By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Partial or total collapse of lung or a part of a lung is called atelectasis. There are many small air sacs within the lungs. They are called alveoli. This condition occurs when these sacs get deflated or filled with fluid.
‘When some of your alveoli don’t fill with air, it’s called atelectasis’ (Read more)
The alveoli as a result do not expand the way they should when you breathe. Atelectasis may involve small or large portions of the lung. This totally depends on what causes the condition.
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Many times there may be no obvious signs and symptoms.
When many alveoli are involved or when atelectasis occurs quickly, enough oxygen will not come to the blood. Many symptoms may be caused due to low blood oxygen. The commons symptoms are –
- Difficulty in breathing – more so if you already have a lung disease
- Rapid shallow breathing
- Sharp chest pain, while taking deep breath or coughing
- Increased heart rate
- Blue colored skin, lips, fingernails or toenails
- Pneumonia may develop in the affected lung part (in this case pneumonia symptoms may manifest)
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Note – Severe trouble in breathing is an alarming sign. When it occurs one should seek immediate medical attention.
Causes of atelectasis can be broadly of two kinds –
1. Obstructive – occurs due to blocked airway. Few examples include –
- Mucus plug in the airway – occur commonly during and after surgery, and are common in children, patients of cystic fibrosis and severe asthma.
- Foreign body in the airway – happens when an object is inhaled into the lung and is common among children.
- Tumor inside the airway – can obviously narrow the airway.
2. Non-obstructive – occurs due to pressure on the airway from outside the lung. The below mentioned are common –
- Injury – chest trauma leading to compression of lungs
- Pleural effusion – condition in which the fluid builds up around the lungs and inside the chest wall
- Pneumothorax – condition in which air builds up between the linings of your lung and chest
- Pneumonia – is a lung infection
- Scarring of lung tissue – can occur due to lung disease, injury or surgery
- Surgery – atelectasis can happen during or after any surgical procedure
- Tumor – large size tumor can cause lung compression and deflate it
- Surfactant deficiency – Surfactant is a substance contained in the alveoli, it helps them stay open. Its deficiency is seen in infants born prematurely.
Apart from these, atelectasis can also be caused due to the effect of general anesthesia. Varying amount of atelectasis develops in almost everyone who has undergone major surgery.
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Types of Atelectasis
Types are broadly the same as mentioned in the causes i.e. obstructive and non-obstructive.
Non-obstructive Atelectasis is again of the below mentioned subtypes –
Relaxation or compressive – fluid or air building up between your chest wall lining and lung surface pulls the lungs inward. With this the alveoli lose air. Depending on the location of pathology it is either relaxation or compressive atelectasis
Adhesive – the alveoli will collapse if the surfactant is not made sufficiently.
Cicatricial – when the lung tissue has scars it does not hold as much air as they should. This can be seen in conditions like sarcoidosis.
Replacement – when alveoli are filled with tumor, particular area of the lung collapses.
Acceleration – the acceleration of jet planes can close the airways in the lungs. It causes difficulty in breathing, chest pain and cough.
Rounded (folded lung) – this is linked to pleural diseases. Asbestosis is one of the most common causes for this condition. (Read more)
Atelectasis as a complication
It occurs as a complication of other respiratory problems like –
- Chest injuries
- Fluid in the lungs
- Respiratory weakness
- Cystic fibrosis
It also occurs as a complication after surgery and when one breathes in a foreign object.
The below mentioned factors puts you at the risk of developing atelectasis:
- Lung diseases – COPD, asthma, cystic fibrosis etc
- Pain / injury – that makes cough painful or cause shallow breathing
- Weak breathing muscles – caused due to neuromuscular diseases, spinal cord injuries or muscle dystrophy
- Any condition that makes swallowing difficult
- Old age
- Confinement to bed
- Medicines that may cause shallow breathing
- Recent surgery – chest or abdominal surgery
- Recent general anesthesia
Complications of Atelectasis
- Hypoxemia – Low blood oxygen
- Respiratory failure
In children – keep the small objects out of reach. Keep an eye on children playing with toys and having pieces of nuts or hard eatables around them.
If a surgery has been planned, one should talk to the doctor about the post operative care and precautions to be taken to avoid these conditions. According to some research works, some kinds of breathing exercises and muscle training have reduced the risk of developing post-surgical atelectasis. The doctor / surgeon may help you in this regard.
You can use a spirometer as directed by your physician. It will promote proper breathing.
Read – Symptoms That Hint Towards Different Diseases In Babies
Atelectasis is diagnosed following a thorough examination by a doctor. Plain chest X-ray will suffice for the diagnosis. The below mentioned tests may help to confirm the diagnosis or to determine the type and severity of the condition.
- C T Scan
- Blood gas test
- Ultrasound of thorax
Principles – Treatment depends on the cause and severity of atelectasis.
- Mild cases may not need treatment at all.
- Sometimes mucus thinning medicines are helpful.
- If there is blockage, surgery or other treatments will be needed.
Chest physiotherapy – include techniques which help in breathing deeply after surgery. These would help to re-expand the collapsed lung tissue.
- Deep breathing exercises (incentive spirometry) – should be performed. To remove secretions and increase lung volume one may use devices to assist deep coughing.
- Postural drainage – Being in head low position (head lower than chest) allows mucus to drain better from the lungs.
- Percussion / chest tap – chest should be tapped over the collapsed area. This loosens the mucus.
- Mechanical mucus clearing devices – air pulse vibrator vest or hand held instruments may be used to clear the mucus from the lungs.
Surgery – The mucus is sucked or bronchoscopy conducted to remove the obstructions in the airway. Removal or shrinkage of tumor with or without radiation or chemotherapy is essential if tumor is involved in blocking the airways.
Breathing treatments – Sometimes a breathing tube may be needed. CPAP (Continuous positive airway pressure) will be needed when people cannot cough and have low oxygen after surgery.
Read – 31 Easy And Effective Home Remedies For Dyspnoea
Atelectasis – Ayurveda concept
Atelectasis cannot be compared to any single disorder explained in Ayurveda texts. Seeing the etiology and the pattern in which this disease develops and the range of symptoms it causes we can closely correlate atelectasis to few conditions explained in Ayurveda.
From the perspective of causes
1. Among the causes for obstructive atelectasis, the mucus plugs can be compared to increased kapha in the lungs. Chest is said to be the most important location of kapha and lungs are also located in chest cavity. Therefore there are more chances for kapha to undergo pathological increase in this region. Dyspnea and cough are mentioned among the signs of increase of kapha. These symptoms are also found in atelectasis. Kapha is made up of earth and water elements. When the earth element is proportionally increased the kapha tends to get hard and thick and forms plugs leading to blockage of airways.
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2. Among the non-obstructive causes –
- Injury or chest trauma and scarring of lung tissue – A condition called urakshata is caused by direct or indirect trauma to the chest. Urakshata in fact means chest injury. It should be treated on the lines of treating urakshata.
- Pleural effusion – can be viewed as increase of kapha in the chest, around the lungs. Here the water portion of kapha exceeds beyond its earth component.
- Pneumothorax – when the kapha which supports the chest organs, lungs in this context, get reduced, the vayu increases and troubles the organs. This condition can be considered as build up of pathological vayu around the lungs.
- Pneumonia – kshataja kasa, kshyaja kasa and rajayakshma can cause symptoms similar to those of pneumonia leading to manifestation of bronchitis.
- Tumor – arbuda has been explained in Ayurveda which explains various types of tumors. These can impart pressure on the respiratory passages and cause bronchitis.
- Surfactant deficiency – Avalambaka Kapha mentioned in Ayurveda, as a subtype of kapha is said to protect and support the chest organs. This can be compared to the surfactant. Deficiency of avalambaka kapha leads to lack of support to the lungs. The portion of lung not getting the support from kapha will obviously collapse.
Read – Charaka Kasa Chikitsa – 18th Chapter
From the perspective of symptoms
- When difficulty in breathing, rapid shallow breathing and wheezing are predominantly present in atelectasis, it can be considered similar to the explanation of svasa
- When cough is predominant it shall be considered similar to kasa
- Sharp chest pain, while taking deep breath or coughing is same as the explanation of kshataja kasa or urakshata.
- Blue colored skin, lips, fingernails or toenails
- When pneumonia develops in atelectasis it shall be considered on the lines of kasa, svasa and kshaya
From the perspective of complications
Hypoxemia, pneumonia and respiratory failure are the most important complications of atelectasis. These stages are difficult to handle as the symptoms are sever and aggressive. The symptoms of these conditions are probably collectively explained in the symptoms of vitiation of Pranavaha Srotas i.e. channels carrying vital life force or oxygen. They are – prolonged breathing, shortness of breath, difficulty in breathing, frequent and interrupted breathing, highly disturbed breathing patterns which look scary, abnormal sounds during breathing and painful breathing.
Read – Pranavaha Srotas: Channels Carrying Vital Life Element – Oxygen
These symptoms explain the complicated stage of atelectasis.
The complications of atelectasis leading to severe complications or at times death can be said to be due to injury of Sthanamula Marma located in the chest. These are the vital points located one on either side in the chest cavity, close to the lungs. Injury to this marma is said to cause cough severe breathlessness and gradual death. These marmas are anatomically compared to the lungs and base of the lungs.
Read – Sthanamoola Marma: Components, Location, Effect Of Injury
Treatment of atelectasis with Ayurveda interventions shall be done on the lines of one of the above said conditions mentioned above after having understood the causes and symptoms of atelectasis in an Ayurveda way. Many times combination of formulations and therapies will be needed. Depending on the cause and condition of atelectasis the treatment principles of the below mentioned conditions shall be skillfully administered.
- Kapha vriddhi / kshaya
- Avalambaka Kapha kshaya
- Kasa – kshataja, ksayaja
- Svasa – tamaka svasa
- Pranavaha Sroto Dushti Janya Vikara