Pulmonary emphysema is a progressive, chronic disease of the lungs, caused primarily by active and passive smoking and exposure to air pollution. It is characterized by irritation of the alveoli, the small air pockets in the lungs, causing difficulty in breathing. Damage to the lungs is incurable and life-threatening, as treatments can only slow the progression of the disease. Pulmonary emphysema and chronic bronchitis are now referred to as chronic obstructive pulmonary disease, known by the acronym COPD. These diseases claimed the lives of 3 million people around the world in 2012, or 6% of deaths from all causes. (1) In France in 2000, 1,7 million people were affected, i.e. 4,1% of the total population and 7,5% of those over 40. (2)

The most common symptoms of pulmonary emphysema, and more generally chronic obstructive pulmonary disease, are shortness of breath during daily activities (dyspnea), a feeling of lack of air and tightness in the chest, wheezing, chronic cough with coughing up large amounts of mucus, bluish discoloration of the lips and nail beds. Symptoms often do not appear until the disease is at an advanced stage, thus delaying the initiation of treatment and thus compromising the diagnosis.

In the lungs, the bronchi branch into thousands of thinner tubes called bronchioles that themselves end in clusters of tiny pockets of air, the alveoli. When air reaches these alveoli, oxygen passes into the blood through their irrigated walls in small blood vessels called capillaries. At the same time, carbon dioxide passes from the capillaries to the alveoli. It is the exchange of gas. Pulmonary emphysema is characterized by the progressive destruction of the pulmonary alveoli which allow this gas exchange during respiration.

Smoking, active and passive, alone explains more than 80% of COPD cases. (2) Regular exposure to poor air quality is the other major exogenous risk factor: air pollution in large urban centers, the presence of toxic products, dust and gas in the air at the place of work (foundry, iron and steel, building & public works…) and smoke in unsanitary habitats. Finally, it should be noted that, since smoking among women has caught up with that of men, this disease now affects both sexes equally.

There are also endogenous risk factors for pulmonary emphysema: frequent infections of the lower respiratory tract during childhood, as well as a hereditary and rare genetic predisposition, causing a deficiency in alpha-1-antitrypsin (AAT) proteins. ).

A lung function test (using a spirometry), a chest x-ray, and blood tests can help assess damage to the lungs. These are irreversible, because there is no curative treatment to date. But treating the symptoms can alleviate them and slow the progression of the disease.

It includes taking bronchodilators (with an inhaler) to open the airways and taking steroid drugs to fight inflammation. The treatment must also include a set of elements intended to improve the general state of health of the patient and to adopt an irreproachable hygiene of life, imperatively passing by the stopping of smoking, but also the adoption of a balanced diet. , maintaining a healthy weight and limiting exposure to stress. Pulmonary rehabilitation by physiotherapy and oxygen therapy may also be prescribed. As a last resort, surgery can intervene, by bullectomy, reduction of lung volume and lung transplantation.