Pulmonary emphysema: symptoms, treatment, cure

Pulmonary emphysema refers to a disease that affects the lungs. This serious condition is characterized by progressive destruction of the pulmonary alveoli. Pulmonary emphysema is a complication of chronic obstructive pulmonary disease (COPD) which affects 3.5 million French people. Tobacco being the main cause. What is pulmonary emphysema? What are the symptoms ? How do you put the diagnostic official ? What treatment to stop emphysema? What life expectancy? We take stock with the Dr Djamel Bennegadi, pulmonologist at the University Hospital of Melun (Seine-et-Marne).

Definition: what is pulmonary emphysema?

The term “emphysema” correspond to the presence of gas in a tissue at a location where it normally does not. The most frequently encountered emphysema is located at the level of the lungs. So, pulmonary emphysema is a pulmonary pathology which is defined by the progressive destruction of alveoli and blood vessels lungs. Pulmonary emphysema exists in different forms. It can be localized to a part of the lung or extend to the whole of the pulmonary apparatus.

What is the mechanism of occurrence of pulmonary emphysema?

The main cause of emphysema is smoking but exposure to chemicals may also be responsible. Tobacco or chemical substances gradually destroy the alveoli and blood vessels of the lungs. The distension of the alveoli thus caused prevents the expiration of the air they contain. Indeed, the alveoli are very small cavities that look like bags located at the end of a bronchiole, corresponding to the finest ramifications of the bronchi. “emphysema can be localized to a part of the lung or diffused to the whole of the pulmonary apparatus, 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. Gas exchange takes 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 load in oxygen and 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 types of pulmonary emphysema?

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 decreases 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, who are often overweight.

► During generalized panlobular emphysema, the alveoli and blood vessels are affected at the same time. Panlobular emphysema is rarer and affects younger, leaner subjects who are sometimes non-smokers.

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

What is the average age of pulmonary emphysema?

Emphysema is a pathology that most often begins from 50 years old.

What are the symptoms of pulmonary emphysema?

The manifestations of pulmonary emphysema are not specific to this pathology, which causes few manifestations during the first months of the disease. Gradually, this disease can become disabling and lead to chronic respiratory failure.

• THE main symptom East difficulty breathing most often felt during exercise and which gradually intensifies. Typically, breathing is faster and exhalation is longer. Mild breathing difficulty, such as shortness of breath or dyspneaappears gradually, mainly during efforts to become increasingly disabling and occur at rest.
• a pallor accompanied bytiredness and D’weight loss may appear.
• In cases of advanced emphysema, the pulmonary alveoli cease to function normally, which makes gas exchange and oxygenation of the body difficult. We then observe cyanosis of the lips (they turn blue) and a complete physical weakening due to shortness of breath.

What causes pulmonary emphysema?

COPD linked to chronic smoking remains the leading cause of emphysema. “It can also be the consequence of professional or domestic exposure to dust or chemical substances.“, explains the pulmonologist. Similarly, pollution can also be responsible. Remember that COPD causes irreversible lung damage which can cause severe and very debilitating complications such as chronic respiratory failure representing a real handicap in daily life due to the presence of permanent shortness of breath, significant fatigue, episodes of frequent bronchial superinfections requiring an oxygen supply and the need to be hospitalized for more or less long periods.

• A chronic, respiratory condition in childhood can cause emphysema.
• Emphysema can be linked in rare situations to a genetic anomaly that disrupts the proportion of enzymes present in the lungs.
• There tuberculosis is also a cause.
• THE smokingespecially when settled over very long years, from 15 to 20 years, is involved in about 85% of cases of emphysema.

What is the link between pulmonary emphysema and Covid?

A Coronavirus (Covid) infection can lead to emphysema. The most serious complication of contamination by the coronavirus is respiratory damage characterized by shortness of breath then significant breathing difficulties leading to emergency admission to an intensive care unit to benefit from being put on respirators.

Is emphysema cancer?

No, emphysema is not cancer but it can be a risk factor for bronchopulmonary cancer (BPC).

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

► A chest scan makes it possible 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 beginning of the disease, then find an anomaly of exchanges at the level of the lungs with an increase in the quantity of carbon dioxide and a reduction in the quantity of oxygen in the blood.

► A scintigraphy may also be recommended.

You can’t reverse the disease once it has spread.

COPD and emphysema are pathologies that are too often underdiagnosed because they begin in the majority of situations with manifestations that seem innocuous and very banal, such as a very mild cough accompanied by sputum or slight shortness of breath, often wrongly attributed to being overweight, lack of exercise or age. These manifestations can evolve very slowly for years before the patient feels real discomfort that will motivate him to consult or talk to his doctor. It can take years, sometimes 10 to 20 years, between the start of the appearance of the first manifestations and the significant and disabling discomfort caused by emphysema.

When to consult?

Do not hesitate to seek the advice of your doctor, especially if you are a smoker, when mild, apparently banal respiratory symptoms appear, such as shortness of breath or a cough with or without sputum. This will ask you to carry out an assessment (X-ray, EFR, blood gas, etc.) and will advise you to stop smoking, which remains the first attitude to adopt.

You can’t reverse the disease once it has spread

What is the treatment to stop pulmonary emphysema?

You can’t reverse the disease once it has spread, but we can slow it down and relieve symptoms. The first step is obviously to quit smoking. This is essential so that the disease does not spread in record time. A treatment based on bronchodilators is needed to increase the diameter of the bronchi as well as corticosteroids (to reduce inflammation), much like in the treatment of asthma. In an acute crisis, it may be necessary to resort to oxygen (mask or nasal goggles to inject oxygen) and nebulizations. This is why when we talk about emphysema, we often come across the image of a person attached to their oxygen cylinder, which must therefore always be close at hand. It is completed by respiratory physiotherapy sessions “Respiratory rehabilitation makes it possible to limit annoying shortness of breath with nutritional support, respiratory physiotherapy, etc.“, underlines the specialist. There are COPD schools on the national territory. Even if they do not treat the disease strictly speaking, these treatments can prove to be vital. By letting his respiratory capacity decrease, the patient risks have long-term cardiac complications.

When to consider an operation in case of pulmonary emphysema?

“In case of severe respiratory failure, a lung transplant can be tried 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 distention of the alveoli and therefore can no longer expand to breathe well. The ultimate recourse is a lung transplant if the clinical and functional conditions allow it.Fortunately, it is rarely necessary to reach that point.

What prevention to limit the risk of pulmonary emphysema?

To prevent pulmonary emphysema, it is necessary to quit smoking permanently. The ideal, to protect oneself, is not to start smoking, smoking being the first responsible for emphysema. In addition, it is necessary to prevent occupational exposure to certain chemicals.

What is the life expectancy with pulmonary emphysema?

It is estimated that the life expectancy for pulmonary emphysema is around 48 years for smokers and of 67 for non-smokers.

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