OVERVIEW

What is atelectasis?

Atelectasis refers to a reduction in the volume or air content of a lung segment or lobe.

Due to bronchial narrowing or insufficient pulmonary surfactant, the affected lung tissue contracts, losing normal lung function, leading to atelectasis ^[1].

What are the types of atelectasis?

Atelectasis is generally divided into two types: obstructive atelectasis and non-obstructive atelectasis ^[2].

1. Obstructive atelectasis. Mainly caused by airway obstruction.

2. Non-obstructive atelectasis can be further classified into several types, the most common being compressive atelectasis, relaxation atelectasis, cicatricial atelectasis, acceleration atelectasis, rounded atelectasis, and segmental atelectasis.

   • Compressive atelectasis is primarily caused by pathological changes in adjacent lung organs;
   • Relaxation atelectasis is commonly seen in pleural effusion;
   • Cicatricial atelectasis is a sequela of chronic lung inflammation, with tuberculosis being the main form;
   • Acceleration atelectasis is more common in chest tissue collapse caused by vertical acceleration, mainly affecting pilots and patients with specific trauma;
   • Rounded atelectasis, also known as atelectatic pseudotumor, is associated with other pleural diseases;
   • Segmental atelectasis typically refers to the collapse of a specific lung segment, possibly due to bronchitis.

Is atelectasis contagious?

Atelectasis is generally not contagious because it is not caused by microorganisms or parasites. It mainly results from external pressure on the bronchi or bronchial lesions, so it is not infectious.

Can atelectasis heal on its own?

Atelectasis usually cannot heal on its own.

Atelectasis may be caused by inflammation, tuberculosis, or tumors, all of which require treatment for recovery. Only when the underlying condition improves can the collapsed lung area reopen. Therefore, atelectasis cannot resolve spontaneously.

Is atelectasis serious?

Atelectasis is not necessarily a severe condition. Its severity depends on the size of the affected lung area, whether it disrupts normal lung structure, and the extent of respiratory impairment ^[1].

If the atelectasis is limited to a small area and does not impair lung function, the patient may not exhibit noticeable symptoms and may not require intervention.

If the atelectasis affects a large area, symptoms such as chest tightness, shortness of breath, and difficulty breathing may occur, necessitating prompt medical evaluation.

If an entire lung lobe is collapsed and complicated by infections (e.g., fungal infections), leading to lung inflammation, mucosal damage, increased inflammatory secretions, and impaired secretion clearance, treatment may require prolonged antibiotic therapy. Additionally, measures must be taken to prevent respiratory failure due to airway obstruction, which could result in hypoxemia, hypercapnia, or life-threatening respiratory failure.

SYMPTOMS

What are the common manifestations of atelectasis?

The common manifestations of atelectasis usually include coughing, excessive phlegm, and other symptoms. Patients may also experience chest tightness, shortness of breath, fatigue, and difficulty breathing.

If the atelectasis is severe, patients may develop symptoms such as dyspnea, chest suffocation, and cyanosis of the lips.

Without timely treatment, the condition may gradually affect the heart, leading to diseases such as heart failure ^[1].

What serious consequences can atelectasis cause?

The severe consequences of atelectasis are related to the underlying disease, which may include tumors, mucus plugs, or foreign bodies ^[3].

1. Tumors. If the growth of a tumor is not actively managed, the compressed distal lung tissue may lack proper gas exchange or airflow.

2. Mucus plugs. After pulmonary infections such as pneumonia, delayed clearance of phlegm can lead to mucus plugs. These plugs may cause obstruction, resulting in bronchiolitis obliterans and impairing lung ventilation and gas exchange.

3. Foreign bodies. Severe cases caused by foreign bodies may lead to choking or a series of other serious adverse reactions.

If atelectasis persists for a long time, secondary infections may develop on top of it, causing bronchial damage and retention of inflammatory secretions. Over time, this can lead to bronchiectasis or lung abscesses.

CAUSES

What are the causes of atelectasis?

Atelectasis may be caused by bronchial obstruction, space-occupying lesions in the chest, etc. ^[1].

1. Bronchial obstruction. The most common cause of atelectasis is bronchial obstruction. When a bronchus is blocked, external air cannot enter the alveoli, and the original gas in the alveoli is absorbed, leading to alveolar collapse. Additionally, the lungs gradually shrink, reducing oxygen concentration. Over time, capillaries may leak, eventually causing atelectasis. Diseases that can lead to bronchial obstruction include various tumors, lung infections, chronic obstructive pulmonary disease (COPD), asthma, acute bronchitis, or trauma.

2. Space-occupying lesions in the chest. Conditions such as pleural effusion, emphysema, diaphragmatic hernia, or massive ascites can compress the lungs, reducing functional residual gas and resulting in atelectasis.

Who is prone to atelectasis?

People susceptible to atelectasis mainly include children, the elderly, those with respiratory infections, and individuals undergoing major abdominal surgery.

1. Children. Atelectasis in children is often caused by foreign body aspiration. Most affected children exhibit symptoms like choking, coughing, or gagging, but milder cases may go unnoticed.

2. The elderly. Atelectasis in older adults is primarily caused by tumors such as lung cancer, manifesting as coughing. Patients with recurrent asthma may also develop lung tissue damage if untreated, increasing the risk of atelectasis.

3. Individuals with respiratory infections. Atelectasis is associated with respiratory abnormalities. Persistent acute or chronic respiratory infections can lead to poor breathing, bronchial deformation, and increased susceptibility to atelectasis.

4. Patients undergoing major abdominal surgery. Postoperative pain, restricted breathing, or difficulty expelling mucus can block bronchi and cause atelectasis. Additionally, impaired bronchial mucosal function and excessive mucus accumulation in the airways after surgery may also contribute to atelectasis.

DIAGNOSIS

What symptoms of atelectasis require medical attention?

Medical attention is usually required when mild chest discomfort, difficulty breathing, or other accompanying symptoms occur.

1. Mild chest discomfort. If atelectasis is mild, the patient may have no obvious symptoms or only mild chest discomfort. Once aware of this discomfort, seek medical attention immediately to eliminate potential risks and ensure health.

2. Difficulty breathing. Severe atelectasis may cause difficulty breathing, especially after overexertion. It may also be accompanied by symptoms such as shortness of breath, chest pain, cyanosis, chest tightness, palpitations, or dry cough.

3. Other accompanying symptoms. If atelectasis or the underlying disease is not treated promptly, secondary infections may occur, leading to symptoms like chest pain, chills, hemoptysis, tachycardia, shallow breathing, or even respiratory arrest. These indicate severe illness and require immediate medical attention.

What tests are needed to diagnose atelectasis?

Diagnosing atelectasis generally requires imaging tests, pulmonary function tests, bronchoscopy, blood tests, etc.

1. Imaging tests. Atelectasis is often detected through X-rays and CT scans. Both can provide lung images to determine if atelectasis is present. X-rays are the most reliable diagnostic method.

2. Pulmonary function tests. These tests assess whether lung ventilation is abnormal and determine the extent of lung tissue damage, aiding in diagnosis.

3. Bronchoscopy. This helps evaluate the affected lung lobes and segments, providing a basis for surgical treatment. Additionally, bronchoscopic interventions, such as stent placement, can relieve airway obstruction or open narrowed bronchi under external pressure to re-expand collapsed lung tissue. Bronchoscopy is crucial for identifying the underlying cause of atelectasis.

4. Blood tests. These can detect inflammation or increased lymphocytes (as seen in tuberculosis), among other indicators.

TREATMENT

Does atelectasis require treatment?

Atelectasis requires treatment. If left untreated, it may lead to respiratory failure, emphysema, lung infections, and other conditions ^[1].

1. Respiratory failure. Atelectasis affects ventilation, often causing chest tightness and difficulty breathing. Severe atelectasis can impair gas exchange, leading to respiratory failure, severe hypoxia, carbon dioxide retention, and metabolic acidosis.

2. Emphysema. This frequently occurs with atelectasis, causing chest distension and shortness of breath after minimal activity. Chest X-rays may show increased translucency. Untreated, it can worsen and become life-threatening.

3. Lung infections. Clinically, atelectasis often results from bronchial obstruction due to inflammation or tumors, leading to secondary infections that disrupt organ function.

What are the treatment options for atelectasis?

Treatment depends on the underlying cause ^[2].

1. For acute bronchial obstruction (e.g., foreign bodies). Suction or bronchoscopy can clear blockages to reinflate the lung, supplemented by oxygen therapy to correct metabolic disturbances. External causes like pneumothorax, pleural effusion, or tumors may require surgery or thoracentesis.

2. For chronic atelectasis with mucus obstruction. Techniques like postural drainage (head down, feet elevated) and chest percussion help expel mucus.

   Bronchial/lung diseases with atelectasis often involve infections. Treat primary conditions alongside antibiotics (e.g., penicillin like amoxicillin-clavulanate or tetracyclines). Bacterial sputum cultures guide targeted antibiotic selection.

DIET & LIFESTYLE

What are the lifestyle precautions for patients with atelectasis?

Patients with atelectasis should pay attention to daily care and dietary adjustments.

1. Daily care. Patients need to avoid respiratory infections, protect lung function, strengthen breathing and muscle exercises, and enhance nutritional support. At the same time, patients should maintain clear airways, frequently pat their backs, and expectorate phlegm.

2. Dietary adjustments. Patients should increase the intake of nutrients in daily life, such as a high-protein, high-calorie diet rich in vitamins and low in sugar. Additionally, consuming more fiber-rich foods helps maintain regular bowel movements.

Special attention should be paid to postoperative fever patients, who are advised not to overuse analgesics. Moderate aerobic exercise is recommended to enhance cardiopulmonary function.

How can family members assist patients in relieving discomfort?

Family members can help patients relieve discomfort by providing environmental care, reminding them of follow-up visits, and medication adherence.

1. Environmental care. Ensure the patient has a quiet and comfortable environment. Patient-centered care, such as playing TV or light, pleasant music, can help them feel the warmth of home. Additionally, encourage patients to maintain daily living and work abilities, engage socially, and face reality.

2. Reminding follow-up visits. Family members should regularly take the patient to the hospital for check-ups, typically once a month. Seek medical attention promptly if special circumstances arise. Watch for signs of recurrence and other persistent abnormal symptoms.

3. Medication reminders. Family members should supervise the patient to take medication on time. Medications may be stored by the family, and patients should not stop or reduce doses arbitrarily to avoid delaying recovery.

PREVENTION

Can Atelectasis Be Prevented? How to Prevent It?

Some risk factors for atelectasis can be mitigated by changing behaviors or lifestyle to avoid the disease or its recurrence. Specific prevention methods include actively treating underlying conditions, avoiding iatrogenic factors, quitting smoking, and regular health checkups.

1. Actively Treat Underlying Conditions: Seek early and scientific treatment for diseases that may lead to atelectasis, and strictly follow medical advice regarding medication.
2. Avoid Iatrogenic Factors: Choose reputable medical institutions for examinations and treatment, minimize the use of anesthetics, and reduce painkiller intake, as these drugs can suppress the cough reflex.
3. Quit Smoking: Heavy smoking may directly increase the risk of postoperative atelectasis, so patients are encouraged to quit smoking.
4. Regular Health Checkups: Middle-aged and elderly individuals should undergo regular health examinations, especially respiratory system checks, and seek medical attention promptly if discomfort arises.