Lung scarring, or pulmonary fibrosis, occurs when lung tissue becomes damaged and scarred, impairing lung function. This scarring can result from various conditions, including chronic inflammation, infections, or exposure to harmful substances. Symptoms include persistent cough and shortness of breath. Early diagnosis and management are crucial to slowing progression and improving quality of life. Lung scarring: Why does it happen and how serious is it?
The tissues of the lungs can get affected whenever there is inflammation (swelling) caused by a variety of reasons. These include infections, insults caused by noxious chemicals such as cigarette smoke, air pollution, abnormal tissue seen in lung cancers, or other rarer diseases such as lung fibrosis, often caused by pigeon exposure in India. When diagnosed at an early stage, and when treatment is instituted quickly, these lung changes are often transient and heal well, leaving behind almost no obvious evidence of damage.
However, when addressed at an advanced stage, or when not treated adequately, the healing can occur with scarring, which then persists for life.
When the scarring is in the tissues of the lung, these are called “sequelae” or fibrotic changes, which can lead to loss of lung function. The loss of lung function can manifest with shortness of breath, inability to perform activities that involve physical exertion, and an increased susceptibility to infections. “Scar cancer” is a term that is used for cancers developing in such scar tissues, possibly as a result of mutations that occur during the recurring insults that such tissue is prone to.
When the tubes of the lungs or the airways get scarred, they can remain abnormally distended, with poor defence mechanisms to prevent further injury, and this is called “bronchiectasis”. Bronchiectasis is fairly common in India, the commonest cause being the scarring after an infection such as tuberculosis. People with bronchiectasis can often produce sputum on a daily basis, reflecting an ongoing inflammation and poor local defence mechanisms. The inflamed tubes of the lungs are often inhabited by bacteria and fungi, which are difficult to eradicate. Bronchodilators (medications that help open up such inflamed tubes), mucolytics (medications that help liquefy phlegm) and physiotherapy to help drainage of secretions, assisted with “cough-assist devices” can help. What also helps is preventive measures such as vaccination for pneumococcal pneumonia, influenza and prompt use of antibiotics when indicated.
Scar tissue, whether in the lung substance or the tubes of the lungs tends to be friable, and even trivial infections can cause bleeding in such scars, and hemoptysis (coughing up blood) is a symptom that is not infrequent in patients with lung scars. Surgically removing such tissue is an option if the episodes recur, or are life-threatening.
Regenerative science for the lung is at its nascent stages, and the use of stem cells might hold some promise in the future. Currently, lungs once scarred remain scarred for life, and all our efforts are directed towards preventing further scarring and optimizing symptoms and lung function to help those with scars have a better quality of life. When approached with a preventive attitude, one can prevent scars with early initiation of treatment, and if already scarred, one can prevent the worsening of the scars with regular treatment.
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