Dermatologic Manifestations of Pulmonary Disease: Overview, Cyanosis and Clubbing, Lung Cancer, Hypertrophic ...
Bibasilar Atelectasis: Symptoms, Causes, And Complications
Bibasilar atelectasis is when there is a collapse in the bottom part of both lungs. It can cause symptoms such as shortness of breath, coughing, wheezing, and more.
Atelectasis is a partial or total collapse of one or both lungs. It may occur for a number of reasons.
For example, when something pushes against the tiny air sacs in the lungs, or alveoli, and causes them to collapse. It may also occur when the oxygen and carbon dioxide in the alveoli move into the bloodstream and no new air moves in, due to an obstruction in the small airways, for example.
It may also result from impaired pulmonary surfactant production or function. Pulmonary surfactant is a fluid that helps prevent the alveoli from collapsing.
Bibasilar atelectasis can cause severe complications if left untreated. How doctors treat it will vary based on what has caused the collapse.
This article explores the causes, symptoms, and possible complications of bibasilar atelectasis. It also discusses how doctors diagnose and treat the condition.
A person's lungs comprise several areas that healthcare professionals call lobes. The right lung has three lobes, and the left lung has two lobes.
When someone experiences bibasilar atelectasis, the lowermost lobes of their lungs collapse entirely or partially.
The lobes of the lungs are filled with alveoli, which are arranged in clusters and surrounded by blood vessels. When a person breathes in and out, the alveoli allow their blood to collect oxygen and get rid of carbon dioxide.
During bibasilar atelectasis, the alveoli in the base of the lungs deflate and stop performing this essential task. Oxygen may not be able to reach the vital organs, making the condition life-threatening in some cases.
It can also cause scarring, which could lead to reduced lung function afterward.
According to the American Lung Association (ALA), people may confuse atelectasis with pneumothorax. This is because some people also refer to pneumothorax as a "collapsed lung". While the two conditions are similar, they have different causes.
In some cases, pneumothorax may lead to atelectasis on one side.
If only a small portion of the lung collapses, bibasilar atelectasis may not cause any symptoms. If a person does experience symptoms, these may include:
A person may have other symptoms as well, depending on the underlying cause.
Older research from 2014 suggests that bibasilar atelectasis is more common after major surgery and anesthesia.
There is a range of other possible causes, as well. Doctors class these causes as either obstructive or nonobstructive.
Obstructive causesA person may experience obstructive atelectasis when something blocks their airway and prevents their lung from filling correctly. This can occur for a variety of reasons, including:
Pressure rather than a blockage causes nonobstructive atelectasis.
Factors that can put pressure on the lungs and make it hard for them to fill up include:
According to the ALA, atelectasis and pneumothorax are similar, so a thorough diagnosis is necessary. Doctors may conduct a physical exam and may also want to monitor a person's oxygen levels or lung function periodically to note any changes.
If they suspect atelectasis, healthcare professionals may order a chest X-ray, ultrasound, or CT scan to confirm their diagnosis.
A doctor may also perform a fiberoptic bronchoscopy. This procedure involves a healthcare professional inserting a tube through a person's nose or mouth to get a closer look at their airways.
How doctors treat bibasilar atelectasis depends largely on the underlying cause of the collapse.
To treat blockages, they will first try to remove the obstruction, using methods such as suction, drainage, or chest percussion. Some medications may also help break up and expel fluids.
To treat causes related to pressure, doctors will relieve the pressure in the lung and allow it to expand fully. This should restore function in the lungs.
When surgery causes atelectasis, doctors may recommend therapies to allow the lungs to expand naturally. They may tell a person to do deep breathing exercises, walk around after surgery to increase their breathing, and gently cough up mucus if possible.
Healthcare professionals will treat lung conditions or medical conditions causing atelectasis to help prevent further collapse. For instance, if a person has a tumor, they may require radiation therapy, surgery, or chemotherapy.
Early treatment of bibasilar atelectasis may improve a person's outlook and prevent the risk of complications.
If there is extensive damage to the lungs or the collapse is not treated urgently, possible complications can include:
Older research from 2014 suggests that many people experience bibasilar atelectasis while they are still in the hospital and recovering from surgery.
If a person is already in the hospital, this can make diagnosis and treatment easier, and may help prevent complications.
In cases where a person notices symptoms when they are no longer in the hospital, it is crucial for them to visit a doctor urgently for treatment.
However, a person's outlook may depend on the underlying cause of atelectasis.
Bibasilar atelectasis describes a collapse in the lower lobes of both lungs. It may cause shortness of breath and rapid, shallow breathing, as well as other symptoms.
Older research from 2014 suggests that bibasilar atelectasis is more frequent following major surgery and anesthesia. However, a range of factors may cause it, including a foreign object in the lungs or pleural effusion.
Treatment will depend on the underlying cause of bibasilar atelectasis. A person should contact a healthcare professional as soon as possible if they experience any symptoms of the condition.
Progressing Interstitial Lung Abnormalities Linked To Respiratory Distress
In smokers without known interstitial lung disease (ILD), worsening pulmonary parenchymal abnormalities on chest CT were still associated with more severe acute respiratory disease (ARD) events, a secondary analysis of the COPDGene Study revealed.
Progression of such interstitial lung abnormalities (ILAs) -- summed together in an artificial intelligence-based quantitative interstitial abnormality (QIA) index -- was associated with greater risks of a severe ARD event between the smokers' baseline visit and roughly 5-year follow-up visit in the trial (OR 1.29 for each annual percentage increase, 95% CI 1.06-1.56) and later on as well (OR 1.26 for each annual percentage increase, 95% CI 1.05-1.52).
Associations remained after adjusting for factors like coronary artery disease, congestive heart failure, diabetes, hypertension, and high cholesterol, reported Bina Choi, MD, of Brigham and Women's Hospital and Harvard Medical School in Boston, and coauthors in Radiology.
QIAs are associated with decreased lung function and a higher risk of respiratory symptoms and death, despite not meeting diagnostic criteria for advanced pulmonary disease.
"QIA includes features like reticulation and ground-glass opacities as well as subtle density changes with important clinical implications," said Choi in a press release. "In some patients, QIA may be a precursor to advanced diseases such as pulmonary fibrosis or emphysema."
Additionally, the researchers found that people in the highest quartile of QIA progression (≥1.2% annually) experienced more frequent ARD events (IRR 1.46, 95% CI 1.14-1.86) and severe ARD events (IRR 1.79, 95% CI 1.18-2.73) when compared with peers in the lowest quartile (≤-1.7%) during the intercurrent period between the baseline and 5-year visits.
"The association of QIA progression with acute events in the intercurrent period suggests that some QIAs represent areas of active disease and inflammation, and the association with events in the subsequent period suggests QIAs may additionally represent irreversible changes that continue to cause symptoms and exacerbations after radiographic progression," Choi's group wrote.
Indeed, ARD events are known to occur even in people with a smoking history without chronic obstructive pulmonary disease (COPD) who show no spirometric obstruction or emphysema on imaging.
"While many acute respiratory disease events are likely related to airway disease and COPD, some may instead be associated with QIA especially in people without obstruction or emphysema," said Choi.
For the present study, QIA was calculated automatically -- based on a model trained on ground-glass opacities, nodularity, linear scarring, centrilobular nodules, reticulation, honeycombing, and subpleural lines -- and expressed as a percentage of lung volume affected.
Choi and colleagues said that risk factors for QIA progression include female sex, advanced age, and presence of MUC5B polymorphism.
Brent Little, MD, of Mayo Clinic Florida in Jacksonville, expressed concerns regarding the automated QIA index, as a previous study had 45.6% of people flagged this way for QIA when 6.9% actually had ILAs according to visual inspection of CT scans. "The low specificity of the algorithm and high percentage of participants judged to have QIA point to overestimation, perhaps in part caused by reversible parenchymal features such as dependent atelectasis."
Little did note, writing in an invited editorial, that the association between QIA and events, in contrast with the lack of association seen between QIA and emphysema, could point to the use of QIA as a biomarker.
"Could QIA serve as an imaging biomarker in the same way that coronary calcium scores correlate well with risk of future major adverse cardiovascular events?" he posed. "QIA could be viewed as a composite of multiple alveolar, small airway, and interstitial disease processes of varying chronicity that, taken together, might represent an important index of lung health."
A total of 3,972 participants from the COPDGene Study were included in this secondary analysis. Patients were excluded if they had a history of lung diseases other than COPD or asthma, or if their baseline CT indicated ILD or bronchiectasis.
Of the included patients, 53.4% were women, the average age was 60.7 years, and the average BMI at baseline was 29.1. The study population was 23.9% Black and 76.1% white. Over 43% were current smokers at baseline, with an average history of 42.4 pack-years.
CT scans were performed alongside serum laboratory measurements, spirometry, scans, and questionnaires at the initial visit and at a follow-up visit about 5 years later. A follow-up program provided participants with questionnaires every 3 to 6 months in between the two visits, as well as after the follow-up visit, to assess ARDS and its associated events.
At baseline, average lung occupied by QIA was 6% and that occupied by emphysema was 7%.
As for other CT-based airway metrics of airway disease, the average wall thickness for a hypothetical airway of 10-mm internal lumen perimeter on CT was 2.3 mm, and the quantitative density measurement of air trapping on localized parametric response mapping of paired inspiratory and expiratory CT scans was 15.6%.
ARD episodes were those involving increased cough or dyspnea lasting 48 hours and requiring antibiotics or corticosteroids. Severe ARD events were ones that ultimately required either hospitalization or an emergency room visit.
Between baseline and 5-year follow-up, 35.1% of patients experienced one or more ARD events, with those who experienced them having an average of 4.4 events. Severe ARD events were reported in 15.8% of patients, at an average of 2.8 events per person. After the follow-up visit, 22.2% of patients had one or more severe ARD events and experienced an average of 2.7 events.
In regard to emphysema, each annual percentage increase between initial and follow-up visits was associated with an 11% greater chance of having one or more intercurrent ARD events (OR 1.11, 95% CI 1.03-1.20, P=0.005). However, this association did not hold up following the second visit, nor was an association found between emphysema progression and severe ARD events, either intercurrently or subsequently.
Limitations to the study included its observational design, reliance on questionnaires for ARD event data, and lack of certain clinical details such as ARD event timing, Choi's group acknowledged.
Elizabeth Short is a staff writer for MedPage Today. She often covers pulmonology and allergy & immunology. Follow
Disclosures
Choi reported grants from the NIH, National Heart, Lung, and Blood Institute, the American Lung Association, and consulting fees from Quantitative Imaging Solutions.
Little reported no disclosures.
Primary Source
Radiology
Source Reference: Choi B, et al "Association of acute respiratory disease events with quantitative interstitial abnormality progression at CT in individuals with a history of smoking" Radiology 2024; DOI:10.1148/radiol.231801.
Secondary Source
Radiology
Source Reference: Little BP "Quantitative interstitial abnormality progression: association with acute respiratory events and implications for clinical practice" Radiology 2024; DOI:10.1148/radiol.240791.
Please enable JavaScript to view the comments
The Best Exercises To Try If You Have COPD
While there's no cure for chronic obstructive pulmonary disease (COPD), exercise can improve COPD symptoms and help you feel better.
Breathing difficulties can make people with COPD feel like they can't exercise or that it's unsafe. But doing the right exercises at the right intensity can help.
Guidelines from the American Lung Association recommend 20 to 30 minutes of moderate exercise for three to four days a week for people with COPD.
Your doctor may encourage physical activity because it can improve shortness of breath and other COPD symptoms. Before you start a new routine, ask them which activities to try and what to avoid.
Chronic obstructive pulmonary disease (COPD) refers to a group of progressive lung diseases that block airflow and make it hard to breathe. These lung diseases include:
Symptoms of COPD include:
According to the National Heart, Lung, and Blood Institute, nearly 16 million people in the United States have COPD, and more people have it but don't know it.
A combination of breathing exercises and physical activity can help improve symptoms of COPD.
Breathing exercisesBefore starting an exercise program, it's helpful to practice breathing exercises for COPD. Doing these regularly can help make physical exertion easier and more comfortable.
If you have moderate to severe COPD, your doctor may first refer you to a pulmonary rehabilitation program.
Breathing exercises may include pursed lip breathing and belly breathing, also called diaphragmatic breathing.
Physical exercisesGood physical activity choices for people with COPD include aerobic or cardiovascular exercises as well as upper body resistance or weight training to help strengthen the heart, lungs, and surrounding respiratory muscles.
The following are eight types of exercises that are good options for people with COPD:
Always warm up and stretch before exercising and cool down afterward. This reduces stress on your heart, muscles, and joints.
Start slowly and gradually increase the intensity and duration of your workouts. For example, you might begin by exercising for 10 minutes two times a week and work up to 30 minutes four times a week.
Aim to keep your heart rate at 50% to 80% of your maximum heart rate (which is 220 minus your age) while exercising. This may be difficult for people with COPD but should still be a goal to work toward.
It's never a bad idea for anyone to monitor their heart rate during exercise.
Exercise can't reverse lung damage, but it can improve your physical endurance and strengthen your respiratory muscles. This can help you feel better physically and mentally. You'll be able to participate in more activities without losing your breath or getting tired.
Inactivity can cause a decline in cardiovascular function and muscle mass. Over time, you may find yourself more and more breathless every time you exert yourself. Everyday activities might become more challenging.
It takes time to build cardiovascular endurance and strengthen your respiratory muscles. That's why it's important to be consistent and establish a regular exercise routine.
You might feel like you can stop workouts once you're breathing better, but if you stop using those muscles regularly, shortness of breath will likely return.
The RPE scale is designed to measure the intensity of your exercise. It's a simple way to rate your own level of difficulty for a specific physical activity. This can help you monitor your exertion, stay in the safe zone, and track your improvement.
Once you receive a COPD diagnosis, you'll likely take prescription medication to manage symptoms and improve your breathing. Your doctor may prescribe different types of medications, such as pills, bronchodilators, and inhaled corticosteroids.
These medications help relax the muscles around your airway and reduce inflammation. Depending on the severity of your COPD, you may need oxygen therapy to ensure there's enough oxygen in your bloodstream.
A history of cigarette smoking causes about 75% of COPD cases. But other factors can play a role, too.
Long-term exposure to certain types of dust, chemicals, and fumes (often in the workplace) can also increase the risk.
COPD can also develop in people who have never smoked or been exposed to pollutants. The disease can develop if you have a deficiency of alpha-1 antitrypsin (AAT), a protein in your bloodstream. If your body lacks AAT, your white blood cells may attack your lungs, resulting in lung damage.
The right exercises can help improve symptoms of COPD and your quality of life. Talk with your doctor before starting any new exercise routine. They may give you specific information about how to exercise safely based on your individual health profile.
Comments
Post a Comment