Chronic obstructive pulmonary disease (COPD) is the main disease caused by cigarette smoke. It is one of the most frequent causes of debilitation and mortality in the world. In the course of this disease one observes progressive obstruction of the bronchi (small pipes that bring the air to our lungs) and a progressive destruction of the lung itself.
This lung destruction is called emphysema.
From normal to disease
Computed tomographic view of a normal lung
Computed tomographic view of a severe emphysema lung.
Breathing is difficult since air barely enters or exits the lung. Breathlessness appears first during strenuous exercises and then, as the disease progresses, occurs during less and less intense efforts (i.e. dressing, eating, speaking, taking a shower...). Limitation of exercise capacities severely affects the quality of life and may also be responsible for social isolation of the patients.
In emphysema patients, the lungs become so hyperinflated that the patient can’t even draw air into the lung.
Distended thorax (severe emphysema)>
Standard treatment of emphysema. Stop smoking. This is the first step ! Medication called broncho-dilators, usually administered via aerosols, can partly relief bronchial obstruction. Pulmonary rehabilitation plays a key role in stopping global muscular and cardio vascular deconditioning. The efficacy of theses treatments is unfortunately rather limited.
Surgical treatment of emphysema In selected patientsfrom , suffering emphysema lung volume reduction surgery (LVRS) can be proposed which consists in cutting away the most diseased areas of the lung, in order for the healthiest parts of the lung to have more room and to function better. In the most severe patients, lung transplantation may also be an option. These surgical procedures are unfortunately not widely proposed due to the surgical related mortality (death) and morbidity (complications) and to the limited number of donor lungs available for transplantation.
Minimally invasive treatment of emphysema. Several minimally invasive techniques aimed at reducing the effects of emphysema via the normal airways have recently been developed. These techniques are intended to be as effective as surgery but with much lesser risk of mortality and morbidity.
Two techniques have undergone high quality scientific studies but have unfortunately shown suboptimal results:
creating a airway bypass between emphysematous zones and the bronchial tree
blocking regional airflow via one way valves
Two other techniques are presently being developed and undergo scientific research:
Endoscopic application of biological glue or steam via the bronchial tree, resulting in shrinking of the damaged lung zones treated by this technique