From the Guidelines
Treatment for moderate to severe bullous lung disease should prioritize lung volume reduction through surgical or bronchoscopic interventions, such as bullectomy, endobronchial one-way valves, or lung coils, in selected patients with significant hyperinflation refractory to optimized medical care. This approach is supported by the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report 1. The management of bullous lung disease involves a comprehensive strategy to alleviate symptoms, prevent complications, and improve quality of life. Key considerations include:
- Interventional bronchoscopy and surgery for patients with heterogeneous or homogenous emphysema and significant hyperinflation 1
- Surgical bullectomy for patients with a large bulla 1
- Lung transplantation for patients with very severe COPD and without relevant contraindications 1
- Optimized medical care, including smoking cessation, bronchodilators, and pulmonary rehabilitation programs, to slow disease progression and improve functional capacity. In severe cases, these interventions can help reduce air trapping, decrease hyperinflation, and enhance gas exchange in the remaining functional lung tissue, ultimately improving morbidity, mortality, and quality of life for patients with moderate to severe bullous lung disease 1.
From the Research
Treatment Options for Moderate to Severe Bullous Lung Disease
- Surgical treatment is a viable option for patients with moderate to severe bullous lung disease, particularly those with large bullae that compress healthy adjacent lung tissue 2.
- The goal of surgery is to remove the bullae and improve lung function, while minimizing the risk of complications and preserving as much healthy lung tissue as possible 2, 3.
- Preoperative evaluation is crucial and includes pulmonary function tests (PFTs), computed tomography (CT) scans, and arterial blood gas analysis (ABG) to assess the extent of bullous disease and the quality of the surrounding lung tissue 2.
- Surgical techniques include bullectomy, with or without decortication, and minimally invasive procedures such as video-assisted thoracic surgery (VATS) 2, 3.
- Postoperative care is critical to minimize complications and includes aggressive tracheobronchial toilet, vigorous chest physiotherapy, and adequate pain control 2.
Medical Management
- Inhaled bronchodilators, such as tiotropium bromide, are a mainstay of pharmacological treatment for chronic obstructive pulmonary disease (COPD), which may coexist with bullous lung disease 4, 5, 6.
- Tiotropium bromide has been shown to improve lung function, health-related quality of life, and exercise tolerance, and reduce dyspnea and acute exacerbations of COPD 4, 5, 6.
- However, the use of tiotropium bromide in the treatment of bullous lung disease specifically is not well established, and more research is needed to determine its efficacy in this context.
Patient Selection and Outcomes
- Patient selection is critical for successful surgical treatment of bullous lung disease, and patients with diffuse pulmonary parenchymal involvement may have poorer outcomes and higher complication rates 2, 3.
- Surgery can improve symptoms and lung function in patients with bullous lung disease, particularly those with localized parenchymal involvement, and can prevent potentially fatal complications such as pneumothorax and recurrent infections 3.