers due to the fact that tobacco smoke causes neutrophil migration to the terminal respiratory tract, which have a devastating effect on the elastic foundation of the alveoli.
In addition, chronic smoking of tobacco smoke resin is accumulated, and the formation of the lung alpha-t-antitrypsin is significantly reduced. Smoking also causes an imbalance in the oxidant / antioxidant with a predominance of oxidants, which has a damaging effect on the alveolar walls and promotes the development of emphysema.
It is still unclear why smoking causes the development of emphysema in only 10 - 15% of smokers. In addition to the deficiency of alpha-t-antitrypsin is likely to play a role of some unknown factors (possibly genetic) that predispose to the development of emphysema in smokers.
Exposure to aggressive environmental factors. Aggressive factors of environmental pollution (pollutants) not only cause damage to the respiratory tract, but the alveolar walls, contributing to the development of emphysema. Among these factors are the most important of sulfur dioxide and nitrogen are the main generators of thermal power stations and transport. In addition, a major role in the development of emphysema are black smoke and ozone. Elevated ozone concentrations are associated with the use of a fresco in the home (refrigerators, household sprays, perfumes, aerosol dosage forms). In hot weather, the atmosphere is photochemical reaction of nitrogen dioxide (a product of combustion of transport fuels) with ultraviolet light, ozone is formed, which causes the development of inflammation of the upper respiratory tract infections.
The mechanism of emphysema under the influence of prolonged exposure to atmospheric conditions is as follows:
direct damaging effects on the alveolar membrane
activation of proteolytic and antioxidant activity in the broncho-pulmonary system, which causes destruction of the elastic framework of the pulmonary alveoli increased production of mediators of inflammatory reactions - leukotrienes and cytokines damaging occupational hazards, the presence of persistent or recurrent infection bronhopullyunalnoy
Older people who have emphysema detected most often affects, as a rule, the simultaneous influence of several etiological factors over many years of life. In some cases, a role played by mechanical stretching of the lungs (the brass band musicians, glass blowers).
