Pulmonary Emphysema and Fibrosis

¹ The Veterans Administration Hospital, Tucson, Arizona.

1) Thirty-seven patients with pulmonary emphysema and/or fibrosis have been reviewed. The outstanding symptoms are dyspnea, cyanosis and cough. The main findings on examination are barrel-shaped chest with limited respiratory excursion, hyper-resonance on percussion, hypertrophy of the auxiliary respiratory muscles and decreased pulmonary function. Roentgenograms are typical showing hyperaeration and/or fibrosis. Review of autopsy findings reveals simultaneous occurrence of emphysema and fibrosis in almost all cases. Emphysema involves either both lungs diffusely in the vesicular form or forms irregular, large "air cysts" in the bullous form. Frequent complications are recurrent pneumonia, hypertension of the lesser circulation with pulmonary atherosclerosis and cor pulmonale, spontaneous pneumothorax and cerebral changes.

2) No specific cause is known.

3) Treatment is unsatisfactory and is limited to the alleviation of symptoms, oxygen being the most effective agent. Artificial pneumoperitoneum and abdominal supports have been used to relieve dyspnea. Surgical intervention is reserved for cases with one or more giant bullae and consists of resection or drainage of the bullae.