Gers County Faces Lung Health Crisis: One Specialist & Rising Respiratory Illnesses

The rural department of Gers, in southwestern France, is facing a critical shortage of respiratory specialists, compounded by rising rates of respiratory illness and a new surge in vaping among young people. With only one hospital-based pulmonologist serving the entire population, healthcare professionals are scrambling to maintain essential care and bolster preventative measures. The situation highlights broader challenges in rural healthcare access and the evolving landscape of respiratory health risks.

A Critical Shortage in Gers

The closure of the pneumology department at the Auch hospital, following the departure of two practitioners, has left Dr. Sammy Rakotonirina as the sole hospital-based pulmonologist for the Gers department. “One pulmonologist for an entire department is, of course, completely insufficient,” Dr. Rakotonirina stated. Fortunately, Dr. Élise Noël-Savina from the University Hospital of Toulouse (CHU de Toulouse) now provides support one day a week as part of a reinforcement mission involving a team of four volunteer pulmonologists. This situation mirrors broader challenges in French “medical deserts”, where access to healthcare is severely limited.

In the absence of a fully staffed department, a “transversal” activity model has been implemented. This involves providing consultations, specialist opinions, and respiratory function tests across various hospital services. The goal is to prevent residents of Gers from having to travel to Toulouse for procedures like spirometry or chest scans.

Respiratory Illnesses: A Local Profile

The types of respiratory illnesses seen in Auch reflect the unique characteristics of the Gers region. Patients are often referred by their general practitioners with respiratory symptoms. Common diagnoses include pleurisy, rare diseases, and a significant number of cases of Chronic Obstructive Pulmonary Disease (COPD). COPD, a progressive lung disease primarily linked to tobacco smoking, is particularly prevalent in Gers due to a combination of agricultural exposures and smoking rates.

Agricultural exposures – including pesticides, organic dusts, and phytosanitary products – contribute significantly to respiratory risk. “In Gers, we see many very severe cases of COPD due to agricultural exposure combined with smoking, more so than in urban environments,” explains Dr. Noël-Savina. Domestic pollution from poorly insulated homes and wood-burning stoves also plays a role.

Lung cancer rates are also a growing concern, with diagnoses occurring at younger ages, including women. This trend is linked to continued tobacco use, but also increasingly to environmental factors like pollution. Research increasingly points to pollution as a significant factor in lung cancer development, even among non-smokers.

The Rise of Puff Bars and Youth Vaping

While traditional cigarette consumption is declining due to price increases (Australia’s strong tobacco taxes are cited as an example), the industry has found a new avenue to attract young consumers: disposable electronic cigarettes, commonly known as “puff bars.” These devices are causing alarm among healthcare professionals. “We are seeing children aged 11, 12, and 13 who are smoking puff bars,” warns Dr. Noël-Savina. “It’s catastrophic.”

The consequences are already becoming apparent, with younger patients presenting with COPD, emphysema, and even lung cancer at earlier ages. The focus, the doctors emphasize, must be on prevention and health education, starting in middle school. Reports indicate a growing trend of youth transitioning from puff bars to traditional cigarettes.

Expanding Expertise and Regional Collaboration

The Centre Hospitalier d’Auch is investing in diagnostic equipment, such as a spirometry cabin, to improve local respiratory care. The hospital is also actively involved in raising awareness and promoting prevention through events like World COPD Day and World Asthma Day. A free respiratory screening event is scheduled for May 6, 2026, requiring pre-registration.

For patients seeking consultation with a pulmonologist, the recommended pathway remains to first consult with their general practitioner, who can then contact the pneumology secretariat at the Auch hospital. Current wait times for appointments are approximately three weeks.

Artificial Intelligence in Respiratory Medicine

Looking ahead, the hospital is exploring the potential of artificial intelligence (AI) to enhance respiratory care. Research is underway to analyze chest scans to predict how patients with pulmonary hypertension will respond to treatment. While acknowledging the potential benefits of AI, Dr. Noël-Savina cautions, “We need to master AI before it masters us,” emphasizing the importance of careful implementation and oversight. AI could be particularly valuable in improving early detection of lung cancer.

The Centre de Référence des Maladies Pulmonaires Rares (National Reference Centre for Rare Pulmonary Diseases) and associated regional competence centers play a vital role in managing complex respiratory conditions. These centers, including one at the CHU de Toulouse, focus on diagnosis, treatment, research, and training for rare pulmonary diseases. The CHU de Toulouse is recognized for its expertise in rare diseases, with 87 designated expert centers. More information about the CHU’s rare disease centers is available on their website.

What’s next: Ongoing efforts to recruit additional respiratory specialists, coupled with continued investment in preventative measures and public health education, are crucial to addressing the challenges facing the Gers department and ensuring access to quality respiratory care for all residents.