Atelectasis refers to an airless lung tissue. This is not a disease in its own right, but rather a condition that results from another underlying disease. The complaint may affect the entire lung, although in most cases it affects circumscribed sections of the lung.
What is atelectasis?
In atelectasis, either parts of the lungs or the entire lung are deflated. Translated from the Greek, the term means “incomplete expansion.” This condition particularly affects the alveoli (air sacs). These have a very important function, as this is where oxygen exchange takes place. When the alveoli collapse, the corresponding area is no longer available for oxygen exchange. Therefore, atelectasis is a condition that must be taken seriously. Doctors distinguish between primary and congenital atelectasis. The acquired form results from another disease, while the congenital form exclusively affects newborns and premature infants, respectively.
Causes
Causes of congenital atelectasis include central nervous dysfunction, malformations, or surfactant deficiency, which can occur in premature infants. Surfactant is a mixture of water, proteins, and fats produced by the lungs that serves to lower the surface tension of the fluid layer in the alveoli to allow deployment. There are several forms of atelectasis:
- In compression atelectasis, the collapsed area of the lung is squeezed, preventing it from unfolding. This can be due to a variety of causes, such as a tumor, injury to the lung or chest wall, pus, water or blood accumulation, or swollen lymph nodes.
- In contraction atelectasis, the trigger for the lack of ventilation is scarring of the lung that is a consequence of lung disease, such as tuberculosis.
- In the case of microatelectasis, the lung tissue at the corresponding site received too little blood supply, which can happen, for example, in a shock situation. As a result, it could not form enough surfactant. The surface tension of the fluid thereby pulls the lung in the alveoli together at this point.
- Obstructive atelectasis (subtype of resorptive atelectasis) occurs when a lung branch is pinched off and the air trapped behind it is absorbed into the blood, for example, by a tumor, an ingested object, or swollen lymph nodes.
Symptoms, complaints and signs
In atelectasis, lung function is reduced because gas exchange can no longer take place. As a result, the level of oxygen in the blood decreases. The body now tries to compensate for this condition. It accelerates breathing and increases the heart rate. Due to the lowered oxygen level, the skin sometimes turns bluish. The symptoms resulting from atelectasis depend, among other things, on how large the corresponding affected lung section is. Another factor is whether the atelectasis developed acutely or gradually. Furthermore, the individual causes shape the symptoms. If atelectasis occurs suddenly, for example due to obstructed airways, there is severe shortness of breath and in some cases stabbing pain in the chest. Atelectasis that develops slowly, affecting only small areas of the lungs, causes only mild symptoms. These include shortness of breath and coming out of breath more quickly, especially during exertion. Large collapsed areas of the lungs, on the other hand, can lead to circulatory shock, in which blood pressure drops sharply and the heart beats very fast. Symptoms of congenital atelectasis often appear shortly after birth or in the first hours of life. The skin turns bluish in affected premature infants. They also breathe rapidly, with the areas between the ribs and above the sternum being drawn in when they breathe in, and increased movement of the nostrils.
Diagnosis and course
The physician usually already suspects atelectasis on the basis of the typical symptoms that indicate it. In most cases, the underlying disease also leads to the assumption that pulmonary dysfunction is present. Breathing problems are always expected in a premature infant.Therefore, the baby’s breathing, skin color, heart rate, muscle tone and reflexes are closely monitored immediately after birth. Immature lungs are among the most common causes of complications. X-ray examination secures the diagnosis. It can also determine the degree of immaturity of the lungs. In the case of acquired atelectasis, it is important to identify the underlying disease. This is done by taking an anamnesis (detailed conversation with the affected person) to ask him about the complaints and known diseases. The lungs are then listened to. If atelectasis is present, the breath sounds are attenuated. A muffled sound is detected when the chest is tapped with the fingers. The additional X-ray examination again secures the final diagnosis. Depending on the cause, for example, a lung tumor, fluid or bruising in the chest, further examinations follow, such as examination of the blood, a computer or magnetic resonance imaging.
Complications
Atelectasis has several causes and can lead to various complications. First, atelectasis can lead to inflammation of the lungs (pneumonia). In the worst cases, this inflammation can spread throughout the body, leading to sepsis or blood poisoning. Sepsis can degenerate into septic shock. In this case, there is a sharp drop in blood pressure, which leads to a deficiency in the supply of blood to various organs. This can lead to failure of these organs. The lungs and kidneys are particularly susceptible. Furthermore, the risk of developing edema is increased. These accumulations of water in the lungs can become chronic, and scarring (fibrosis) of the lung tissue can occur. As a result, the lungs can no longer expand properly, the affected person has difficulty breathing and experiences shortness of breath. The oxygen supply to the body is no longer properly ensured, and a so-called central cyanosis occurs. In addition, atelectasis constricts the pulmonary vessels, which can lead to a strain on the right heart, which can be weakened as a result. As the disease progresses, the right heart enlarges (right heart hypertrophy) and may eventually fail (right heart failure). Affected individuals are severely limited in quality of life and suffer a decline in performance.
When should you see a doctor?
Suspicion of atelectasis is a reason to see a physician immediately. A number of warning signs can be used to determine whether the syndrome is present. Typical symptoms include difficulty breathing, stabbing pain in the chest, and an accelerated pulse rate. Each of these symptoms should be clarified by a medical professional to rule out a serious cause or to diagnose the syndrome. Medical advice is needed at the latest when typical symptoms (circulatory problems, a strong feeling of tightness in the chest, a strongly increased pulse, etc.) appear. Patients with congenital atelectasis should consult their family doctor regularly. Again, contact the emergency physician at the first symptoms of an acute syndrome. If atelectasis is detected and treated early, serious consequences can be reliably avoided. If lung damage has already occurred and the patient collapses, first aid measures must be taken. Treatment by emergency medical services must be given immediately to avoid serious consequences such as cor pulmonale or pneumonia of the lungs.
Treatment and therapy
Treatment for atelectasis is primarily based on the causes. The goal is to restore lung function and ensure a supply of sufficient oxygen to the body. In the case of a lung tumor, surgery is usually performed to remove the growth. In the case of a pneumothorax, in which air has entered the intercostal space, causing a section of the lung to collapse, surgery is sometimes necessary. Mild forms, on the other hand, often do not require treatment. If a foreign body is in the airway, it must be removed. If there is a mucus plug, suctioning is performed. In congenital atelectasis, which is usually based on insufficient lung maturity, the lack of surfactant must be compensated for by giving the premature baby the substance as a drug. In the case of very pronounced breathing problems, the baby is artificially ventilated.
Outlook and prognosis
The prognosis of atelectasis depends on the underlying disease present. If there is a foreign body in the lungs or airways, there is a good chance of recovery in most cases. In one operation, the foreign body can be removed and breathing is possible again without damage. This depends on the size of the foreign body and the tissue it has damaged. The healing path of pneumonia, on the other hand, is more extensive. In addition to treatment with medication or hospitalization, it can have a fatal course. If the organism is not supplied with sufficient oxygen, there is also a risk of further complications, which have a negative impact on the overall prognosis. Heart problems can occur, which can lead to an acute health situation. In the event of a heart attack or stroke, the patient is at risk of lifelong impairment due to paralysis or dysfunction. In addition, there is also the risk of premature death. In the event of persistent lung dysfunction, artificial respiration may be required. If lung function cannot be restored to the extent required, the patient can only be cured by organ transplantation. This presents numerous challenges and involves a long road to recovery. If it is successful, an adaptation of everyday life to the changed conditions must take place. Nevertheless, it is possible to be largely symptom-free for many years of life.
Prevention
Acquired atelectasis cannot be prevented, but only partially counteracted. Pregnant women with suspected preterm birth are given a drug that helps the unborn baby’s lungs mature. Labor-inhibiting drugs are also used to try to delay the birth.
Aftercare
The extent to which follow-up care becomes necessary depends on the underlying disease. In principle, however, immunity does not build up even after a cure. The complexity of the causes allows re-infection. If the typical symptoms occur, doctors order an X-ray for diagnosis. Tapping on the chest can sometimes also provide clarity. If the initial illness causes foreign bodies in the lungs or airways and no tissue was damaged during treatment, follow-up care is not required. The patient is discharged and need not fear further consequences. In many other cases, however, follow-up care is of great importance. In these cases, the lungs are usually so extensively damaged that normal everyday life is no longer possible. Those affected can hardly cope with even minor stresses. Since a final cure can only be achieved through a lung transplant, help is needed in everyday private and professional life. Aftercare aims to prevent complications by all necessary means. Since atelectasis can be acquired and congenital, treatment methods must be adapted. Patients in whom the causes are not eliminated require permanent treatment. Often the symptoms can be stopped with the help of medication. Regular visits to the doctor then become necessary.
What you can do yourself
People suffering from atelectasis require comprehensive medical treatment. In most cases, surgery is needed, which can be supported by those affected by taking it easy and following other medical guidelines. In addition, it must be ensured that the medication is optimally adjusted. Especially when painkillers are administered, a well-adjusted medication is important to relieve the patient’s discomfort and thus also to positively influence the healing process. If unusual symptoms occur, the doctor must be informed. Mild forms of alectasis often do not require extensive treatment. In most cases, it is sufficient to remove the foreign body from the airways and not to strain the lungs for a few days to weeks. Congenital alectasis must be evaluated by a pediatrician. Parents should keep a close eye on the affected child and make sure he or she is getting enough air. In case of severe breathing problems, intensive medical treatment is required in any case. Since this is also a considerable burden for the parents, therapeutic support should be sought. The doctor in charge can often also put the child in touch with a self-help group. There, parents can exchange information with other sufferers.
