From the Guidelines
Emphysematous bullae are abnormal air-filled spaces in the lungs that develop when alveolar walls break down and merge, creating large air pockets typically greater than 1 cm in diameter, most commonly resulting from chronic obstructive pulmonary disease (COPD), particularly emphysema. These bullae can also occur due to alpha-1 antitrypsin deficiency, smoking, or rarely as congenital defects. Patients with bullae often experience progressive shortness of breath, decreased exercise tolerance, and may be at increased risk for pneumothorax (collapsed lung) 1.
Key Characteristics of Emphysematous Bullae
- Typically greater than 1 cm in diameter
- Result from breakdown and merging of alveolar walls
- Most commonly associated with COPD, particularly emphysema
- Can also be caused by alpha-1 antitrypsin deficiency, smoking, or congenital defects
Management and Treatment
Management primarily focuses on treating the underlying lung disease with:
- Bronchodilators
- Smoking cessation
- Pulmonary rehabilitation In select cases where bullae are large, compressing healthy lung tissue, and causing significant symptoms, surgical intervention called bullectomy may be considered to remove the bullae and allow better expansion of the remaining functional lung tissue 1.
Preventative Measures
Patients with emphysematous bullae should:
- Avoid activities that cause sudden changes in pressure, such as scuba diving
- Receive pneumococcal and influenza vaccinations to prevent respiratory infections that could worsen their condition 1.
From the Research
Definition and Characteristics of Emphysematous Bullae
- Emphysematous bullae are closed air-containing spaces in lung parenchyma that may severely compromise lung function in patients with chronic obstructive pulmonary disease (COPD) 2.
- They contribute to increased lung volume and worsen the mechanical disadvantage of the inspiratory muscles by increasing the residual volume (RV) and RV/total lung capacity ratio 3.
- Bullae are common accompaniments of chronic obstructive pulmonary disease, especially emphysema 3.
Treatment Options for Emphysematous Bullae
- Surgery and thoracoscopy are two commonly performed procedures used to treat bullae 3.
- Bronchoscopic transbronchial decompression of emphysematous bullae can be an effective therapeutic option and warrants further investigation 3.
- Transthoracic decompression of emphysematous bullae is a simple and minimally invasive procedure that can result in significant symptomatic, radiological, and functional improvement 2.
- Thoracoscopic technique using fibrin glue is a minimally traumatizing technique that can be used in patients with very low lung function with a minimal risk 4.
- Surgical resection of giant emphysematous bullae can produce significant immediate functional improvement, which declines with time but persists at least 3 years 5.
Patient Selection and Evaluation
- Patient selection remains one of the most important aspects of successful surgery for bullous disease 6.
- Operation is indicated for patients who have incapacitating dyspnea with large bullae that fill more than 30% of the hemithorax and result in the compression of healthy adjacent lung tissue 6.
- Patients who have bullous disease in the presence of diffuse lung disease (emphysematous or nonemphysematous) should be evaluated on an individual basis and surgery should be performed on patients in whom even a small increase in pulmonary function might be of major benefit 6.
- CT remains the most important preoperative evaluation because it is useful in assessing the extent of bullous disease and the quality of the surrounding lung tissue 6.