Pulmonary emphysema: symptoms, treatment, life expectancy

L’pulmonary emphysema is a serious condition characterized by progressive destruction of the pulmonary alveoli. It is a complication of the Chronic obstructive pulmonary disease (COPD) which affects 3.5 million French people. Tobacco being the main cause. Emphysema is a pathology that most often begins insidiously from the age of 50.

Definition: what is pulmonary emphysema?

Lpulmonary emphysema designates the distension of the pulmonary alveoli with destruction alveolar walls of the lungs. It can be localized to part of the lung or extend to the entire pulmonary system. “Emphysema can be localized to part of the lung or diffuse to the entire pulmonary system, punctual or more often chronic following numerous pulmonary pathologies such as COPD (chronic obstructive pulmonary disease), tuberculosis where the professional exhibitions“, 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 varying numbers in the lung, which reduces the volume of gas exchange between the alveoli and the blood.

► During centrilobular emphysema, only the alveoli are affected initially 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.

► During paralesional emphysema, the lesions develop near scars caused by previous illness.

What is the cause of pulmonary emphysema?

COPD 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, the pollution may also be responsible.

• A chronic and respiratory condition in childhood can also cause emphysema.
• Emphysema can be linked in rare situations to a genetic abnormality which disrupts the proportion of enzymes present in the lungs.
• There tuberculosis is also a cause.
• THE smokingespecially when it has been present for very long years, from 15 to 20 years, is involved in approximately 85% of cases of emphysema.

Emphysema can be a risk factor for bronchopulmonary cancer.

Tobacco and pulmonary emphysema

The main cause of emphysema is smoking.

→ Tobacco or chemical substances gradually destroy the alveoli and blood vessels of the lungs.

→ The distension of the alveoli thus caused prevents air from exhaling that 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. That allows the air contained in the alveolus to be charged with oxygen and to get rid of carbon dioxide so that 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. Little by little, the disease can lead to respiratory failure chronic.

• THE main symptom East respiratory discomfort most often felt during exercise and which gradually intensifies. Typically, breathing is faster and exhalation is longer. Slight respiratory discomfort, such as shortness of breath or dyspneaappears little by little, mainly during efforts to become more and more disabling and occurs at rest.
• A pallor accompanied bytiredness and D’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?

► There pulmonary radiography highlights a distended chest with horizontality of the ribs and diaphragm testifying to pulmonary distension, long expiration and slightly amplified inspiration accompanied by bronchial snoring (or groans).

► A chest 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.

► THE blood gasnormal 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 can also be recommended.

We cannot reverse the disease once it has spread.

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 symptoms.

1. The first measure consists to stop smoking. This is essential so that the disease does not spread in record time.
2. A treatment based on bronchodilators is necessary to increase the diameter of the bronchi as well as corticosteroids (to reduce inflammation), much like in the treatment of asthma.
3. In the event of an acute crisis, it may be necessary to resort to oxygen (mask or nasal goggles 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.
4. It is completed 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 last resort is a lung transplant. if clinical and functional conditions permit. Fortunately, it rarely has to come to this.

What prevention can be done to limit the risk of pulmonary emphysema?

To prevent pulmonary emphysema, it is necessary quit smoking permanently. The ideal, to protect yourself, is to do not start smokingsmoking being the primary cause of emphysema. Furthermore, 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 of 67 years for non-smokers.

Thanks to Dr Djamel Bennegadi, pulmonologist at Melun University Hospital (Seine-et-Marne).