{"id":24535,"date":"2026-02-28T22:54:08","date_gmt":"2026-03-01T02:54:08","guid":{"rendered":"https:\/\/cliniqueomicron.ca\/emphyseme\/"},"modified":"2026-03-08T14:30:12","modified_gmt":"2026-03-08T18:30:12","slug":"emphysema","status":"publish","type":"page","link":"https:\/\/cliniqueomicron.ca\/en\/emphyseme\/","title":{"rendered":"Emphysema: causes, symptoms and treatment | Clinique Omicron"},"content":{"rendered":"
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\n\t\t\t\t\t\n\n\n\n\nEmphysema: causes, symptoms and treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Emphysema is the permanent destruction of the pulmonary alveoli, caused mainly by smoking. Diagnosis, spirometry, bronchodilators and management in Quebec.\">\n<meta name=\"keywords\" content=\"emphys\u00e8me traitement, emphys\u00e8me pulmonaire sympt\u00f4mes, emphys\u00e8me tabagisme BPCO, emphys\u00e8me diagnostic spirom\u00e9trie, emphys\u00e8me bronchodilatateurs, d\u00e9ficit alpha-1 antitrypsine emphys\u00e8me, emphys\u00e8me oxyg\u00e9noth\u00e9rapie, emphys\u00e8me Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n.co-wrap * { font-family: 'Poppins', sans-serif; box-sizing: border-box; }\n.co-wrap { max-width: 1100px; margin: 0 auto; padding: 30px 0 60px; }\n.co-label { font-family: 'Cinzel', serif; font-size: 14px; font-weight: bold; letter-spacing: 1px; text-transform: uppercase; color: #4D6577; margin-bottom: 14px; display: block; }\n.co-wrap h1 { font-size: 32px; font-weight: 500; color: #323C52; margin: 0 0 22px; line-height: 1.2; }\n.co-intro { font-size: 16px; line-height: 1.75; color: #4D6577; margin-bottom: 36px; padding-bottom: 32px; border-bottom: 1px solid rgba(77,101,119,.2); }\n.co-wrap h2 { font-size: 20px; font-weight: 600; color: #323C52; margin: 32px 0 12px; }\n.co-wrap p { font-size: 15px; color: #4D6577; line-height: 1.7; margin-bottom: 14px; }\n.co-list { list-style: none; padding: 0; margin: 12px 0 24px; }\n.co-list li { font-size: 15px; color: #4D6577; padding: 10px 14px 10px 38px; margin-bottom: 8px; border-radius: 6px; position: relative; background: rgba(77,101,119,.06); border-left: 3px solid #4D6577; }\n.co-list li::before { content: \"\u2713\"; position: absolute; left: 12px; font-weight: 700; color: #4D6577; }\n.co-table { width: 100%; border-collapse: collapse; margin: 14px 0 22px; font-size: 14px; border-radius: 8px; overflow: hidden; table-layout: fixed; }\n.co-table thead tr { background: #323C52; color: #fff; }\n.co-table thead th { padding: 11px 16px; text-align: left; font-weight: 600; font-size: 13px; }\n.co-table tbody tr:nth-child(even) { background: rgba(77,101,119,.06); }\n.co-table tbody tr:nth-child(odd) { background: #fff; }\n.co-table td { padding: 10px 16px; color: #4D6577; border-bottom: 1px solid rgba(77,101,119,.12); font-size: 14px; vertical-align: top; }\n.co-table td:first-child { font-weight: 600; color: #323C52; }\n.co-infobox { display: flex; gap: 12px; background: rgba(77,101,119,.06); border-radius: 8px; border-left: 4px solid #4D6577; padding: 14px 18px; margin: 18px 0 28px; font-size: 14px; color: #4D6577; line-height: 1.65; }\n.co-infobox .ico { font-size: 18px; flex-shrink: 0; }\n.co-urgence { background: #fff8f8; border-left: 5px solid #c0392b; border-radius: 6px; padding: 20px 26px; margin: 24px 0 32px; }\n.co-urgence .co-urgence-titre { font-size: 13px; font-weight: 700; color: #c0392b; letter-spacing: 1.5px; text-transform: uppercase; margin-bottom: 10px; }\n.co-urgence p { color: #5a2020; font-size: 14px; margin: 0 0 10px; line-height: 1.7; }\n.co-urgence p:last-child { margin-bottom: 0; }\n.co-disclaimer { font-size: 13px; color: #8a9aaa; font-style: italic; border-top: 1px solid rgba(77,101,119,.15); padding-top: 24px; margin-top: 40px; line-height: 1.6; }\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Pneumologie & M\u00e9decine interne & M\u00e9decine de famille<\/span>\n <h1>Emphys\u00e8me pulmonaire<\/h1>\n\n <div class=\"co-intro\">\n L'emphys\u00e8me pulmonaire est d\u00e9fini anatomopathologiquement comme une destruction permanente et irr\u00e9versible des parois alv\u00e9olaires \u2014 sans fibrose significative \u2014 entra\u00eenant un \u00e9largissement anormal et permanent des espaces a\u00e9riens distaux situ\u00e9s en aval des bronchioles terminales. Cette destruction aboutit \u00e0 une perte de la surface d'\u00e9change gazeux (surface alv\u00e9olaire normale : 70\u2013100 m\u00b2 \u2192 r\u00e9duite \u00e0 20\u201330 m\u00b2 dans les formes avanc\u00e9es), une r\u00e9duction de l'\u00e9lasticit\u00e9 pulmonaire et un collapsus expiratoire pr\u00e9matur\u00e9 des petites voies a\u00e9riennes (trappage a\u00e9rien) \u2192 hyperinflation pulmonaire statique et dynamique \u2192 limitation des d\u00e9bits expiratoires \u2192 dyspn\u00e9e progressive. L'emphys\u00e8me constitue, avec la bronchite chronique, l'une des deux composantes anatomiques principales de la bronchopneumopathie chronique obstructive (BPCO) \u2014 bien que les deux entit\u00e9s coexistent fr\u00e9quemment, l'emphys\u00e8me pr\u00e9domine dans le ph\u00e9notype dit \u00ab pink puffer \u00bb (patient maigre, dyspn\u00e9ique au premier plan, peu d'hypers\u00e9cr\u00e9tion bronchique, PaO\u2082 relativement pr\u00e9serv\u00e9e au repos, PaCO\u2082 normale ou basse). La cause principale et de loin pr\u00e9dominante est le tabagisme actif (responsable de 85\u201390 % des cas) \u2014 l'inhalation de fum\u00e9e de tabac active les macrophages alv\u00e9olaires et les neutrophiles \u2192 lib\u00e9ration de prot\u00e9ases (\u00e9lastase, m\u00e9talloprot\u00e9ases \u2014 MMP-9, MMP-12) \u2192 destruction de l'\u00e9lastine et du collag\u00e8ne des parois alv\u00e9olaires \u2014 processus aggrav\u00e9 par l'inactivation des antiprot\u00e9ases endog\u00e8nes (alpha-1 antitrypsine) par les radicaux libres de la fum\u00e9e de tabac. Le d\u00e9ficit en alpha-1 antitrypsine (AAT) \u2014 mutation Z (PiZZ) du g\u00e8ne SERPINA1 \u2014 repr\u00e9sente la cause g\u00e9n\u00e9tique la plus fr\u00e9quente d'emphys\u00e8me (1\u20132 % des cas de BPCO) et doit \u00eatre syst\u00e9matiquement recherch\u00e9 chez tout patient emphys\u00e9mateux jeune (<45 ans), non-fumeur ou avec pr\u00e9dominance basale de l'emphys\u00e8me au scanner. Au Qu\u00e9bec, la BPCO touche environ 8\u201310 % de la population adulte de plus de 40 ans et est la 3e cause de mortalit\u00e9 par maladie chronique apr\u00e8s les maladies cardiovasculaires et le cancer.\n <\/div>\n\n <h2>Physiopathologie, types anatomiques et pr\u00e9sentation clinique<\/h2>\n <ul class=\"co-list\">\n <li><strong>Types anatomiques d'emphys\u00e8me :<\/strong> centrolobular (centro-acinar) emphysema - most frequent - destruction of respiratory bronchioles and proximal alveolar ducts \u2192 predominance in the upper lobes \u2192 directly linked to smoking; panlobular (pan-acinar) emphysema - uniform destruction of the entire acinus \u2192 predominance in the lower lobes \u2192 characteristic of AAT deficiency (PiZZ) but also observed in advanced stages of smoking ; paraseptal (subpleural) emphysema - destruction of distal alveoli near interlobular septa and pleura \u2192 subpleural bullae \u2192 risk of spontaneous pneumothorax (especially in tall, slender young adults); cicatricial (paracicatricial) emphysema - around fibrotic lesions (tubercular sequelae, silicosis)<\/li>\n <li><strong>Pr\u00e9sentation clinique et \u00e9volution :<\/strong> progressive exertional dyspnoea (cardinal symptom - insidious, often trivialized by the patient for years) \u2192 rest dyspnoea in advanced stages; progressive limitation of daily activities (mMRC scale: grade 0 to 4); chronic productive cough if associated chronic bronchitis (absent or only slightly marked in pure emphysema); thoracic distension (barrel chest, hypersonority on percussion, diminished vesicular murmurs, prolonged expiration pursed lips); signs of hyperinflation: horizontalized ribs, flattened diaphragms, enlarged retrosternal space on radiography; weight loss, muscle wasting (respiratory cachexia) in advanced stages; cyanosis and digital hippocratism rare in pure emphysema (more frequent in hypercapnic chronic bronchitis)<\/li>\n <li><strong>Complications :<\/strong> Acute exacerbations of COPD (AEBPD) - acute worsening of dyspnea + increase in secretions + change in their appearance - triggered by viral infections (rhinovirus, influenza - 50-70 %) or bacterial infections (<em>H. influenzae<\/em>, <em>M. catarrhalis<\/em>, <em>S. pneumoniae<\/em>) ou par la pollution ; pneumothorax spontan\u00e9 secondaire (rupture de bulles sous-pleurales \u2014 urgence) ; hypertension pulmonaire (HTP) secondaire \u2192 cor pulmonale \u2192 insuffisance cardiaque droite (\u0153d\u00e8mes, turgescence jugulaire, h\u00e9patom\u00e9galie) ; insuffisance respiratoire chronique hypox\u00e9mique (PaO\u2082 <60 mmHg au repos \u2192 indication d'oxyg\u00e9noth\u00e9rapie longue dur\u00e9e \u2014 OLD) ; polyglobulie secondaire (compensation de l'hypox\u00e9mie chronique)<\/li>\n <li><strong>D\u00e9ficit en alpha-1 antitrypsine (AAT) :<\/strong> g\u00e8ne SERPINA1 \u2014 prot\u00e9ase inhibitrice h\u00e9patique \u2192 taux s\u00e9rique normal AAT : 1,0\u20132,0 g\/L ; g\u00e9notype PiZZ \u2192 AAT <0,5 g\/L \u2192 emphys\u00e8me panlobulaire pr\u00e9dominant aux bases + h\u00e9patopathie (cirrhose \u2014 10\u201315 % des adultes PiZZ) + vasculite (rarement) ; \u00e2ge de d\u00e9but : 30\u201350 ans chez les fumeurs PiZZ, 50\u201360 ans chez les non-fumeurs PiZZ ; d\u00e9pistage : dosage s\u00e9rique AAT + ph\u00e9notypage (iso\u00e9lectrofocalisation) ou g\u00e9notypage (PCR all\u00e8les S et Z) ; traitement sp\u00e9cifique : perfusion IV d'AAT purifi\u00e9e humaine (Prolastin, Zemaira) \u2014 60 mg\/kg\/semaine \u2014 ralentit la progression chez les PiZZ avec VEMS 35\u201360 % pr\u00e9dit (RAPID trial \u2014 Chapman 2015 \u2014 NEJM)<\/li>\n <\/ul>\n\n <h2>Diagnosis and treatment<\/h2>\n <table class=\"co-table\">\n <colgroup><col style=\"width:200px;\"><col style=\"width:42%;\"><col><\/colgroup>\n <thead>\n <tr><th>Appearance \/ Treatment<\/th><th>Mechanism, technique and procedures<\/th><th>Interpr\u00e9tation, cibles et pr\u00e9cautions<\/th><\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Spirom\u00e9trie post-bronchodilatateur<br><small style=\"font-weight:400;color:#7a8fa0;\">Gold standard diagnostic BPCO\/emphys\u00e8me<\/small><\/td>\n <td>Mesure des volumes et d\u00e9bits pulmonaires apr\u00e8s administration d'un bronchodilatateur \u00e0 courte dur\u00e9e d'action (salbutamol 400 \u00b5g) ; param\u00e8tres cl\u00e9s : VEMS (volume expiratoire maximal en 1 seconde) ; CVF (capacit\u00e9 vitale forc\u00e9e) ; rapport VEMS\/CVF ; BPCO confirm\u00e9e si VEMS\/CVF <0,70 post-bronchodilatateur (crit\u00e8res GOLD 2023) ; s\u00e9v\u00e9rit\u00e9 selon VEMS % pr\u00e9dit : GOLD 1 \u226580 % (l\u00e9ger) ; GOLD 2 50\u201379 % (mod\u00e9r\u00e9) ; GOLD 3 30\u201349 % (s\u00e9v\u00e8re) ; GOLD 4 <30 % (tr\u00e8s s\u00e9v\u00e8re) ; emphys\u00e8me sp\u00e9cifique : augmentation du volume r\u00e9siduel (VR) + capacit\u00e9 pulmonaire totale (CPT) + VR\/CPT >40 % (hyperinflation) + diminution de la DLCO (capacit\u00e9 de diffusion du CO \u2014 refl\u00e8te la perte de surface alv\u00e9olaire \u2014 tr\u00e8s sensible pour l'emphys\u00e8me)<\/td>\n <td>La spirom\u00e9trie est sous-utilis\u00e9e en m\u00e9decine de premi\u00e8re ligne au Qu\u00e9bec \u2014 d\u00e9pistage recommand\u00e9 chez tout fumeur ou ex-fumeur \u226540 ans avec dyspn\u00e9e ou toux chronique (GOLD 2023 + SPLF) ; le rapport VEMS\/CVF <0,70 fixe est critiqu\u00e9 chez les sujets \u00e2g\u00e9s (surestimation de la BPCO \u2014 utiliser le rapport LLN \u2014 Lower Limit of Normal \u2014 bas\u00e9 sur les \u00e9quations de r\u00e9f\u00e9rence GLI-2012) ; la r\u00e9versibilit\u00e9 partielle au bronchodilatateur n'exclut pas la BPCO ni l'emphys\u00e8me (contrairement \u00e0 l'asthme pur \u2014 r\u00e9versibilit\u00e9 compl\u00e8te) ; pl\u00e9thysmographie corporelle pour la mesure pr\u00e9cise des volumes pulmonaires statiques (VR, CPT) si spirom\u00e9trie insuffisante<\/td>\n <\/tr>\n <tr>\n <td>TDM thoracique haute r\u00e9solution (HRCT)<br><small style=\"font-weight:400;color:#7a8fa0;\">Quantification et ph\u00e9notypage de l'emphys\u00e8me<\/small><\/td>\n <td>Scanner thoracique sans injection en coupes millim\u00e9triques (HRCT) : visualisation directe des zones de destruction alv\u00e9olaire \u2192 plages hypodenses sans paroi visible (emphys\u00e8me centrolobulaire : distribution centro-lobulaire pr\u00e9dominant aux apex ; panlobulaire : destruction diffuse des lobes inf\u00e9rieurs \u2014 AAT) ; score de densitom\u00e9trie pulmonaire : pourcentage de voxels <\u2212950 UH (unit\u00e9s Hounsfield) \u2192 quantification objective de l'emphys\u00e8me (corr\u00e9lation avec la DLCO et le VEMS) ; d\u00e9tection des bulles d'emphys\u00e8me (zones a\u00e9riques >1 cm) ; \u00e9valuation des bronches (\u00e9paississement pari\u00e9tal bronchique = bronchite chronique), de l'air trapping en expiration, des nodules pulmonaires (d\u00e9pistage cancer du poumon)<\/td>\n <td>Indication du TDM : confirmation diagnostique si spirom\u00e9trie \u00e9quivoque + bilan pr\u00e9op\u00e9ratoire (chirurgie de r\u00e9duction de volume ou transplantation) + d\u00e9pistage cancer poumon (LDCT \u2014 low dose CT \u2014 recommand\u00e9 annuellement pour les fumeurs 50\u201380 ans avec \u226520 paquets-ann\u00e9es \u2014 USPSTF 2021 + programme qu\u00e9b\u00e9cois en d\u00e9veloppement) + \u00e9valuation des bulles pour bullectomie + suspicion d'AAT (pr\u00e9dominance basale) ; la TDM n'est pas recommand\u00e9e syst\u00e9matiquement pour le diagnostic de BPCO \u2014 la spirom\u00e9trie reste l'outil de r\u00e9f\u00e9rence<\/td>\n <\/tr>\n <tr>\n <td>Bronchodilatateurs inhal\u00e9s \u2014 BACA, LABA, LAMA<br><small style=\"font-weight:400;color:#7a8fa0;\">Basic pharmacological treatment<\/small><\/td>\n <td>Bronchodilatateurs \u00e0 courte dur\u00e9e d'action (BACA) : salbutamol (Ventolin) 100 \u00b5g\/bouff\u00e9e \u2014 1\u20132 bouff\u00e9es au besoin (soulagement symptomatique rapide \u2014 d\u00e9lai 5 min \u2014 dur\u00e9e 4\u20136h) ; bronchodilatateurs \u00e0 longue dur\u00e9e d'action b\u00eata-2 (LABA) : formot\u00e9rol (Foradil) 12 \u00b5g\/capsule 1\u00d7\/j ou salm\u00e9t\u00e9rol (Serevent) 50 \u00b5g 2\u00d7\/j \u2014 dur\u00e9e 12h ; indacat\u00e9rol (Onbrez) 150\u2013300 \u00b5g 1\u00d7\/j \u2014 dur\u00e9e 24h ; bronchodilatateurs anticholinergiques \u00e0 longue dur\u00e9e d'action (LAMA) : tiotropium (Spiriva) 18 \u00b5g 1\u00d7\/j \u2014 r\u00e9duit l'hyperinflation dynamique, am\u00e9liore la tol\u00e9rance \u00e0 l'effort, r\u00e9duit les exacerbations (UPLIFT trial \u2014 Tashkin 2008 \u2014 NEJM) ; um\u00e9clidinium (Incruse) 62,5 \u00b5g 1\u00d7\/j ; glycopyrronium (Seebri) 50 \u00b5g 1\u00d7\/j ; double bronchodilatation LABA+LAMA (um\u00e9clidinium\/vilant\u00e9rol Anoro ; indacat\u00e9rol\/glycopyrronium Ultibro ; formot\u00e9rol\/aclidinium Duaklir) : sup\u00e9rieure \u00e0 la monoth\u00e9rapie sur les sympt\u00f4mes et les exacerbations (FLAME trial \u2014 Wedzicha 2016 \u2014 NEJM)<\/td>\n <td>Strat\u00e9gie th\u00e9rapeutique GOLD 2023 selon le groupe ABCD (sympt\u00f4mes \u2014 score mMRC\/CAT \u2014 + risque d'exacerbations) : groupe A (peu symptomatique, faible risque) \u2192 BACA au besoin ou LABA ou LAMA ; groupe B (symptomatique, faible risque) \u2192 LABA + LAMA d'embl\u00e9e ; groupe E (risque \u00e9lev\u00e9 d'exacerbations) \u2192 LABA + LAMA \u00b1 CSI si \u00e9osinophiles sanguins \u2265300\/\u00b5L ou si asthme-BPCO overlap ; corticost\u00e9ro\u00efdes inhal\u00e9s (CSI) : non recommand\u00e9s en monoth\u00e9rapie dans la BPCO \u2014 utilis\u00e9s en triple th\u00e9rapie (LABA + LAMA + CSI) si \u00e9osinophiles \u2265300\/\u00b5L + exacerbations fr\u00e9quentes (IMPACT trial \u2014 Lipson 2018 \u2014 NEJM \u2014 r\u00e9duction exacerbations 15 % vs double bronchodilatation)<\/td>\n <\/tr>\n <tr>\n <td>R\u00e9habilitation respiratoire et cessation tabagique<br><small style=\"font-weight:400;color:#7a8fa0;\">The most effective interventions for survival<\/small><\/td>\n <td>Cessation tabagique : intervention la PLUS efficace pour ralentir la progression de l'emphys\u00e8me et r\u00e9duire la mortalit\u00e9 (Lung Health Study \u2014 Anthonisen 1994 \u2014 JAMA \u2014 r\u00e9duction de 50 % de la d\u00e9croissance annuelle du VEMS) ; approche multimodale : counseling motivationnel (5A \u2014 Ask, Advise, Assess, Assist, Arrange) + th\u00e9rapie de remplacement nicotinique (TRN \u2014 timbres, gommes, inhalateurs) + var\u00e9nicline (Champix \u2014 1 mg \u00d7 2\/j \u00d7 12 semaines \u2014 NNT 5\u20136 \u2014 1re ligne CPAM 2023) + bupropion (Zyban \u2014 150 mg \u00d7 2\/j \u2014 2e ligne) ; r\u00e9habilitation respiratoire (RR) : programme multidisciplinaire supervis\u00e9 (8\u201312 semaines minimum) \u2014 exercice a\u00e9robie + renforcement musculaire + \u00e9ducation + soutien psychosocial + nutritionnel \u2192 am\u00e9lioration significative de la dyspn\u00e9e (score Borg), de la tol\u00e9rance \u00e0 l'effort (TM6 \u2014 test de marche de 6 min) et de la qualit\u00e9 de vie (St. George's Respiratory Questionnaire) \u2014 Cochrane McCarthy 2015 \u2014 b\u00e9n\u00e9fice maintenu 12\u201318 mois<\/td>\n <td>La r\u00e9habilitation respiratoire est sous-r\u00e9f\u00e9r\u00e9e au Qu\u00e9bec malgr\u00e9 son niveau de preuve (A \u2014 GOLD 2023) \u2014 accessible dans les centres hospitaliers universitaires et certains GMF-U ; la RR est rembours\u00e9e par la RAMQ dans le cadre de programmes sp\u00e9cifiques ; nutritionnel : correction de la malnutrition (IMC cible \u226521 kg\/m\u00b2) + suppl\u00e9mentation prot\u00e9ique si masse musculaire r\u00e9duite \u2192 am\u00e9liore la survie ; vaccinations : influenza annuel + pneumocoque (PCV20 ou PPV23 + PCV13 \u2014 r\u00e9duction des exacerbations infectieuses) + COVID-19 + Tdca<\/td>\n <\/tr>\n <tr>\n <td>Oxyg\u00e9noth\u00e9rapie longue dur\u00e9e (OLD) et interventions chirurgicales<br><small style=\"font-weight:400;color:#7a8fa0;\">Stades avanc\u00e9s \u2014 GOLD 3\u20134<\/small><\/td>\n <td>OLD : indiqu\u00e9e si PaO\u2082 \u226455 mmHg au repos (ou \u226459 mmHg avec polyglobulie ou cor pulmonale) mesur\u00e9e 2 fois \u00e0 3 semaines d'intervalle en \u00e9tat stable \u2192 objectif SaO\u2082 \u226590 % (PaO\u2082 60\u201365 mmHg) \u2014 d\u00e9bit 1\u20133 L\/min \u2014 dur\u00e9e minimale 15\u201318h\/jour (NOCTURNAL oxygen therapy trial + MRC trial \u2014 r\u00e9duction mortalit\u00e9 30\u201350 % \u00e0 5 ans si utilis\u00e9e \u226515h\/j) ; ventilation non invasive (VNI) nocturne : indiqu\u00e9e si hypercapnie chronique s\u00e9v\u00e8re (PaCO\u2082 >55 mmHg) + hospitalisation r\u00e9cente pour exacerbation hypercapnique (HOT-HMV trial \u2014 Murphy 2017 \u2014 NEJM \u2014 r\u00e9duction r\u00e9hospitalisations) ; chirurgie de r\u00e9duction de volume pulmonaire (CRVP) : r\u00e9section des zones d'emphys\u00e8me les plus s\u00e9v\u00e8res (lobes sup\u00e9rieurs \u2014 emphys\u00e8me h\u00e9t\u00e9rog\u00e8ne) \u2192 am\u00e9lioration du VEMS + qualit\u00e9 de vie + survie chez les patients s\u00e9lectionn\u00e9s (NETT trial \u2014 Fishman 2003 \u2014 NEJM) ; transplantation pulmonaire (emphys\u00e8me terminal r\u00e9fractaire \u2014 BODE index \u22657)<\/td>\n <td>L'OLD doit \u00eatre utilis\u00e9e \u226515\u201318h\/jour pour \u00eatre efficace (les \u00e9tudes n'ont pas d\u00e9montr\u00e9 de b\u00e9n\u00e9fice si <15h\/jour) ; la SaO\u2082 cible est 90\u201393 % \u2014 ne pas viser >96 % (risque d'hypercapnie aggrav\u00e9e \u2014 drive hypoxique) ; valve endobronchique (Zephyr, Spiration) : alternative mini-invasive \u00e0 la CRVP endoscopique chez les patients avec emphys\u00e8me h\u00e9t\u00e9rog\u00e8ne + absence de CLP (collateral lung pathways \u2014 \u00e9valuation par scanner de perfusion Chartis) \u2014 r\u00e9duction significative du VR et am\u00e9lioration du VEMS (LIBERATE trial \u2014 Criner 2018 \u2014 AJRCCM) ; roflumilast (Daxas) 500 \u00b5g\/jour per os \u2014 inhibiteur de la phosphodiest\u00e9rase-4 \u2014 r\u00e9duit les exacerbations chez les patients GOLD 3\u20134 avec bronchite chronique pr\u00e9dominante (Calverley 2009 \u2014 Lancet)<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span>Visit <strong>d\u00e9ficit en alpha-1 antitrypsine (AAT)<\/strong> est la cause g\u00e9n\u00e9tique la plus fr\u00e9quente d'emphys\u00e8me et est chroniquement sous-diagnostiqu\u00e9 \u2014 on estime que seulement 5\u201310 % des individus PiZZ au Canada ont re\u00e7u un diagnostic. Le d\u00e9pistage est recommand\u00e9 chez tout patient avec BPCO ou emphys\u00e8me diagnostiqu\u00e9 avant 45 ans, chez les non-fumeurs ou petits fumeurs avec emphys\u00e8me, en cas d'emphys\u00e8me pr\u00e9dominant aux bases \u00e0 la TDM, et chez les apparent\u00e9s du premier degr\u00e9 d'un cas confirm\u00e9. Le test de d\u00e9pistage initial est le dosage s\u00e9rique de l'AAT (taux <0,8 g\/L suspect \u2014 confirmer par ph\u00e9notypage ou g\u00e9notypage). Au Qu\u00e9bec, la th\u00e9rapie de remplacement par AAT purifi\u00e9e (Prolastin ou Zemaira) est disponible mais son acc\u00e8s via la RAMQ est conditionn\u00e9 \u00e0 des crit\u00e8res stricts (PiZZ confirm\u00e9 + VEMS 25\u201365 % pr\u00e9dit + non-fumeur).<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Urgence \u2014 Exacerbation aigu\u00eb s\u00e9v\u00e8re et pneumothorax<\/div>\n <p>Dial <strong>911<\/strong> or go immediately to the emergency room if an emphysematous patient presents : <strong>dyspn\u00e9e s\u00e9v\u00e8re au repos<\/strong> or sudden worsening uncontrollable by the usual bronchodilators; ; <strong>cyanosis<\/strong> lips or extremities; ; <strong>confusion, drowsiness or agitation<\/strong> (signs of acute hypercapnia - CO\u2082 narcosis); ; <strong>douleur thoracique unilat\u00e9rale soudaine + dyspn\u00e9e brutale<\/strong> (secondary spontaneous pneumothorax - vital emergency in advanced emphysema) ; <strong>HR >120 bpm + RF >30\/min<\/strong> at rest.<\/p>\n <p>L'administration d'oxyg\u00e8ne \u00e0 haute concentration chez un patient BPCO hypercapnique chronique peut <strong>aggraver la r\u00e9tention de CO\u2082<\/strong> - target SaO\u2082 88-92 % in pre-hospital and emergency care (Venturi mask 24-28 %).<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins de Clinique Omicron prennent en charge les patients atteints d'emphys\u00e8me et de BPCO \u2014 spirom\u00e9trie diagnostique, \u00e9valuation de la s\u00e9v\u00e9rit\u00e9 (score mMRC, CAT), prescription des bronchodilatateurs inhal\u00e9s adapt\u00e9s, accompagnement \u00e0 la cessation tabagique, d\u00e9pistage du d\u00e9ficit en AAT, vaccination, et r\u00e9f\u00e9rence en r\u00e9habilitation respiratoire ou en pneumologie selon la s\u00e9v\u00e9rit\u00e9. Le suivi longitudinal des patients stables est assur\u00e9 dans nos points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un professionnel de sant\u00e9 qualifi\u00e9. Toute aggravation de la dyspn\u00e9e chez un patient emphys\u00e9mateux n\u00e9cessite une \u00e9valuation m\u00e9dicale sans d\u00e9lai.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Emphys\u00e8me : causes, sympt\u00f4mes et traitement | Clinique Omicron Pneumologie & M\u00e9decine interne & M\u00e9decine de famille Emphys\u00e8me pulmonaire L’emphys\u00e8me pulmonaire est d\u00e9fini anatomopathologiquement comme une destruction permanente et irr\u00e9versible des parois alv\u00e9olaires \u2014 sans fibrose significative \u2014 entra\u00eenant un \u00e9largissement anormal et permanent des espaces a\u00e9riens distaux situ\u00e9s en aval des bronchioles terminales. Cette… <a href=\"https:\/\/cliniqueomicron.ca\/en\/emphyseme\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Emphysema: causes, symptoms and treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Emphys\u00e8me : Causes, sympt\u00f4mes et traitement | Brossard | Clinique Omicron","_metasync_otto_description":"L'emphys\u00e8me est une destruction permanente des alv\u00e9oles pulmonaires caus\u00e9e principalement par le tabagisme. Diagnostic, spirom\u00e9trie, bronchodilatateurs et pr...","_metasync_otto_keywords":"","_metasync_otto_og_title":"Emphys\u00e8me : causes, sympt\u00f4mes et | Brossard | Clinique Omicron","_metasync_otto_og_description":"L'emphys\u00e8me est une destruction permanente des alv\u00e9oles pulmonaires caus\u00e9e principalement par le tabagisme. Diagnostic, spirom\u00e9trie, bronchodilatateurs et pr...","_metasync_otto_twitter_title":"Emphys\u00e8me : causes, sympt\u00f4mes et | Brossard | Clinique Omicron","_metasync_otto_twitter_description":"L'emphys\u00e8me est une destruction permanente des alv\u00e9oles pulmonaires caus\u00e9e principalement par le tabagisme. Diagnostic, spirom\u00e9trie, bronchodilatateurs et pr...","rank_math_title":"","rank_math_description":"","_yoast_wpseo_title":"","_yoast_wpseo_metadesc":"","_aioseo_title":"Emphys\u00e8me : causes, sympt\u00f4mes et traitement | Clinique Omicron","_aioseo_description":"L'emphys\u00e8me est une destruction permanente des alv\u00e9oles pulmonaires caus\u00e9e principalement par le tabagisme. 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