The term emphysema refers both to abnormal enlargement and destruction of distal spaces of the lung. Diagnosis of emphysema is achieved by high resolution CT-scan of the thorax. Advanced forms of emphysema are associated with severe respiratory insufficiency. Isolated forms of emphysema may present as giant bullae with normal surrounding parenchyma. Diffuse panlobular emphysema is frequently associated with a genetic disease characterized by a severe deficit in alpha1-antitrypsin (AAT). Common forms of emphysema are observed in the distal lung of patients with COPD, or around fibrous and retractile lesions of the lung. Apart from the possible beneficial effect of augmentation therapy in case of severe deficit in AAT, there is no medical therapy currently active on the emphysematous process. Surgical approaches include bullaectomy which may be indicated in some cases of giant bullae, and lung transplantation and lung volume reduction surgery whose indications are both restricted to selected cases of advanced emphysema.