Pulmonary Atelectasis : What is & how to treat it

Pulmonary atelectasis is a disorder caused by obstruction or external compression of the bronchi, which causes part or all of the lung to empty of air. People with the condition may have difficulty breathing or respiratory failure if the atelectasis is severe. They can also develop pneumonia. Although usually asymptomatic, atelectasis can also in some cases cause hypoxemia, that is, a decrease in the amount of oxygen carried in the blood and chest pain. Treatment consists of removing the obstruction from the airways and ensuring that deep breaths are taken.

 What is pulmonary atelectasis?

Pulmonary atelectasis corresponds to the reversible collapse of the pulmonary alveoli, with loss of volume, following an absence of ventilation, while blood circulation is normal there. It results from a complete obstruction of the bronchus or the bronchioles ventilating the part concerned. Atelectasis can involve an entire lung, a lobe or segments.

What are the causes of pulmonary atelectasis?

Pulmonary atelectasis is usually caused by an interior obstruction of one of the main bronchi originating in the trachea and leading directly to the lung tissue.This can be caused by the presence of: 

  • an inhaled foreign body, such as a tablet, food or even a toy;
  • a tumor ;
  • a plug of mucus.
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Atelectasis can also result from a bronchus compressed from the outside by:

  • a malignant or benign tumor;
  • lymphadenopathy (lymph node that increases in size);
  • pleural effusion (abnormal accumulation of fluid in the pleural cavity, which is the space between the lung and the chest);
  • pneumothorax (abnormal accumulation of air in the pleural cavity).

Atelectasis can also be secondary to a surgical intervention requiring intubation, or to a supine position, in particular in obese patients and in cases of cardiomegaly (abnormal enlargement of the heart).

Finally, any conditions or interventions that decrease deep breathing or suppress a person’s ability to cough can promote pulmonary atelectasis:

  • asthma;
  • inflammation;
  • disease of the bronchial wall;
  • cystic fibrosis;
  • a complication during general anesthesia (thoracic and abdominal surgeries in particular);
  • high doses of opioids or sedatives;
  • chest or abdominal pain.

People who are very overweight or obese are at greater risk of developing atelectasis.

 What are the symptoms of pulmonary atelectasis?

In addition to the appearance of dyspnea, i.e. difficulty in breathing, and hypoxemia, i.e. a decrease in the amount of oxygen in the blood vessels , pulmonary atelectasis remains mostly asymptomatic. The presence and severity of dyspnea and hypoxemia depend on how quickly the atelectasis develops and the extent of the affected lung:

  • if atelectasis involves only a limited part of the lung or develops slowly: symptoms are usually mild or absent;
  • if a large number of alveoli are affected and atelectasis occurs rapidly, dyspnea may be severe and respiratory failure may develop.
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Heart rate and respiratory rate may also increase, and sometimes the skin may turn a bluish color due to the decrease in oxygen levels in the blood. This is called cyanosis. Symptoms may also reflect the disorder that caused the atelectasis (for example, chest pain from injury) or the disorder that causes it (for example, chest pain on deep breathing, due to pneumonia).

Pneumonia can result from pulmonary atelectasis, resulting in cough, dyspnea, and pleural pain.

Although cases are rare, pulmonary atelectasis can be fatal in newborns and young children.

 How to treat pulmonary atelectasis?

The first step in the treatment of atelectasis is to remove the cause of the airway obstruction by:

  • cough ;
  • aspiration of the respiratory tract;
  • bronchoscopic removal;
  • surgical extraction, radiotherapy, chemotherapy or laser treatment in the event of a tumor;
  • drug treatment with the aim of thinning the mucus or opening the respiratory tract (nebulization of alphadornase, bronchodilators), in the event of persistent mucous plug.
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This first step can be accompanied:

  • oxygen therapy;
  • thoracic physiotherapy to help maintain ventilation and the evacuation of secretions;
  • lung expansion techniques such as directed cough;
  • deep breathing exercises;
  • the use of an incentive spirometer;
  • treatment with antibiotics if a bacterial infection is suspected;
  • more rarely, the insertion of an intubation tube (endotracheal intubation) and mechanical ventilation.

Once the atelectasis is treated, the alveoli and the collapsed part of the lung gradually re-inflate to their original appearance. When the treatment is too late or the obstruction leaves scars, it happens that certain areas are damaged irreversibly.