From the Guidelines
Bullous emphysema is a severe form of emphysema characterized by the formation of large air-filled sacs called bullae in the lungs, which can be treated with surgical interventions such as bullectomy or lung volume reduction surgery in severe cases, as recommended by recent guidelines 1.
Definition and Causes
Bullous emphysema is a condition where the walls between air sacs (alveoli) break down and merge, creating abnormally large air spaces that can measure more than 1 cm in diameter. This condition primarily affects the upper portions of the lungs and is most commonly caused by long-term cigarette smoking, though it can also result from alpha-1 antitrypsin deficiency, a genetic disorder.
Symptoms and Treatment
The bullae reduce the lung's surface area available for gas exchange, leading to symptoms such as:
- Progressive shortness of breath
- Decreased exercise tolerance
- Chronic cough
- Chest tightness As the disease advances, patients may require supplemental oxygen therapy. Treatment focuses on:
- Smoking cessation
- Bronchodilators like albuterol or tiotropium
- Inhaled corticosteroids
- Pulmonary rehabilitation
- Surgical interventions such as bullectomy (removal of bullae) or lung volume reduction surgery in severe cases, as supported by studies 1.
Surgical Interventions
For very large bullae causing significant compression of functional lung tissue, surgical intervention may provide substantial symptom relief by allowing the remaining healthy lung tissue to expand and function more effectively. Recent developments in thoracoscopic surgery have facilitated the operation, and lung transplantation may be considered in selected patients with very severe COPD, as recommended by guidelines 1.
Recent Guidelines
Recent guidelines, such as the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report, recommend surgical or bronchoscopic modes of lung volume reduction in selected patients with heterogeneous or homogenous emphysema and significant hyperinflation refractory to optimized medical care 1. The guidelines also suggest that bullectomy may be considered in selected patients with a large bulla, and lung transplantation may be considered in patients with very severe COPD and without relevant contraindications 1.
From the Research
Definition and Characteristics of Bullous Emphysema
- Bullous emphysema is a type of emphysema characterized by the presence of large air-filled bullae (blebs) in the lungs, which can compress adjacent normal lung tissue and lead to respiratory symptoms 2, 3, 4.
- The bullae can be single or multiple and can occupy a significant portion of the lung, leading to impaired lung function and shortness of breath 5, 6.
Causes and Risk Factors
- Bullous emphysema can be caused by a variety of factors, including smoking, illicit drug use, and genetic predisposition 6.
- The condition can also be associated with underlying lung disease, such as diffuse emphysema, which can affect the outcome of surgical treatment 3, 5.
Diagnosis and Evaluation
- Diagnosis of bullous emphysema typically involves imaging studies, such as computed tomography (CT) scans, to assess the extent of the bullae and the underlying lung disease 3, 4.
- Pulmonary function tests (PFTs) are also essential to evaluate lung function and determine the best course of treatment 2, 5.
Treatment Options
- Surgical treatment, such as bullectomy or lung volume reduction surgery (LVRS), may be indicated for patients with large bullae and significant symptoms or complications 2, 3, 5.
- The goal of surgery is to remove the bullae and improve lung function, while minimizing the risk of complications and preserving as much functional lung tissue as possible 3, 4.
- Non-surgical treatment, such as smoking cessation and pulmonary rehabilitation, may also be recommended to manage symptoms and slow disease progression 3, 6.