Pulmonary emphysema is a serious condition that often begins around age 50.
Pulmonary emphysema is a pathology that most often begins after the age of 50 without making any noise. It is a complication of chronic obstructive pulmonary disease (COPD) which affects 3.5 million French people. It is a risk factor for bronchopulmonary cancer.
Definition: what is pulmonary emphysema?
Pulmonary emphysema is characterized by progressive destruction of the pulmonary alveoli (lungs). “Emphysema can be localized to a part of the lung or diffuse throughout the pulmonary system, punctual or more often chronic following numerous pulmonary pathologies such as COPD (chronic obstructive pulmonary disease), tuberculosis or occupational exposures.“, explains Dr Djamel Bennegadi, pulmonologist. There are several types of pulmonary emphysema:
► Bullous emphysema which is characterized by the presence of bubbles of different sizes and in variable numbers in the lung, which reduces the volume of gas exchange between the alveoli and the blood.
► During centrilobular emphysema, only the alveoli are initially affected with destruction of the central region of the pulmonary lobule. Centrilobular emphysema is the most common and affects smokers, often overweight.
► During generalized panlobular emphysema, the alveoli and blood vessels are affected at the same time. Panlobular emphysema is rarer and affects younger, thinner people who are sometimes non-smokers.
► In paralesional emphysema, lesions develop near scars caused by a previous disease.
What is the cause of pulmonary emphysema?
COPD, itself linked to chronic smoking, remains the primary cause of emphysema. “It can also be the consequence of professional or domestic exposure to dust or chemical substances.” explains the pulmonologist. Likewise, pollution can be responsible.
- A chronic, respiratory condition in childhood can also cause emphysema.
- Emphysema can be linked in rare situations to a genetic anomaly which disrupts the proportion of enzymes present in the lungs.
- Tuberculosis is also a cause.
- Smoking, especially when it lasts for very long years, from 15 to 20 years, is involved in approximately 85% of cases of emphysema.
Tobacco and pulmonary emphysema
The main cause of emphysema is smoking.
→ Tobacco or chemical substances gradually destroy the alveoli and blood vessels in the lungs.
→ The distension of the alveoli thus caused prevents the expiration of the air they contain. The alveoli are very small cavities which resemble bags located at the end of a bronchiole, corresponding to the finest ramifications of the bronchi. Gas exchanges take place at the level of the pulmonary alveoli through the alveolar wall by diffusion of oxygen and carbon dioxide. This allows the air contained in the alveolus to be charged with oxygen and to get rid of carbon dioxide so that the venous blood which is poor in oxygen (O2) and rich in carbon dioxide (CO2) is transformed into arterial blood richer in oxygen and poorer in carbon dioxide.
What are the symptoms of pulmonary emphysema?
Pulmonary emphysema causes few manifestations at first. Gradually, the disease can lead to chronic respiratory failure.
- The main symptom is respiratory difficulty felt most often during exercise and which gradually intensifies. Typically, breathing is faster and exhalation is longer. Slight respiratory discomfort, such as shortness of breath or dyspnea, appears little by little, mainly during efforts, becoming increasingly disabling and occurring at rest.
- Pallor accompanied by fatigue and weight loss may appear.
- In cases of advanced emphysema, the pulmonary alveoli stop functioning normally, making gas exchange and oxygenation of the body difficult. We then observe cyanosis of the lips (they turn blue) and complete physical weakening due to shortness of breath.
How is pulmonary emphysema diagnosed?
► Chest x-ray reveals a distended thorax with horizontality of the ribs and diaphragm reflecting pulmonary distension, long expiration and slightly amplified inspiration accompanied by bronchial snoring (or groans).
► A chest CT scan allows you to visualize the exact location of the emphysema as well as the lesions associated with it.
► A respiratory functional exploration, EFR, highlights an obstructive syndrome and an increase in residual volume.
► Blood gases, normal at the start of the disease, then find an abnormality of exchanges in the lungs with an increase in the quantity of carbon dioxide and a reduction in the quantity of blood oxygen.
► A scintigraphy may also be recommended.
What is the treatment to stop pulmonary emphysema?
We cannot reverse the disease once it has spread, but we can slow it down and relieve the symptoms.
- The first step is to stop smoking. This is essential so that the disease does not spread in record time.
- Treatment with bronchodilators is necessary to increase the diameter of the bronchi as well as corticosteroids (to reduce inflammation), much like in the treatment of asthma.
- In the event of an acute attack, it may be necessary to resort to oxygen (mask or nasal glasses allowing oxygen to be instilled) and nebulizations. This is why when we talk about emphysema, we often have the image of a person attached to their oxygen tank, which we must always have within reach.
- It is supplemented by respiratory physiotherapy sessions.Respiratory rehabilitation helps limit annoying shortness of breath with nutritional support, respiratory physiotherapy, etc.“, underlines the specialist.
When to consider an operation in case of pulmonary emphysema?
“In case of severe respiratory failure, a lung transplant can be attempted according to the pre-transplant functional assessment.“, adds Dr. Bennegadi. Surgery can be used to reduce the volume of the lungs, which have taken up too much space in the rib cage due to the distension of the alveoli and can therefore no longer expand to breathe properly. The ultimate The only recourse is lung transplantation if clinical and functional conditions permit. Fortunately, it is rarely necessary to reach this point.
What prevention can be done to limit the risk of pulmonary emphysema?
To prevent pulmonary emphysema, you must stop smoking permanently. The ideal way to protect yourself is not to start smoking, smoking being the primary cause of emphysema. In addition, it is necessary to prevent occupational exposure to certain chemical substances.
What is the life expectancy with pulmonary emphysema?
It is estimated that the life expectancy for pulmonary emphysema is around 48 years for smoking patients and 67 years for non-smokers.
Thanks to Dr Djamel Bennegadi, pulmonologist at Melun University Hospital (Seine-et-Marne).