Lungs ( lat. units h. pulmo), the most important organs of the respiratory system in humans, terrestrial animals and some fish. In mammals they are located in the chest. The right and left lungs occupy 4/5 in humans chest, tightly adjacent to its walls, leaving space only for the heart, large blood vessels, esophagus and trachea. Lungs are not the same: right lung more and consists of 3 lobes, the smaller left lung consists of 2 lobes. The weight of each lung ranges from 0.5-0.6 kg.

Each lung, right and left, is shaped like a cone with one side flattened and a rounded apex protruding above the first rib. The lower (diaphragmatic) surface of the lungs adjacent to the diaphragm is concave. Lateral surface lungs (costal) is adjacent to the ribs, the medial (mediastinal) surface of each lung has a depression corresponding to the heart and large vessels. On the mediastinal surface of each lung there are the lung gates, through which the roots pass lung chief bronchus, arteries and nerves, surrounded by connective tissue, emerge veins and lymphatic vessels.

Each lung has three edges: anterior, inferior and posterior. The anterior, sharp edge of the lung separates the costal and medial surfaces. On right lung this edge is directed almost vertically throughout. In the lower front part of the left lung there is a cardiac notch where the heart is located. Below the notch is the so-called tongue. A sharp lower edge separates the lower surface from the costal surface, the posterior edge is rounded. Each lung is divided into lobes by deep fissures: the right - into three, the left - into two. The oblique fissure runs almost identically on both lungs; it begins at the back at the level of the third thoracic vertebra and penetrates deep into the lung tissue, dividing it into 2 lobes, connected to each other only near the root. There is also a horizontal fissure on the right lung. It is less deep and shorter, departs from the oblique on the costal surface, goes forward almost horizontally at the level of the 4th rib to the anterior edge of the lung. Then she moves on to him medial surface. Ends anterior to the root. This fissure at the right lung separates middle share from the top.

Every lung is covered serosa- pleura. The pleura has two layers. One is tightly fused with the lung - the visceral pleura; the other is attached to the chest - the parietal, or parietal, pleura. Between both sheets there is a small pleural cavity filled with pleural fluid (about 1-2 ml), which facilitates the sliding of the pleural sheets during respiratory movements. Covering the lung on all sides, the visceral pleura at the root of the lung directly continues into the parietal pleura.

The lobes of the lungs are separate, anatomically distinct areas of the lung with a lobar bronchus that ventilates them. Consistency lung soft, elastic. The color of children's lungs is pale pink. In adults, the lung tissue gradually darkens, and signs appear closer to the surface. dark spots due to particles of coal and dust that are deposited in the connective tissue base of the lung.

Each segmental bronchus of the lung corresponds to a bronchopulmonary neurovascular complex. Segment - area lung tissue, having its own vessels and nerve fibers, it is ventilated by a separate bronchus. Each segment resembles a truncated cone, the apex of which is directed towards root of the lung. And the wide base is covered with visceral pleura. Pulmonary segments separated from each other by intersegmental septa, consisting of loose connective tissue in which intersegmental veins pass. Normally, the segments do not have clearly defined visible boundaries.

The segments are formed by pulmonary lobules separated by interlobular connective tissue septa. The number of lobules in one segment is about 80. The shape of the lobule resembles an irregular pyramid with a base diameter of 0.5-2 cm. The apex of the lobule includes a lobular bronchus, which branches into 3-7 terminal bronchioles with a diameter of 0.5 mm. Their mucous membrane is lined with single-layer ciliated epithelium, between the cells of which there are individual secretory cells (Clara), which are the source of restoration of the epithelium of the terminal bronchioles. The lamina propria of the mucous membrane is rich in elastic fibers, which pass into the elastic fibers of the respiratory department, due to which the bronchioles do not collapse.

The functional unit of the lung is the acinus. This is a system of branches of one terminal bronchiole, which is divided into 14-16 respiratory (respiratory) bronchioles, forming up to 1500 alveolar ducts, carrying up to 20 thousand alveolar sacs and alveoli. There are 16-18 acini in one pulmonary lobule. In humans, there are an average of 21 alveoli per alveolar tract. Externally, the alveoli look like irregularly shaped vesicles; they are separated by interalveolar septa 208 microns thick. Each septum is the wall of two alveoli, between which a dense network is located in the septum blood capillaries, elastic, reticular and collagen fibers and connective tissue cells.

The number of alveoli in both human lungs is 600-700 million, their total surface is 40-120 m2. The large surface area of ​​the alveoli promotes better gas exchange. On one side of this surface there is alveolar air, constantly renewed in its composition, on the other - blood continuously flowing through the vessels. Oxygen diffusion occurs through the extensive surface of the alveolar membrane and carbon dioxide. During physical work, when the alveoli stretch significantly during deep breaths, the size of the respiratory surface increases. The larger the total surface of the alveoli, the more intense the diffusion of gases.

The shape of the alveoli is polygonal, the entrance to the alveoli is rounded, due to the presence of elastic and reticular fibers. The interalveolar septa have pores through which the alveoli communicate with each other.

The alveoli are lined from the inside with two types of cells: respiratory alveolocytes (the majority of them) and granular cells (large alveolocytes). Respiratory alveolocytes line 97.5% of the surface of the alveoli. These are flattened cells with a thickness of 0.1-0.2 microns, they are in contact with each other and are located on their own basement membrane, facing the capillary. This structure promotes better gas exchange. The network of blood vessels entwining the alveoli contains several tens of cubic centimeters of blood. Red blood cells remain in the pulmonary vesicles for 0.75 s at rest, and when physical activity this time is significantly reduced. However, such a short time is enough for gas exchange.

Large alveolocytes produce lipoprotein surfactant, this film of surface-active lubricant of their surfactant is covered from the inside of the alveoli. Surfactant prevents the alveoli from collapsing during exhalation, helps remove foreign particles from the respiratory tract and has bactericidal activity. Large alveolocytes are also located on the basement membrane and are believed to be the source of restoration of the cellular lining of the alveoli. The alveoli are entwined with a dense network of reticular and collagen fibers and blood capillaries, which are adjacent to the basement membrane of the alveolocytes. Each capillary borders several alveoli, which facilitates gas exchange.

By alternately inhaling and exhaling, a person ventilates the lungs, maintaining a relatively constant gas composition in the alveoli. A person breathes atmospheric air with a high content of oxygen (20.9%) and a low content of carbon dioxide (0.03%), and exhales air in which there is 16.3% oxygen and 4% carbon dioxide.

The composition of alveolar air differs significantly from the composition of atmospheric, inhaled air. It contains less oxygen (14.2%). Nitrogen and inert gases that make up the air do not take part in respiration, and their content in inhaled, exhaled and alveolar air is almost the same. Exhaled air contains more oxygen than alveolar air because the alveolar air is mixed with air that is in the airways. When we breathe, we do not fully fill or empty our lungs. Even after the deepest exhalation, there is always about 1.5 liters of air left in the lungs. At rest, a person usually inhales and exhales about 0.5 liters of air. With a deep inhalation, a person can inhale an additional 3 liters of air, and with a deep exhalation, they can exhale an extra 1 liter of air. A value such as vital capacity (the maximum volume of air exhaled after the deepest inhalation) is an important anthropometric indicator. In men it is 3.5-4.5 liters, in women it is on average 25% less. Under the influence of training, lung volume increases to 6-7 liters.

Inhalation and exhalation are carried out by changing the volume of the chest due to contraction and relaxation of the respiratory muscles - the intercostal muscles and the diaphragm. When you inhale, the diaphragm flattens, lower sections the lungs passively follow it, the air pressure in the lungs becomes lower than atmospheric pressure and the air enters the bronchi and lungs through the trachea. When you exhale, the stomach retracts slightly, the curvature of the dome of the diaphragm increases, and the lungs push out air.

The lungs grow mainly due to an increase in the volume of the alveoli. In a newborn, the diameter of the alveoli is 0.07 mm, the diameter of the alveoli in an adult is 0.2 mm. In old age, the volume of the alveoli increases, their diameter reaches 0.3-0.35 mm. Increased growth of the lungs and differentiation of their individual elements occur before the age of 3. By the age of eight, the number of alveoli reaches the number of an adult. The alveoli grow especially vigorously after the age of 12. By the age of 12, the volume of the lungs increases 10 times compared to the volume of the lungs of a newborn, and by the end of puberty - 20 times (mainly due to an increase in the volume of the alveoli).

It is important to know what the lungs are, where they are located in a person, and what functions they perform. The respiratory organ is located in the chest in humans. The chest is one of the most interesting anatomical systems. The bronchi, heart, some other organs and large vessels are also located here. This system is formed by the ribs, spine, sternum and muscles. It reliably protects all important internal organs and, thanks to the pectoral muscles, ensures the uninterrupted functioning of the respiratory organ, which almost completely occupies the chest cavity. The respiratory organ expands and contracts several thousand times a day.

Where are a person's lungs located?

The lungs are a paired organ. Right and left lung play main role in the respiratory system. They distribute oxygen throughout the circulatory system, where it is absorbed by red blood cells. The work of the respiratory organ leads to the release of carbon dioxide from the blood, which breaks down into water and carbon dioxide.

Where are the lungs located? The lungs are located in the human chest and have a very complex connecting structure with the airways, circulatory systems, lymphatic vessels and nerves. All these systems are intertwined in an area called the “gate.” The pulmonary artery, main bronchus, branches of nerves, and bronchial artery are located here. The so-called “root” contains lymphatic vessels and pulmonary veins.

The lungs look like a vertically dissected cone. They have:

• one convex surface (costal, adjacent to the ribs);
• two convex surfaces (diaphragmatic, medial or median, separating the respiratory organ from the heart);
• interlobar surfaces.

The lungs are separated from the liver, spleen, colon, stomach and kidneys. The separation is carried out using a diaphragm. These internal organs border large vessels and the heart. They are limited from behind by the back.

The shape of the respiratory organ in humans depends on the anatomical features of the body. They can be narrow and elongated or short and wide. The shape and size of the organ also depend on the phase of breathing.

To better understand where and how exactly the lungs are located in the chest and how they border with other organs and blood vessels, you need to pay attention to the photos that are located in the medical literature.

The respiratory organ is covered with a serous membrane: smooth, shiny, moist. In medicine it is called pleura. The pleura in the region of the pulmonary root passes to the surface chest cavity and forms the so-called pleural sac.

Anatomy of the lungs

It is important to remember that the right and left lungs have their own anatomical features and are different from each other. First of all they have different quantities lobes (separation occurs due to the presence of so-called slits located on the surface of the organ).

On the right there are three lobes: lower; average; upper (in upper lobe there are oblique fissure, horizontal fissure, right lobar bronchi: upper, lower, middle).

In the left there are two lobes: the upper (here is the lingular bronchus, the carina of the trachea, the intermediate bronchus, the main bronchus, the left lobar bronchi - lower and upper, the oblique fissure, the cardiac notch, the uvula of the left lung) and the lower. The left one differs from the right one in its larger size and the presence of a tongue. Although according to such an indicator as volume, the right lung is larger than the left.
The base of the lungs rests on the diaphragm. The upper part of the respiratory organ is located in the area of ​​the collarbone.

The lungs and bronchi must be in close relationship. The work of some is impossible without the work of others. Each lung contains so-called bronchial segments. There are 10 of them in the right, and 8 in the left. Each segment contains several bronchial lobes. It is believed that there are only 1600 bronchial lobes in the human lungs (800 each in the right and left).

The bronchi branch (bronchioles form alveolar ducts and small alveoli, which form breathing tissue) and form a complexly woven network or bronchial tree, which supplies the circulatory systems with oxygen. The alveoli contribute to the fact that when exhaling, the human body releases carbon dioxide, and when inhaling, it is from them that oxygen enters the blood.

Interestingly, when you inhale, not all the alveoli are filled with oxygen, but only a small part of them. The other part is a kind of reserve that comes into play during physical activity or stressful situations. Maximum quantity The air that a person can inhale characterizes the vital capacity of the respiratory organ. It can range from 3.5 liters to 5 liters. In one breath, a person absorbs approximately 500 ml of air. This is called tidal volume. The vital capacity of the lungs and tidal volume are different for women and men.

The blood supply to this organ occurs through the pulmonary and bronchial vessels. Some perform the function of gas removal and gas exchange, others provide nutrition to the organ; these are the vessels of the small and large circle. The physiology of breathing will certainly be disrupted if the ventilation of the respiratory organ is disrupted or the speed of blood flow decreases or increases.

Lung functions

• normalization of blood pH;
• protection of the heart, for example from mechanical impact(when there is a blow to the chest, it is the lungs that suffer);
• protecting the body from various respiratory infections(parts of the lung secrete immunoglobulins and antimicrobial compounds);
• blood storage (this is a kind of blood reservoir human body, approximately 9% of the total blood volume is located here);
• creating voice sounds;
• thermoregulation.

The lungs are a very vulnerable organ. Its diseases are very common all over the world and there are a lot of them:

• COPD;
• asthma;
• bronchitis of different types and types;
• emphysema;
• cystic fibrosis;
• tuberculosis;
• pneumonia;
• sarcoidosis;
• pulmonary hypertension;
• pulmonary embolism, etc.

They can be triggered by various pathologies, gene diseases, and poor lifestyle choices. The lungs are very closely related to other organs found in the human body. It often happens that they suffer even if the main problem is related to a disease of another organ.

Sholokhova Olga Nikolaevna

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Human lungs and bronchi: where they are located, what they consist of and what functions they perform

Studying the structure of the human body is a difficult but interesting activity, because studying your own body helps you to know yourself, others and understand them.

A person cannot help but breathe. After a few seconds, his breathing repeats, then after a few more, again, again, and so on for the rest of his life. The respiratory organs are important for human life. Everyone needs to know where the bronchi and lungs are located in order to understand their feelings during a disease of the respiratory system.

Lungs: anatomical features

The structure of the lungs is quite simple; for each person they are approximately the same normally, only the size and shape may differ. If a person has an elongated chest, the lungs will also be elongated and vice versa.

This organ of the respiratory system is vital, as it is responsible for providing the entire body with oxygen and removing carbon dioxide. The lungs are a paired organ, but they are not symmetrical. Every person has one lung larger than the other. The right one is distinguished by its large size and 3 lobes, while the left one has only 2 lobes and is smaller in size. This is due to the location of the heart on the left side of the chest.

Where are the lungs located?

The location of the lungs is in the middle of the chest, they fit tightly to the heart muscle. In shape they resemble a truncated cone pointing upward. They are located next to the collarbones at the top, protruding slightly beyond them. Base paired organ falls on the diaphragm, which separates the chest and abdominal cavity. You can learn better about where exactly a person’s lungs are located by looking at photographs of them.

Structural elements of the lungs

This organ has only 3 important elements, without which the organ will not be able to perform its functions.

• Bronchi.
• Bronchioles.
• Alveoli.

To know where the bronchi are located in the body, you need to understand that they are an integral part of the lungs, therefore the bronchial tree is located in the same place as the lungs, in the middle of this organ.

Bronchi

The structure of the bronchi allows us to talk about them as a tree with branches. They look like an overgrown tree with small branches at the end of the crown. They continue the trachea, dividing into two main tubes, in diameter these are the widest passages of the bronchial tree for air.

When the bronchi branch, where are the small air passages located? Gradually, as they enter the lungs, the bronchi divide into 5 branches. The right section of the organ is divided into 3 branches, the left into 2. This corresponds to the lobes of the lungs. Then more branches occur, during which a decrease in the diameter of the bronchi occurs, the bronchi are divided into segmental ones, and then even smaller. This can be seen in the photo with the bronchi. There are 18 such segments in total, 8 on the left side and 10 on the right.

The walls of the bronchial tree consist of closed rings at its base. Inside, the walls of the human bronchi are covered with mucous membrane. When infection penetrates into the bronchi, the mucous membrane thickens and narrows in diameter. Such inflammatory process can reach a person's lungs.

Bronchioles

These air passages are formed at the ends of branched bronchi. The smallest bronchi, located separately in the lobes of the lung tissue, have a diameter of only 1 mm. Bronchioles are:

• end;
• respiratory.

This division depends on where the branch with the bronchioles is located in relation to the edges of the tree. At the ends of the bronchioles there is also their continuation - the acini.

The acini may also look like branches, but these branches are already independent and have alveoli on them - the smallest elements of the bronchial tree.

Alveoli

These elements are considered microscopic pulmonary vesicles, which directly perform the main function of the lungs - gas exchange. There are a lot of them in the lung tissue, so much they capture large area to deliver oxygen to humans.

The alveoli in the lungs and bronchi have very thin walls. When a person simply breathes, oxygen penetrates through these walls into the blood vessels. In the blood stream it is found by red blood cells, and with red blood cells it travels to all organs.

People don’t even think about the fact that if these alveoli were a little smaller, there would not be enough oxygen for the functioning of all organs. Due to their tiny size (0.3 mm in diameter), the alveoli cover an area of ​​80 square meters. Many people don’t even have housing with such space, but their lungs can accommodate it.

The membranes of the lungs

Each lung is carefully protected from the effects of pathological factors. From the outside they are protected by the pleura - this is a special two-layer membrane. It lies between the lung tissue and the chest. In the middle between these two layers a cavity is formed, which is filled with a special liquid. Such pleural sacs protect the lungs from inflammation and other pathological factors. If they become inflamed on their own, the disease is called pleurisy.

Volume of the main organ of the respiratory system

Located in the middle of the human body, near the heart, the lungs perform a series of important functions. We already know that they supply oxygen to all organs and tissues. In full, this happens simultaneously, but this organ also has the ability to store oxygen due to the alveoli located in it.

The lung capacity is 5000 ml - this is what they are designed for. When a person inhales, he does not use the full volume of his lungs. Typically, 400-500 ml are required for inhalation and exhalation. If a person wants to do deep breath, it uses approximately 2000 ml of air. After such inhalation and exhalation, a reserve of volume remains, which is called functional residual capacity. It is thanks to it that the required level of oxygen is constantly maintained in the alveoli.

Blood supply

Two types of blood circulate in the lungs: venous and arterial. This respiratory organ is very closely surrounded by blood vessels of different sizes. The most basic is the pulmonary artery, which then gradually divides into small vessels. At the end of the branching, capillaries are formed that entwine the alveoli. Very close contact and allows for gas exchange in the lungs. Arterial blood nourishes not only the lungs, but also the bronchi.

This main respiratory organ contains not only blood vessels, but also lymphatic vessels. In addition to the various branches in this organ, there are also branches nerve cells. They are very closely interconnected with blood vessels and bronchi. Nerves can create vascular-bronchial bundles in the bronchi and lungs. Because of this close relationship, doctors sometimes diagnose bronchospasm or pneumonia due to stress or another malfunction of the nervous system.

Additional functions of the respiratory organ

In addition to the well-known function of exchanging carbon dioxide for oxygen, the lungs also have additional features, due to their structure and structure.

Formation of the respiratory organ

The lungs are formed in the thorax of the embryo as early as 3 weeks of pregnancy. Already from the 4th week, bronchopulmonary kidneys gradually begin to form, from which 2 different organs are then formed. Closer to the 5th month, bronchioles and alveoli form. By the time of birth, the lungs and bronchi are already formed and have required quantity segments.

After birth, these organs continue to grow, and only by the age of 25 does the process of the appearance of new alveoli end. This is due to the constant need for oxygen for a growing organism.

While a person is alive, he breathes. What is breathing? These are processes that continuously supply all organs and tissues with oxygen and remove carbon dioxide from the body, which is formed as a result of the metabolic system. Performs these vital important processes which directly interacts with the cardiovascular system. To understand how gas exchange occurs in the human body, you should study the structure and functions of the lungs.

Why does a person breathe?

The only way to obtain oxygen is through breathing. It is not possible to hold it for a long time, since the body requires another portion. Why do we need oxygen at all? Without it, metabolism will not occur, the brain and all other human organs will not work. With the participation of oxygen they split nutrients, energy is released, and every cell is enriched with them. Breathing is commonly called gas exchange. And rightly so. After all, the peculiarities of the respiratory system are to take in oxygen from the air that enters the body and remove carbon dioxide.

What are human lungs

Their anatomy is quite complex and variable. This organ is paired. Its location is the chest cavity. The lungs are adjacent to the heart on both sides - right and left. Nature has made sure that both of these important organs are protected from compression, shock, etc. In front, the barrier to damage is in the back - spinal column, and on the sides are ribs.

The lungs are literally riddled with hundreds of branches of bronchi, with alveoli the size of a pinhead located at their ends. Them in the body healthy person there are up to 300 million pieces. Alveoli perform important role: they supply blood vessels with oxygen and, having a branched system, are able to provide a large area for gas exchange. Just imagine: they can cover the entire surface of a tennis court!

By appearance the lungs resemble semi-cones, the bases of which are adjacent to the diaphragm, and the apices with rounded ends protrude 2-3 cm above the collarbone. The human lungs are a rather unique organ. The anatomy of the right and left lobes is different. So, the first one is slightly larger in volume than the second one, while it is somewhat shorter and wider. Each half of the organ is covered with pleura, consisting of two layers: one is fused with the chest, the other with the surface of the lung. The outer pleura contains glandular cells that produce fluid into the pleural cavity.

The inner surface of each lung has a depression called the hilum. They include the bronchi, the base of which looks like a branching tree, and the pulmonary artery, and a pair of pulmonary veins emerge.

Human lungs. Their functions

Of course, there are no secondary organs in the human body. The lungs are also important in ensuring human life. What kind of work do they do?

• The main functions of the lungs are to carry out respiratory process. A person lives while he breathes. If the supply of oxygen to the body is cut off, death will occur.
• The work of the human lungs is to remove carbon dioxide, due to which the body maintains acid-base balance. Through these organs, a person gets rid of volatile substances: alcohol, ammonia, acetone, chloroform, ether.

• The functions of the human lungs do not end there. The paired organ is still involved in which comes into contact with air. As a result, an interesting chemical reaction occurs. Oxygen molecules in the air and carbon dioxide molecules in dirty blood change places, i.e. oxygen replaces carbon dioxide.
• The various functions of the lungs allow them to participate in the water exchange occurring in the body. Up to 20% of the liquid is removed through them.
• The lungs are active participants in the process of thermoregulation. They release 10% of their heat into the atmosphere when they exhale.
• Regulation is not complete without the participation of the lungs in this process.

How do the lungs work?

The functions of the human lungs are to transport the oxygen contained in the air into the blood, use it, and remove carbon dioxide from the body. The lungs are fairly large soft organs with spongy tissue. The inhaled air enters the air sacs. They are separated from each other by thin walls with capillaries.

There are only small cells between the blood and the air. Therefore, thin walls do not create obstacles for inhaled gases, which facilitates good passage through them. IN in this case The functions of the human lungs are to use necessary and remove unnecessary gases. Lung tissue is very elastic. When you inhale, the chest expands and the lungs increase in volume.

The windpipe, represented by the nose, pharynx, larynx, trachea, looks like a tube 10-15 cm long, divided into two parts called bronchi. Air passing through them enters the air sacs. And when you exhale, the volume of the lungs decreases, the chest decreases in size, and the pulmonary valve partially closes, which allows air to escape again. This is how human lungs work.

Their structure and functions are such that the capacity of this organ is measured by the amount of inhaled and exhaled air. So, for men it is equal to seven pints, for women - five. The lungs are never empty. The air remaining after exhalation is called residual air. When you inhale, it mixes with fresh air. Therefore, breathing is a conscious and at the same time unconscious process that occurs constantly. A person breathes when he sleeps, but he does not think about it. In this case, if you wish, you can interrupt your breathing for a short time. For example, while underwater.

Interesting facts about lung function

They are capable of pumping 10 thousand liters of inhaled air per day. But it is not always crystal clear. Along with oxygen, dust, many microbes and foreign particles enter our body. Therefore, the lungs perform the function of protection against all unwanted impurities in the air.

The walls of the bronchi have many tiny villi. They are needed to trap germs and dust. And the mucus, which is produced by the cells of the walls of the respiratory tract, lubricates these villi, and is then expelled when coughing.

It consists of organs and tissues that fully provide ventilation and respiration. The functions of the respiratory system lie in the implementation of gas exchange - the main link in metabolism. The latter is responsible only for pulmonary (external) respiration. It includes:

1. consisting of the nose and its cavity, larynx, trachea, bronchi.

The nose and its cavity heat, humidify and filter the inhaled air. Its cleansing is achieved through numerous hard hairs and goblet cells with cilia.

The larynx is located between the root of the tongue and the trachea. Its cavity is divided by the mucous membrane in the form of two folds. They are not completely fused in the middle. The gap between them is called the glottis.

The trachea originates from the larynx. In the chest it is divided into bronchi: right and left.

2. Lungs with densely branched vessels, bronchioles and alveolar sacs. They begin the gradual division of the main bronchi into small tubes called bronchioles. They make up the smallest structural lung elements- lobules.

The pulmonary artery carries blood from the right ventricle of the heart. It is divided into left and right. The branching of the arteries follows the bronchi, entwining the alveoli and forming small capillaries.

3. Musculoskeletal system, thanks to which a person is not limited in breathing movements.

These are the ribs, muscles, diaphragm. They monitor the integrity of the airways and maintain them during various postures and body movements. Muscles, contracting and relaxing, contribute to changes. The diaphragm is designed to separate the thoracic cavity from the abdominal cavity. It is the main muscle involved in normal inhalation.

A man breathes through his nose. Next, the air passes through the airways and enters the human lungs, the structure and functions of which ensure the further functioning of the respiratory system. This is a purely physiological factor. This type of breathing is called nasal breathing. In the cavity of this organ, heating, humidification and purification of the air occurs. If the nasal mucosa is irritated, the person sneezes and protective mucus begins to be released. Nasal breathing may be difficult. Then the air enters the throat through the mouth. Such breathing is said to be oral and, in fact, pathological. In this case, the functions of the nasal cavity are disrupted, which causes various diseases respiratory tract.

From the pharynx, air is directed to the larynx, which performs other functions besides conducting oxygen further into the respiratory tract, in particular, reflexogenic. If this organ is irritated, a cough or spasm appears. In addition, the larynx is involved in sound production. This is important for any person, since his communication with other people occurs through speech. They continue to heat and humidify the air, but this is not their main function. By performing certain work, they regulate the volume of air inhaled.

Respiratory system. Functions

The air around us contains oxygen, which can penetrate into our body through the skin. But its quantity is not enough to support life. This is why the respiratory system exists. Transportation of necessary substances and gases is carried out by circulatory system. The structure of the respiratory system is such that it is able to supply the body with oxygen and remove carbon dioxide from it. It performs the following functions:

• Regulates, conducts, humidifies and degreases the air, removes dust particles.
• Protects the respiratory tract from food particles.
• Carries air into the trachea from the larynx.
• Improves gas exchange between the lungs and blood.
• Transports venous blood to the lungs.
• Saturates blood with oxygen and removes carbon dioxide.
• Performs protective function.
• Detains and resolves blood clots, particles of foreign origin, emboli.
• Performs the metabolism of necessary substances.

An interesting fact is that with age there is a limitation functionality respiratory system. The level of ventilation of the lungs and the work of breathing decreases. The causes of such disorders can be various changes in the bones and muscles of a person. As a result, the shape of the chest changes and its mobility decreases. This leads to a decrease in the capabilities of the respiratory system.

Breathing phases

When you inhale, oxygen from the alveoli of the lungs enters the blood, namely the red blood cells. From here, on the contrary, carbon dioxide passes into the air, which contained oxygen. From the moment air enters until air leaves the lungs, its pressure in the organ increases, which stimulates the diffusion of gases.

When you exhale, a pressure greater than atmospheric pressure is created in the alveoli of the lungs. The diffusion of gases: carbon dioxide and oxygen begins to take place more actively.

Every time after exhalation there is a pause. This happens because there is no diffusion of gases, since the pressure of the air remaining in the lungs is insignificant, much lower than atmospheric pressure.

As long as I breathe, I live. Breathing process

• The baby in the womb receives oxygen through her blood, so the baby's lungs do not take part in the process; they are filled with fluid. When a baby is born and takes its first breath, the lungs begin to work. The structure and functions are such that they are able to provide the human body with oxygen and remove carbon dioxide.
• Signals about the amount of oxygen required in a specific period of time are given by the respiratory center, which is located in the brain. Thus, during sleep, much less oxygen is required than during working hours.
• The volume of air entering the lungs is regulated by messages sent by the brain.

• When this signal arrives, the diaphragm expands, which leads to stretching of the chest. This maximizes the volume that the lungs occupy when they expand during inhalation.
• During exhalation, the diaphragm and intercostal muscles relax, and the volume of the chest decreases. This causes air to be pushed out of the lungs.

Types of breathing

• Clavicular. When a person hunches, his shoulders are raised and his stomach is compressed. This indicates insufficient oxygen supply to the body.
• Chest breathing. It is characterized by expansion of the chest due to the intercostal muscles. Such functions help saturate the body with oxygen. This method, purely physiologically, is more suitable for pregnant women.
• Deep breathing fills the lower organs with air. Most often, athletes and men breathe this way. This method is convenient during physical activity.

It is not without reason that they say that breathing is a mirror of mental health. Thus, the psychiatrist Lowen noticed an amazing relationship between the nature and type of a person’s emotional disorder. In people prone to schizophrenia, breathing involves the upper chest. And a person with a neurotic type of character breathes more with his stomach. Usually people use mixed breathing, which involves both the chest and the diaphragm.

Lungs of people who smoke

Smoking causes severe damage to the organs. Tobacco smoke contains tar, nicotine and hydrogen cyanide. These harmful substances have the ability to settle on the lung tissue, resulting in the death of the organ epithelium. The lungs of a healthy person are not subject to such processes.

People who smoke have lungs that are dirty gray or black in color due to congestion. huge amount dead cells. But these are not all negative aspects. Lung functions are significantly reduced. Negative processes begin, leading to inflammation. As a result, a person suffers from chronic obstructive pulmonary diseases, which contribute to the development respiratory failure. It, in turn, causes numerous disorders that occur due to a lack of oxygen in the tissues of the body.

Social advertising constantly shows clips and pictures with the difference between the lungs of a healthy person and a smoker. And many people who have never picked up a cigarette breathe a sigh of relief. But you shouldn’t get your hopes up too much, thinking that the terrible sight that is the lungs of a smoker has nothing to do with you. What's interesting is what's special external differences at first glance no. Neither an x-ray nor conventional fluorography will show whether the person being examined smokes or not. Moreover, not a single pathologist can determine with absolute certainty whether a person was addicted to smoking during life until he detects typical signs: the condition of the bronchi, yellowing of the fingers, and so on. Why? It turns out that harmful substances floating in the polluted air of cities, entering our body, just like tobacco smoke, enter the lungs...

The structure and functions of this organ are designed to protect the body. It is known that toxins destroy lung tissue, which subsequently, due to the accumulation of dead cells, acquires a dark color.

Interesting things about breathing and the respiratory system

• The lungs are the size of a human palm.
• The volume of the paired organ is 5 liters. But it is not fully used. To ensure normal breathing, 0.5 liters is enough. The volume of residual air is one and a half liters. If you count, then exactly three liters of air volume are always in reserve.
• The older a person is, the less frequent his breathing. In one minute, a newborn inhales and exhales thirty-five times, a teenager twenty, an adult fifteen times.
• In one hour a person takes a thousand breaths, in a day - twenty-six thousand, in a year - nine million. Moreover, men and women do not breathe the same way. In one year, the former take 670 million inhalations and exhalations, and the latter - 746.
• In one minute, it is vital for a person to receive eight and a half liters of air volume.

Based on all of the above, we conclude: you need to take care of your lungs. If you have any doubts about the health of your respiratory system, consult your doctor.

Emphysema– a chronic lung disease characterized by the expansion of small bronchioles (the terminal branches of the bronchi) and the destruction of the partitions between the alveoli. The name of the disease comes from the Greek emphysao - to swell. Air-filled voids form in the lung tissue, and the organ itself swells and increases significantly in volume.

Manifestations of emphysema– shortness of breath, difficulty breathing, cough with a small amount of mucous sputum, signs of respiratory failure. Over time, the chest expands and takes on a characteristic barrel shape.

Reasons for development emphysema divided into two groups:

• Factors that impair the elasticity and strength of lung tissue are inhalation of polluted air, smoking, congenital deficiency of alpha-1-antitrypsin (a substance that stops the destruction of the walls of the alveoli).
• Factors that increase air pressure in the bronchi and alveoli are chronic obstructive bronchitis, blockage of the bronchus by a foreign body.

Prevalence of emphysema. 4% of the world's inhabitants have emphysema, many are unaware of it. It is more common in men aged 30 to 60 years and is associated with chronic bronchitis of a smoker.

Risk of developing the disease some categories are higher than other people:

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

Without treatment, changes in the lungs due to emphysema can lead to loss of ability to work and disability.

Anatomy of the lungs

Lungs– paired respiratory organs located in the chest. The lungs are separated from each other by the mediastinum. It consists of large vessels, nerves, trachea, and esophagus.

Each lung is surrounded by a two-layer membrane, the pleura. One of its layers fuses with the lung, and the other with the chest. Between the sheets of pleura there remains a space - the pleural cavity, in which there is a certain amount pleural fluid. This structure helps the lungs stretch during inhalation.

Due to anatomical features, the right lung is 10% larger than the left. Right lung consists of three lobes, and the left one of two. The lobes are divided into segments, which in turn are divided into secondary lobules. The latter consist of 10-15 acini.
The hilum of the lung is located on the inner surface. This is the place where the bronchi, artery, and veins enter the lung. Together they form the root of the lung.

Lung functions:

• ensure blood saturation with oxygen and removal of carbon dioxide
• participate in heat exchange due to liquid evaporation
• secrete immunoglobulin A and other substances to protect against infections
• participate in the transformation of the hormone angiotensin, which causes vasoconstriction

Structural elements of the lungs:

1. bronchi, through which air enters the lungs;
2. alveoli, where gas exchange occurs;
3. blood vessels that carry blood from the heart to the lungs and back to the heart;

1. Trachea and bronchi- called the respiratory tract.

   The trachea at the level of 4-5 vertebrae is divided into 2 bronchi - right and left. Each of the bronchi enters the lung and forms a bronchial tree there. The right and left are the bronchi of the 1st order; at the place of their branching, the bronchi of the 2nd order are formed. The smallest are bronchi of the 15th order.

   Small bronchi branch, forming 16-18 thin respiratory bronchioles. Alveolar ducts depart from each of them, ending in thin-walled vesicles - alveoli.

   Bronchial function– ensure the passage of air from the trachea to the alveoli and back.

   Structure of the bronchi.

   1. Cartilaginous base of the bronchi
      • large bronchi outside the lung consist of cartilaginous rings
      • large bronchi inside the lung - cartilaginous connections appear between the cartilaginous half-rings. Thus, the lattice structure of the bronchi is ensured.
      • small bronchi - cartilage looks like plates, the smaller the bronchus, the thinner the plates
      • the terminal small bronchi do not have cartilage. Their walls contain only elastic fibers and smooth muscles
   2. Muscle layer bronchi– smooth muscles are arranged circularly. They provide narrowing and expansion of the lumen of the bronchi. At the site of the branching of the bronchi there are special bundles of muscles that can completely block the entrance to the bronchus and cause its obstruction.
   3. ciliated epithelium, lining the lumen of the bronchi, performs a protective function - protects against airborne infections by drip. Small villi remove bacteria and small dust particles from distant bronchi into larger bronchi. From there they are removed when coughing.
   4. Lung glands
      • single-celled glands that secrete mucus
      • small lymph nodes connected to larger lymph nodes in the mediastinum and trachea.
2. Alveolus – a bubble in the lungs, entwined with a network of blood capillaries. The lungs contain more than 700 million alveoli. This structure allows you to increase the surface area in which gas exchange occurs. Atmospheric air enters the bubble through the bronchi. Through the thinnest wall, oxygen is absorbed into the blood, and carbon dioxide is released into the alveoli during exhalation.

   The area around the bronchiole is called the acinus. It resembles a bunch of grapes and consists of branches of the bronchioles, alveolar ducts and the alveoli themselves

3. Blood vessels . Blood enters the lungs from the right ventricle. It contains little oxygen and a lot of carbon dioxide. In the capillaries of the alveoli, the blood is enriched with oxygen and releases carbon dioxide. After this, it collects in the veins and enters the left atrium.

Causes of emphysema

The causes of emphysema are usually divided into two groups.

1. Impaired elasticity and strength of lung tissue:
   • Congenital α-1 antitrypsin deficiency. In people with this abnormality, proteolytic enzymes (whose function is to destroy bacteria) destroy the walls of the alveoli. While normally α-1 antitrypsin neutralizes these enzymes within a few tenths of a second after their release.
   • Birth defects lung tissue structure. Due to their structural features, the bronchioles collapse and the pressure in the alveoli increases.
   • Inhalation of polluted air: smog, tobacco smoke, coal dust, toxic substances. The most dangerous in this regard are cadmium, nitrogen and sulfur oxides emitted by thermal power plants and transport. Their tiny particles penetrate the bronchioles and are deposited on their walls. They damage the ciliated epithelium and blood vessels feeding the alveoli and also activate special cells alveolar macrophages.

     They help increase the level of neutrophil elastase, a proteolytic enzyme that destroys the walls of the alveoli.

   • Hormonal imbalance. An imbalance between androgens and estrogens impairs the ability of bronchiole smooth muscles to contract. This leads to stretching of the bronchioles and the formation of cavities without destruction of the alveoli.
   • Respiratory tract infections: chronic bronchitis, pneumonia . Immune cells, macrophages and lymphocytes, exhibit proteolytic activity: they produce enzymes that dissolve bacteria and the protein that makes up the walls of the alveoli.

     In addition, clots of sputum in the bronchi allow air into the alveoli, but do not release it in the opposite direction.

     This leads to overfilling and overstretching of the alveolar sacs.

   • Age-related changes associated with poor circulation. In addition, older people are more sensitive to toxic substances in the air. With bronchitis and pneumonia, lung tissue recovers worse.
2. Increased pressure in the lungs.
   • Chronic obstructive bronchitis. The patency of the small bronchi is impaired. When you exhale, air remains in them. With a new breath, a new portion of air enters, which leads to overstretching of the bronchioles and alveoli. Over time, disturbances occur in their walls, leading to the formation of cavities.
   • Occupational hazards. Glassblowers, wind players. A feature of these professions is an increase in air pressure in the lungs. The smooth muscles in the bronchi gradually weaken, and blood circulation in their walls is disrupted. When you exhale, all the air is not expelled; a new portion is added to it. A vicious circle develops, leading to the appearance of cavities.
   • Blockage of the lumen of the bronchus a foreign body leads to the fact that the air remaining in the segment of the lung cannot escape out. An acute form of emphysema develops.
   Scientists have not been able to establish the exact cause of the development of emphysema. They believe that the appearance of the disease is associated with a combination of several factors that simultaneously affect the body.

Mechanism of lung damage in emphysema

1. Stretching of bronchioles and alveoli - their size doubles.
2. Smooth muscles are stretched, and the walls of blood vessels become thinner. The capillaries become empty and the nutrition in the acinus is disrupted.
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 occurs between air and blood decreases. The body experiences oxygen deficiency.
5. The enlarged areas compress healthy lung tissue, further impairing 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 become overfilled with blood. This causes disturbances in the functioning of the right side of the heart.

Types of emphysema

There are several classifications of pulmonary emphysema.

According to the nature of the flow:

• Acute. It develops during an attack of bronchial asthma, a foreign object entering the bronchi, or sudden physical exertion. Accompanied by overstretching of the alveoli and swelling of the lung. This is a reversible condition but requires urgent medical attention.
• Chronic. Develops gradually. On early stage the changes are reversible. But without treatment, the disease progresses and can lead to disability.

By origin:

• Primary emphysema. An independent disease that develops in connection with congenital features body. It can even be diagnosed in infants. It progresses quickly and is more difficult to treat.
• Secondary emphysema. The disease occurs against the background of chronic obstructive pulmonary diseases. The onset often goes unnoticed, and symptoms intensify gradually, leading to decreased ability to work. Without treatment, large cavities appear that can occupy an entire lobe of the lung.

By prevalence:

• Diffuse form. The lung tissue is uniformly affected. Alveoli are destroyed throughout the lung tissue. At severe forms A lung transplant may be required.
• Focal form. Changes occur around tuberculosis foci, scars, in places where a blocked bronchus approaches. Manifestations of the disease are less pronounced.

By anatomical features, in relation to the acini:

• Panacinar emphysema(vesicular, hypertrophic). All acini in the lung lobe or the whole lung are damaged and swollen. There is no healthy tissue between them. Connective tissue does not grow in the lung. In most cases there are no signs of inflammation, but there are manifestations of respiratory failure. Formed in patients with severe emphysema.
• Centrilobular emphysema. Damage to individual alveoli in the central part of the acinus. The lumen of the bronchioles and alveoli expands, this is accompanied by inflammation and mucus secretion. On the walls of damaged acini develops fibrous tissue. Between the changed areas, the parenchyma (tissue) of the lungs remains intact and performs its function.
• Periacinar(distal, perilobular, paraseptal) - damage to the extreme parts of the acinus near the pleura. This form develops with tuberculosis and can lead to pneumothorax - rupture of the affected area of ​​the lung.
• Okolorubtsovaya– develops around scars and areas of fibrosis in the lungs. Symptoms of the disease are usually mild.
• Bullous(bubble) shape. In place of the destroyed alveoli, bubbles form, ranging in size from 0.5 to 20 cm or more. They can be located near the pleura or throughout the lung tissue, mainly in upper lobes. Bullae can become infected, compress surrounding tissue, or rupture.
• Interstitial(subcutaneous) - characterized by the appearance of air bubbles under the skin. The alveoli rupture, and air bubbles rise through the lymphatic and tissue gaps under the skin of the neck and head. Bubbles may remain in the lungs, and when they rupture, spontaneous pneumothorax occurs.

Due to the occurrence:

• Compensatory– develops after removal of one lobe of the lung. When healthy areas swell, trying to take up the vacant space. Enlarged alveoli are surrounded by healthy capillaries, and there is no inflammation in the bronchi. The respiratory function of the lungs does not improve.
• Senile– caused by age-related changes in the vessels of the lungs and the destruction of elastic fibers in the wall of the alveoli.
• Lobarnaya– occurs in newborns, more often boys. Its appearance is associated with obstruction of one of the bronchi.

Symptoms of emphysema

Diagnosis of emphysema

Examination by a doctor

If symptoms of pulmonary emphysema appear, consult a therapist or pulmonologist.

Instrumental methods for diagnosing pulmonary emphysema

1. Radiography– examination of the lung condition using x-rays, as a result of which an image is obtained on film (paper) internal organs. Overview shot The chest is made in a direct projection. This means that the patient faces the device during the shooting. An overview image allows you to identify pathological changes in the respiratory system and the extent of their distribution. If the image shows signs of illness, then a additional research: MRI, CT, spirometry, peak flowmetry.

   Indications:

   • Once a year as part of a preventive examination
   • prolonged cough
   • dyspnea
   • wheezing, pleural friction noise
   • decreased breathing
   • pneumothorax
   • suspected emphysema, chronic bronchitis, pneumonia, pulmonary tuberculosis
   Contraindications:
   • breastfeeding period
   Symptoms of pulmonary emphysema:
   • the lungs are enlarged, they compress the mediastinum and overlap each other
   • affected areas of the lung appear excessively transparent
   • expansion of intercostal spaces during active muscle work
   • the lower edge of the lungs is drooping
   • low aperture
   • reduction in the number of blood vessels
   • bullae and areas of tissue airing
2. Magnetic resonance imaging (MRI) of the lungs- a study of the lungs based on the resonant absorption of radio waves by hydrogen atoms in cells, and sensitive equipment records these changes. MRI of the lungs provides information about the condition of large bronchi, vessels, lymphoid tissue, the presence of fluid and focal formations in the lungs. Allows you to obtain sections 10 mm thick and view them from different positions. To study upper parts lungs and areas around the spine are injected intravenously contrast agent- gadolinium drug.

   Disadvantage: air prevents accurate visualization of small bronchi and alveoli, especially at the periphery of the lungs. Therefore, the cellular structure of the alveoli and the degree of destruction of the walls are not clearly visible.

   The procedure lasts 30-40 minutes. During this time, the patient must lie motionless in the tunnel magnetic tomograph. MRI does not involve radiation, so the study is permitted for pregnant and breastfeeding women.

   Indications:

   • there are symptoms of the disease, but no changes can be detected on an x-ray
   • tumors, cysts
   • suspicion of tuberculosis, sarcoidosis, in which small focal changes are formed
   • increase in intrathoracic lymph nodes
   • abnormal development of the bronchi, lungs and their vessels
   Contraindications:
   • presence of a pacemaker
   • metal implants, staples, fragments
   • mental illnesses that do not allow lying for a long time without moving
   • patient weight over 150 kg
   Symptoms of emphysema:
   • damage to alveolar capillaries at the site of destruction of lung tissue
   • circulatory disorders in small pulmonary vessels
   • signs of compression of healthy tissue by expanded areas of the lung
   • increase in pleural fluid volume
   • increase in the size of the affected lungs
   • cavities-bullae different sizes
   • low aperture
3. Computed tomography (CT) of the lungs allow you to obtain a layer-by-layer image of the structure of the lungs. CT is based on the absorption and reflection of X-rays by tissues. Based on the data obtained, the computer creates a layer-by-layer image with a thickness of 1mm-1cm. The study is informative on early stages diseases. When a contrast agent is administered, CT provides more complete information about the condition of the pulmonary vessels.

   During a CT scan of the lungs, the X-ray emitter rotates around the patient lying motionless. The scan lasts about 30 seconds. The doctor will ask you to hold your breath several times. The whole procedure takes no more than 20 minutes. Using computer processing, X-ray images obtained from different points, are summarized into a layer-by-layer image.

   Flaw– significant radiation exposure.

   Indications:

   • if symptoms are present, no changes are detected on the x-ray or they need to be clarified
   • diseases with the formation of foci or diffuse damage to the lung parenchyma
   • chronic bronchitis, emphysema
   • before bronchoscopy and lung biopsy
   • decision on the operation
   Contraindications:
   • allergy to contrast agent
   • extremely serious condition patient
   • severe diabetes mellitus
   • renal failure
   • pregnancy
   • patient weight exceeding the capabilities of the device
   Symptoms of emphysema:
   • an increase in the optical density of the lung to -860-940 HU – these are airy areas of the lung
   • expansion of the roots of the lungs - large vessels entering the lung
   • dilated cells are noticeable - areas of alveolar fusion
   • reveals the size and location of bullae
4. Lung scintigraphy – injection of labeled radioactive isotopes into the lungs, followed by a series of images taken with a rotating gamma camera. Preparations of technetium - 99 M are administered intravenously or in the form of an aerosol.

   The patient is placed on a table around which the sensor rotates.

   Indications:

   • early diagnosis vascular changes in emphysema
   • monitoring the effectiveness of treatment
   • assessment of lung condition before surgery
   • suspicion of oncological diseases lungs
   Contraindications:
   • pregnancy
   Symptoms of emphysema:
   • compression of lung tissue
   • disturbance of blood flow in small capillaries


5. Spirometry – functional examination of the lungs, volume study external respiration. The procedure is carried out using a spirometer device, which records the amount of air inhaled and exhaled.

   The patient puts into his mouth a mouthpiece connected to a breathing tube with a sensor. A clamp is placed on the nose to block nasal breathing. The specialist explains what breath tests must be completed. And an electronic device converts the sensor readings into digital data.

   Indications:

   • breathing disorder
   • chronic cough
   • occupational hazards (coal dust, paint, asbestos)
   • smoking experience over 25 years
   • lung diseases (bronchial asthma, pneumosclerosis, chronic obstructive pulmonary disease)
   Contraindications:
   • tuberculosis
   • pneumothorax
   • hemoptysis
   • recent heart attack, stroke, abdominal or chest surgery
   Symptoms of emphysema:
   • increase in total lung capacity
   • increase in residual volume
   • decreased vital capacity of the lungs
   • reduction in maximum ventilation
   • increased resistance in the airways during exhalation
   • reduction in speed indicators
   • decreased compliance of lung tissue
   With pulmonary emphysema, these indicators are reduced by 20-30%
6. Peak flowmetry - measurement of maximum expiratory flow to determine bronchial obstruction.

   Determined using a device - a peak flow meter. The patient needs to tightly clasp the mouthpiece with his lips and exhale as quickly and forcefully as possible through his mouth. The procedure is repeated 3 times with an interval of 1-2 minutes.

   It is advisable to carry out peak flowmetry in the morning and evening at the same time before taking medications.

   Disadvantage: the study cannot confirm the diagnosis of pulmonary emphysema. The exhalation rate decreases not only with emphysema, but also with bronchial asthma, pre-asthma, and chronic obstructive pulmonary disease.

   Indications:

   • any diseases accompanied by bronchial obstruction
   • evaluation of treatment results
   Contraindications does not exist.

   Symptoms of emphysema:

   • reduction in expiratory flow by 20%
7. Definition gas composition blood - study arterial blood during which the pressure in the blood of oxygen and carbon dioxide and their percentage, the acid-base balance of the blood are determined. The results show how effectively the blood in the lungs is cleared of carbon dioxide and enriched with oxygen. For research, a puncture of the ulnar artery is usually done. A blood sample is taken from a heparin syringe, placed on ice, and sent to the laboratory.

   Indications:

   • cyanosis and other signs oxygen starvation
   • breathing disorders due to asthma, chronic obstructive pulmonary disease, emphysema
   Symptoms:
   • oxygen tension in arterial blood is below 60-80 mmHg. st
   • blood oxygen percentage less than 15%
   • increase in carbon dioxide tension in arterial blood over 50 mmHg. st
8. General blood test – a study that includes counting blood cells and studying their characteristics. For analysis, blood is taken from a finger or from a vein.

   Indications- any diseases.

   Contraindications does not exist.

   Deviations for emphysema:

   • increased number of red blood cells over 5 10 12 / l
   • increased hemoglobin level over 175 g/l
   • increase in hematocrit over 47%
   • decreased erythrocyte sedimentation rate 0 mm/hour
   • increased blood viscosity: in men over 5 cP, in women over 5.5 cP

Treatment of emphysema

Treatment of pulmonary emphysema has several directions:

• improving the quality of life of patients - eliminating shortness of breath and weakness
• prevention of the development of heart and respiratory failure
• slowing the progression of the disease

Treatment of emphysema necessarily includes:

• complete cessation of smoking
• physical exercise to improve lung ventilation
• taking medications to improve the condition of the respiratory tract
• treatment of the pathology that caused the development of emphysema

Treatment of emphysema with medications

Group of drugs	Representatives	Mechanism therapeutic effect	Directions for use
α1-antitrypsin inhibitors	Prolastin	The introduction of this protein reduces the level of enzymes that destroy the connective fibers of lung tissue.	Intravenous injection at the rate of 60 mg/kg body weight. 1 time per week.
Mucolytic drugs	Acetylcysteine ​​(ACC)	Improves the removal of mucus from the bronchi, has antioxidant properties - reduces the production free radicals. Protects the lungs from bacterial infection.	Take 200-300 mg orally 2 times a day.
	Lazolvan	Liquefies mucus. Improves its removal from the bronchi. Reduces cough.	Used orally or inhaled. Orally during meals, 30 mg 2-3 times a day. In the form of inhalations using a nebulizer, 15-22.5 mg, 1-2 times a day.
Antioxidants	Vitamin E	Improves metabolism and nutrition in lung tissues. Slows down the process of destruction of the walls of the alveoli. Regulates the synthesis of proteins and elastic fibers.	Take 1 capsule per day orally. Take courses for 2-4 weeks.
Bronchodilators (bronchodilators) Phosphodiesterase inhibitors Anticholinergics	Teopek	Relaxes the smooth muscles of the bronchi, helps to expand their lumen. Reduces swelling of the bronchial mucosa.	The first two days take half a tablet 1-2 times a day. Subsequently, the dose is increased - 1 tablet (0.3 g) 2 times a day every 12 hours. Take after meals. The course is 2-3 months.
	Atrovent	Blocks acetylcholine receptors in the bronchial muscles and prevents their spasm. Improves external respiration indicators.	In the form of inhalations, 1-2 ml 3 times a day. For inhalation in a nebulizer, the drug is mixed with saline solution.
Theophyllines	Long-acting theophylline	It has a bronchodilator effect, reducing systemic pulmonary hypertension. Increases diuresis. Reduces fatigue of the respiratory muscles.	The initial dose is 400 mg/day. Every 3 days it can be increased by 100 mg until the required therapeutic effect appears. Maximum dose 900 mg/day.
Glucocorticosteroids	Prednisolone	Has a strong anti-inflammatory effect on the lungs. Promotes the expansion of bronchi.	Used when bronchodilator therapy is ineffective. At a dose of 15–20 mg per day. Course 3-4 days.

Therapeutic measures for emphysema

1. Transcutaneous electrical stimulation diaphragm and intercostal muscles. Electrical stimulation with pulsed currents with a frequency of 5 to 150 Hz is aimed at facilitating exhalation. At the same time, the energy supply to the muscles, blood and lymph circulation improves. In this way, fatigue of the respiratory muscles, followed by respiratory failure, is avoided. During the procedure, painless muscle contractions occur. The current strength is dosed individually. The number of procedures is 10-15 per course.
2. Oxygen inhalation. Inhalation is carried out for a long time, 18 hours a day. In this case, oxygen is supplied to the mask at a rate of 2–5 liters per minute. In case of severe respiratory failure, helium-oxygen mixtures are used for inhalation.
3. Breathing exercises- training of the respiratory muscles, aimed at strengthening and coordinating the muscles during breathing. All exercises are repeated 4 times a day for 15 minutes.
   • Exhale with resistance. Exhale slowly through a cocktail straw into a glass filled with water. Repeat 15-20 times.
   • Diaphragmatic breathing. On the count of 1-2-3, take a strong, deep breath, drawing in your stomach. On the count of 4, exhale - inflating your stomach. Then tense your abdominal muscles and cough loudly. This exercise helps to expel mucus.
   • Lying push-up. Lying on your back, bend your legs and clasp your knees with your hands. As you inhale, draw in lungs full of air. As you exhale, stick your stomach out (diaphragmatic exhalation). Straighten your legs. Tighten your abs and cough.

When is surgery needed for emphysema?

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

Indications for surgery for emphysema:

• shortness of breath leading to disability
• bullae occupying more than 1/3 of the chest
• complications of emphysema - hemoptysis, cancer, infection, pneumothorax
• multiple bullae
• permanent hospitalizations
• diagnosis of severe pulmonary emphysema

Contraindications:

• inflammatory process – bronchitis, pneumonia
• asthma
• exhaustion
• severe chest deformity
• age over 70 years

Types of operations for emphysema

1. Lung transplant and its variants: lung transplantation together with a heart; transplantation of a lung lobe. Transplantation is performed in case of large diffuse lesions or multiple large bullae. The goal is to replace the diseased lung with a healthy donor organ. However, the waiting list for transplantation is usually too long and problems with organ rejection may arise. Therefore, such operations are resorted to only as a last resort.


2. Reduced lung volume. The surgeon removes the most damaged areas, approximately 20-25% of the lung. At the same time, the function of the remaining part of the lung and respiratory muscles improves. The lung is not compressed, its ventilation is restored. The operation is performed in one of three ways.

Opening the chest. The doctor removes the affected lobe and places stitches to seal the lung. Then a suture is placed on the chest.

3. Minimally invasive technique (thoracoscopy) under the control of video equipment. 3 small incisions are made between the ribs. A mini-video camera is inserted into one, and surgical instruments are inserted into the others. The affected area is removed through these incisions.
4. Bronchoscopic surgery. A bronchoscope with surgical equipment is inserted through the mouth. The damaged area is removed through the lumen of the bronchus. Such an operation is possible only if the affected area is located near large bronchi.

Postoperative period lasts about 14 days. Significant improvement is observed after 3 months. Shortness of breath returns after 7 years.

Is hospitalization necessary to treat emphysema?

In most cases, patients with emphysema are treated at home. It is enough to take medications according to the schedule, follow a diet and follow the doctor’s recommendations.

Indications for hospitalization:

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

Nutrition for emphysema (diet).

Therapeutic nutrition for pulmonary emphysema is aimed at combating intoxication, strengthening the immune system and replenishing the patient’s high energy costs. Diets No. 11 and No. 15 are recommended.

Basic principles of diet for emphysema

1. Increasing calorie content to 3500 kcal. Meals 4-6 times a day in small portions.
2. Proteins up to 120 g per day. More than half of them must be of animal origin: animal and poultry meat, liver, sausages, fish of any kind and seafood, eggs, dairy products. Meat in any culinary preparation, excluding excessive frying.
All complications of pulmonary emphysema are life-threatening. Therefore, if any new symptoms appear, you should urgently seek help. medical care.

• Pneumothorax. Rupture of the pleura surrounding the lung. In this case, air escapes into the pleural cavity. The lung collapses and becomes unable to expand. Around him in pleural cavity Liquid accumulates and needs to be removed. Appears severe pain in the chest, worsening with inhalation, panic, rapid heartbeat, the patient takes a forced position. Treatment must be started immediately. If the lung does not expand within 4-5 days, surgery will be required.
• Infectious complications. Decreased local immunity increases the sensitivity of the lungs to bacterial infections. Severe bronchitis and pneumonia often develop, which become chronic. Symptoms: cough with purulent sputum, fever, weakness.
• Right ventricular heart failure. The disappearance of small capillaries leads to an increase in blood pressure in the vessels of the lungs - pulmonary hypertension. The load on the right parts of the heart increases, which become overstretched and wear out. Heart failure is the leading cause of death in patients with emphysema. Therefore, at the first signs of its development (swelling of the neck veins, pain in the heart and liver, swelling), it is necessary to call an ambulance.

The prognosis for pulmonary emphysema is favorable under a number of conditions:

• complete cessation of smoking
• prevention frequent infections
• clean air, no smog
• good nutrition
• good sensitivity to drug treatment bronchodilators.