More internal diseaseDid you know that our lungs have around 300 million alveoli? And that spread out, these would cover an area of about 100 square meters? Mostly unconsciously, we inhale and exhale 10 to 15 times per minute at rest. And need six to nine liters of air. The inhalation itself is active. Mainly with the help of the intercostal muscles and the diaphragm. Exhalation, on the other hand, is usually a passive process.
All areas of our respiratory system can become ill. The upper respiratory tract with nose and sinuses are often affected by viral infections. If bacteria are added, the course of the disease is often complicated. The mouth, pharynx and bronchial tubes are then often involved. In the case of a protracted cold, lung or heart muscle inflammation can even occur. Our pulmonary alveoli (alveoli) are particularly sensitive. They can, for example, scar (pulmonary fibrosis) or, in the worst case, dissolve in their structure (pulmonary emphysema). For example, due to heavy smoking. Breathlessness is then the consequence. Sometimes the lungs also become chronically inflamed (e.g., with a chronic inflammation). B. COPD) or is affected by a tumor (bronchial carcinoma).
Focus on pneumology
Clinic for Internal Medicine 2 Marienhospital Stuttgart Boheimstrabe 37 70199 Stuttgart Secretary Laura Perrino
Phone: 0711 6489-8125
Fax: 0711 6489-8126
Our services in detail
1: In asthma, thick mucus (a) is secreted into the bronchial tubes 2: The mucous membrane of the bronchial tubes (b) swells strongly. 3: In an asthmatic attack with respiratory distress, the muscles of the bronchial tubes tense up
In COPD, the fine walls between the alveoli are destroyed (1). Lungs and chest expand (2). On exhalation, they can no longer collapse to normal size
Disease patterns frequently treated in our focus
They suffer from asthma? Then your bronchial system reacts hypersensitive. Has therefore become chronically inflamed. The disease manifests itself in a spasmodic constriction of the small airways. In addition, viscous slime is formed. And due to the swelling of the mucous membranes, attacks of respiratory distress can always occur. The attack usually lasts only a few seconds.
Asthma is usually triggered by external influences such as allergens, chemicals or drugs (extrinsic/exogenous asthma). If, on the other hand, no exact cause can be proven, the disease is called intrinsic/endogenous asthma denotes. It often develops following an upper respiratory tract infection or as a result of overexertion and psychological stress.
Your bronchial tubes are inflamed over a long period of time. Typical accompanying symptoms are cough and expectoration. According to the definition of the World Health Organization (WHO ), the disease in a chronic course extends over at least three months a year and occurs at least in two consecutive years. Smokers in particular are affected.
Chronic obstructive pulmonary disease (COPD) with emphysema
Due to chronic bronchitis, the airways can become increasingly constricted. In technical language this clinical picture is called chronic obstructive bronchitis (obstructive = constricting; engl. = chronic obstructive pulmonary disease). Over the years, the lung tie becomes permanently damaged. The process is insidious. As a sufferer, you will notice the progression of the disease by becoming increasingly short of breath during physical exertion. The fine walls between the alveoli are visibly lost. The vesicles expand. Eventually perish.
As a result, your chest expands and can no longer collapse to its normal size when you exhale: a so-called "sarcoidosis" forms emphysema (emphysema = overinflation). Gas exchange in the lungs is impaired, oxygen exchange in the blood is restricted.
X-ray of pneumonia: The left lobe of the lung (arrow) has become inflamed by bacteria
Sarcoidosis is caused by immune reactions in the body. Nodule-like inflammations can be seen in both lungs (X-ray image)
Pathological changes in the lung tie
Immunological reactions in the body can lead to a disease of the lung skeleton. Sarcoidosis is one of the most common diseases. Rarer is the so-called birdman's lung or farmer's lung. In addition, the lungs are often involved in inflammatory rheumatic diseases. In chronic cases, pulmonary fibrosis can develop.
Sarcoidosis is a rare inflammatory disease that can be acute or chronic. It primarily affects the lungs and lymph nodes, but can affect virtually any organ. Typically, numerous focal granulomas occur, i.e. nodular neoplasms of young connective tie (granulation tie). They are caused by an activation of the immune system. The cause of sarcoidosis is unclear. A connection between genetic factors and environmental factors is investigated.
What is the course of treatment?
Sarcoidosis does not always need to be treated. The acute form of the disease in particular usually heals without complications, even without drug treatment. You are affected by a mild form, and the prognosis for the course of the disease is favorable? Apart from regular control examinations we wait here at first. Sometimes, however, there can be severe discomfort. Or the disease is advanced, and there is a threat of other vital organs being affected. In this case we use cortisone preparations.
Birdman's and farmer's lung
Allergic reactions to bird feathers and hay cause avian and farmer's lung (exogenous allergic alveolitis). The alveoli begin to become inflamed. As a result, symptoms such as cough, shortness of breath, fever and chills occur. The disease can ame life-threatening proportions. Often it is an occupational disease. For example, it can affect pigeon breeders.
Inflammatory rheumatic diseases
The lungs are often involved in inflammatory rheumatic diseases. For example, rheumatoid arthritis, granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA) and scleroderma. Often the lung tie becomes scarred like connective tie. If your lungs are affected, we often have to intensify the treatment.
The so-called pulmonary fibrosis is the final state of chronic inflammation of the lung tie. The alveoli permanently change into connective tie. The cause is unclear. The lung tie becomes scarred; its extensibility. The lung volume decrease. This impairs gas exchange in the lungs. In consequence also the respiration is disturbed. The blood circulation in the pulmonary circulation is also impaired. Over time, this has a detrimental effect on the heart. A therapy with cortisone. Acetylcysteine can slow down the conversion process.
The x-ray shows a lung tumor in the upper lobe of the right lung (arrow)
warning signs of lung cancer are coughing for weeks and bloody sputum
Lung cancer (bronchial carcinoma)
Lung cancer (bronchial carcinoma) is the most common tumor in men. Increasingly, however, women are also affected. In Germany, about 40.000 new cases per year.
The Most important cause for the disease is the Smoking. Passive smoking also plays a significant role. The earlier a lung tumor is detected, the more likely it is to be curable. Typical symptoms of the disease often appear only at an advanced stage. Indication of tumor growth can be, for example, a cough that lasts for weeks. Especially if there is some blood mixed in with the cough expectoration. In addition, shortness of breath may occur. Pain in the area of the chest. Our appeal: If you suffer from such symptoms, then you should take them seriously and have them clarified by a doctor.
An examination for Tumor marker is not usually performed when lung cancer is suspected, as its significance is not particularly high. In the case of special tumor forms, a determination of the tumor markers is useful for monitoring the course of the disease in some cases.
If the lung cancer is still in an early stage, surgery is performed if possible (focus on thoracic surgery). Depending on the exact extent of the disease, chemotherapy follows the surgery. If the disease is already more advanced, you must first undergo chemotherapy and radiation therapy before the procedure is performed. If the tumor has already spread throughout the body and formed metastases, chemotherapy is almost always administered. Cystic fibrosis is a congenital metabolic disease. Also called “cystic fibrosis. Typically forms in the lung. Very viscous mucus in other organs. Among other things, this clogs the bronchial tubes, so that the airways become increasingly narrow and breathing is impeded. At the same time, infections repeatedly develop because invading bacteria can no longer be removed.
The disease is often diagnosed in childhood. The destruction and narrowing of the bronchial tubes progresses over the years until the lungs finally fail completely in adults. Despite the severity of the disease, the prognosis has improved significantly today. And this is due to the constantly further developed therapy concepts.
Healthy lung tie: glandular cells in the mucous membrane form thin mucus that traps inhaled particles. Cilia then transport the mucus into the trachea
Lung tie in cystic fibrosis: altered mucous glands form very viscous secretions. Invading bacteria can no longer be removed and multiply. Immune cells are attracted to destroy the pathogens, which also damage healthy tie. Released genetic material (DNA) makes the mucus even tougher
Lung scintigram: the left lung is well supplied with blood (dark). The middle lobe of the right lung is undersupplied and appears bright (arrow). Caused by an embolism in the artery supplying the middle lobe
Diseases of the pulmonary vessels
Pulmonary embolism – vascular occlusion in the lung
In pulmonary embolism, a blood clot (embolus) lodged in the lung causes an arterial occlusion. The cause of the disease is usually a blood clot (thrombus) in the deep leg or pelvic veins. The clot has detached from it. The disease is manifested by sudden shortness of breath. Noticeable pain in the chest.
How is pulmonary embolism diagnosed?
Scintigraphy can be used to detect pulmonary embolism. In this procedure, small, radioactively labeled substances are injected into the bloodstream. The molecules are also deposited in the lungs during their circulation. Areas with a good blood supply are shown dark in the scintigram. Undersupplied areas appear as a white area.
Pulmonary hypertension (pulmonary hypertension)
Pulmonary hypertension refers to high prere in the pulmonary vessels. Two forms can be distinguished:
– idiopathic pulmonary arterial hypertension (no cause can be named here) – secondary pulmonary hypertension
Cause and symptoms of secondary pulmonary hypertension
The cause can be heart disease, lung disease, rheumatological diseases, HIV infection and various other diseases. If the pulmonary circulation becomes increasingly constricted, the right heart is progressively strained. This eventually ends in high prere of the pulmonary vessels, and right heart failure may develop.
How the disease can be treated
Until a few years ago, there were no treatment options other than lung transplantation. Today, it can be treated effectively with newly developed drugs. The drugs are used alone or in combination. We work closely with our cardiology department in the treatment of cystic fibrosis. This is how important examinations like echocardiogram. Perform right heart catheterization on site. In our pneumological outpatient clinic we will then introduce you to the new forms of therapy. The necessary regular monitoring and control examinations also take place there.