Bullous Emphysema
Author: V. Dimov, M.D.
Reviewer: S. Randhawa, M.D.
Emphysema is a form of chronic obstructive pulmonary disease (COPD). It is often caused by exposure to tobacco smoke. It may progress to may to bullous emphysema. A bulla is an air space defined as being at least 1cm in diameter, and with a wall less than 1mm thick. The imaging findings in two cases of bullous emphysema are shown below.
Case 1
CXR PA and lateral, close-up view (click to enlarge the images), CXR report, CD4/CD8 count.
CBC, CMP, ABG (click to enlarge the images).
CT of the chest, CT report (click to enlarge the images).
Treatment
Case 2
A giant bulla in a patient with COPD.
A giant bulla in a COPD patient. Close-up of the bulla (click to enlarge the images).
The same bulla two years later (click to enlarge the images).
Summary
Mind map of Chronic Obstructive Pulmonary Disease (COPD)
The average annual rate of decline in FEV1 is 20 to 30 mL in normal persons and double that (50 to 60 mL) in smokers with COPD. Smoking cessation delays decline in FEV1 to near normal levels. Stopping smoking is the most effective method to prevent progression of COPD.
Telling smokers their spirometry "lung age" improves quit rates at 12 months from 6.4% to 13.6% according to a study of 561 UK smokers. The "lung age" concept (the age of the average person who has an FEV1 equal to the patient) was developed in 1985 to help patients understand complex PFTs and to show how they are prematurely aged by smoking.
Unaware of the UK study, the 2007 U.S. Preventive Services Task Force guidelines recommended against screening for COPD using spirometry.
References
Chronic Obstructive Pulmonary Disease (COPD). AllergyCases.org.
Desperate to Cry, Desperate Not To. NYTimes.
Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial. BMJ, doi:10.1136/bmj.39503.582396.25 (published 6 March 2008).
Screening for Chronic Obstructive Pulmonary Disease Using Spirometry: Summary of the Evidence for the U.S. Preventive Services Task Force. Annals of Int Med, 1 April 2008 | Volume 148 Issue 7.
Published: 03/10/2004
Updated: 05/14/2009
Labels: Pulmonology
29 Comments:
My father just passed away with bullous emphysema. He is 46 y/o. He smoked 3 packs/day. He underwent the surgery to remove a bullae from the left lung he lived 1 week on the ventillator. He only had about 1/3 of the right lung, it had a bullae as well.
My mother passed away at the age of 52 from bullous emphysema. She smoked, but not that heavily. She had surgery to remove the bullae, and survived another 5 years.
My husband, age 54,had the "Lung Volume Reduction" surgery 10 years ago. At that time, he quit smoking and started walking to enhance the remaining lung volume. He was given ~5yrs life expectancy. Since that time, he has logged over 12,000 miles as a long-distance hiker. (He remains smoke-free). His mother died when he was 6yo from some type of "lung problems"--we now surmise she also had BE. He remains very active.
My sister is having surgery to remove the bullae in both lungs. She is 41. She's smoked 1 1/2 packs of cigarettes a day since she was 16. She had her first surgery when she was 20 and didn't quit smoking.
My dad is fighting for his life at the hospital because of severe breathing difficulty. He has bullous emphysema. Why is this happening? Smoking. He's been a smoker since age 16, he is now 63, and he looks like a 93 year old man because of smoking. His last words before taking him to he hospital were: "I wish I could have a couple smokes".
i have been told that i have got strong marks in my lung because of bullous in both of my lungs and iam only 33 years old male
My dad is also fighting for his life. He is currently in the hospital. He has COPD, Emphysema, and Bollous Disease. I wonder how long his body will actually last. I hate to see the suffering. He will be 71 years old in July. He has not smoked for 6 years but it all seems to be catching up with him.
I HAVE JUST BEEN RELEASED FROM HOSPITAL AFTER A WEEK STAY AND HAVE BULLOUS EMPHYSEMA IN BOTH LUNGS AND THEY ARE GROWING QUITE RAPIDLY - THEY SAY THEY DO NOT KNOW HOW LONG MY LUNGS WILL HOLD OUT DUE TO MASSIVE SCRRING FROM A PRIOR ACCIDENT
I am a 37 year old female with Bullous Emphysema. It has consumed most of my right lung and it has started in my left lung. They're trying to get me my surgery and told me I'd be better afterward. I've been smoking for 29 years now, I started real young.
My husband will be turning 50 this September 2009. He was diagnosed with this bullous emphysema on 06/16/09. My husband has never smoked a day in his life. Doesn't it seem strange that he would have this disease?
If you don't smoke, don't start! If you smoke now quit now! I started smoking when I was about eleven or twelve years old, at age 29 I had some pains and had x-rays done. My lungs were black and scared. I had a good doctor at a critical care unit that treated me with inhalers. I quit smoking at that time. Now I am 53 years old and diagnosed with bullous emphysema. It sure is hard getting around. I will see my doctors again tomarow and find out what my options are. Live every day the best you can and enjoy what you have, don't let it get you down.
My husband is 35 yrs old and had a pnuemothorax in 3/08. He was in the hospital for 11 days. He had 2 chest tubes because the first one wasn't helping to clear the air out of his chest cavity to allow his lung to re-inflate. He smoked since he was 16 yrs old. About 1 1/2 pks a day. I'm very proud to say that he hasn't smoked since! Although his lungs are severly damaged with the Bullous Emphysema.....he doesn't have any problems with shortness of breath. In fact, the night before this happend, he ran up and down 2 flights of stairs about eight times lugging his drum set from the attic to play a show! Weird huh?
My niece,age 42, just had surgery for BE and has numerous bullae that may require more surgery or treatment later on. She never smoked and cause is unknown.
Re: "My niece had surgery for BE and has numerous bullae that may require more surgery or treatment later on. She never smoked and cause is unknown."
25–45% of patients with COPD have never smoked http://bit.ly/3wAucF
3 billion people, half the worldwide population, are exposed to smoke from biomass fuel compared with 1 billion smokers. Exposure to biomass smoke might be the biggest risk factor for COPD globally rather than cigarette smoke.
http://allergynotes.blogspot.com/2009/09/2545-of-patients-with-copd-have-never.html
I have been diagnosed with bullous paniobular emphysema associated with Marfan's Syndrome. I am on the waiting list for a double lung transplant. I am a 51 year old female.
My 29 year old fiancée was recently diagnosed with Bullous Emphysema after smoking heavily for nearly 20 years. She has chainsmoked between 3 to 4 packs a day since we first started dating when we were sophomores in college a decade ago. Even after I quit smoking almost 7 years ago, she has remained a stubbornly committed smoker, always smoking at least three packs per day, and frequently more than that.
She started smoking at age 9, and her mother, also a heavy smoker, let her smoke all she wanted in the house growing up. She started chain smoking upto 2 packs a day when she was 11 years old after her mother, was diagnosed with lung cancer at age 44. Her mother never quit smoking despite being diagnosed with lung cancer and didn’t live to see her 45th birthday, and I’m afraid that my fiancée is headed to a similar fate on account of her slavish addiction to cigarettes.
My fiancée and I were scheduled to have our wedding this October, but now they are looking at surgery in the fall to remove the bullae that has formed in both lungs. Worse, she is continuing to chain smoke, albeit with gasping, labored breaths; and she acts like she’s not even interested in surgery and just wants to proceed with the wedding and honeymoon as planned. At the rate her lungs are deteriorating, I don’t know how long she can make it. I’m worried that she’s not taking this seriously enough, but I don’t know how to tell her.
im 35 years old with moderate bullous diesease just started chantix i hope it works
Re: "35 years old with moderate bullous diesease just started chantix i hope it works"
Varenicline (trade name Chantix in the USA and Champix in Europe) works to quit smoking but cannot reserve the emphysema damage. It you stop smoking the worsening will slow down however. Quitting smoking is the best thing you can do for your health. Good luck!
I just found out my husband has bullous emphysema. He had knowen for a year but just told me. He said the doctor gave him 5 years to live . what can be done? does anyone know if this is true that they can put 5 years max to someones diagnosis? what is the difference between bullous emphysema and regular. He said his was the inherited kind, his father had it also and had a lung out at an early age.
does anyone know anything about boullus emphazema ? what is the difference between that and regular emphazema? I wrote the artical above and need to know. I need to know how serious this is. my husband said the doctor told him he had 4 to 5 years... could that be for real.
I am a 50 year old male with chronic bullous emphysema which i was diagnosed with at age 39.I have had the lung reduction operation on my right lung after my lung capacity was reduced to 25%.I still have bullae in my left lung which I have been told will not be operated on even though my breathing has become more laboured.No one has given me any kind of time frame and often feel the condition is very misunderstood in the wider world and help needed often not available.
Im a 33 year old woman who was just diagnosed with bullous emphysema, after only smoking for barely twenty years. When I was a teenager I probably smoked almost a pack a day, but by the time I was in my twenties I usually chain smoked at least 2 packs a day, which I did for over ten years. I've usually worked as a waitress or server in various restruants and bars, most of which used to always have smoking sections until fairly recently. Growing up, my mother and sister always smoked heavily in the house all the time, and since then almost all of my roommates or boyfriends or ex-boyfriends Ive ever lived with have also smoked, so it just always seemed like not a big deal. Although Ive always had upper respitory infections for years, I started having more chronic breathing problems a little over a year ago, feeling like the asthma attacks I used to have as a girl. A year ago I started trying to cut back to to keep it under a pack and a half a day, but when my breathing difficulty didnt improve after a year, I finally went to see a doctor. I havent gotten to discuss surgical options with the doctor yet, because he said I have to quit smoking first. I keep telling myself I will try to think about quitting as a new years resolution, but I know that I deep down dont really want to quit smoking and I don't have the will power to really quit. I'm just too young for all this, it doesnt seem fair. I've been lonely and single for almost a whole year now, and its just too hard to try to quit smoking; even though Im terrified of facing my emphesyma all alone.
I was just diagnosed with bullous emphysema this week, right before Christmas and I'm really scared. Although I have been a smoker for almost 20 years, I still think of myself as a young woman, only 32, far too young to be dealing with this. I know I was way too young when started smoking, but both my older sisters smoked as did my mother growing up, so it never seemed like a big deal. Ive been smoking around 2 packs a day since my early twenties, but I guess I had never really thought of myself as a particularly heavy smoker until I talked to the doctor after I went in for recuring breathing problems I thought was just my asthma. The doctor told me I need to quit smoking immediately, but I just dont think I can right now, maybe next year, Im still too stressed out about all this. Im absolutely horrified that I might only have 4 to 5 years to live, can that really be the case? -- Rachel
I was diagnosed with bullous emphysema in 1995 after being rushed to the ER with heart palpitations & almost passing out! I started smoking at age 16 yrs old & quit when I was 31 yrs old. My doctor has been monitoing my bullies for 15 years with no incidents. This past year has been a tough one with constant breathing problems. My left lung is in pretty bad shape I have several bullies & blebs on my lungs with one bullae meassuring 14 cm....saw a surgeon last week & he is concerned it is taking up too much space & putting pressure on my right lung. Surgeon feels it should be removed! I am truely scared to death!-Patrina
Im a young woman, only 27 year old, and I was just diagnosed with bullous emphysema after going to the doctor with recurring breathing problems Ive had for the past year or so. Ive smoked about 2 packs a day or so since I was around 17, although I guess I really first started smoking when I was like 13, even though I had asthma growing up. I used to think I was so chic, now Im waiting to schedule lung reduction surgery and worried I might not make it to see my 30th birthday. I tried to quit last year, after having recurring chronic upper respiratory problems, but I just cant give up smoking no matter how hard I try. This terrifying news has only made my cigarette addiction worse.
Im so scared about this I just burst into tears all the time, even at work, but I still havent told anyone about it, not even my mother who always hated my chain smoking. Worse I just moved in with this great guy Ive been dating for a while, and I was starting to get really hopefull for the future with him, but I cant bear to tell him yet, even though I know I'll have to. He knows Ive been sick and has been trying to get me to quit smoking, telling me about how much Im damaging my lungs, but I used to just laugh it off and keep on smoking. Now it hurts to laugh, and I just end up crying again, afraid of whats going to happen to me.
i am 44 yrs old and have severe bullous lung disease. The specialist said that my scans and xrays show the worst example of a set of lungs he had seen. i smoked drugs and tobacco since i was a teenager. They say the average life expectancy of someone with bullous lung disease is about 4yrs. I was diagnosed last year and i get out of breath very easily. How long do i have left?
Average tries to quit until successful = 7
Swimming, movies, anywhere you can't smoke.
Chew sugar-free gum and use nicotine patch.
Hold a pencil.
Don't tell anyone you're quitting, so there's less expectation, pressure.
Even one puff makes you take up smoking again.
Brainwash yourself that smoking is bad and you'll come to believe it.
List all the bad things about it: the smell, the bad breath, the danger of starting a fire, etcetera.
I have emphysema, my mother died of it, and now my brother is in hospital for it. I worked where the residents chain-smoked, had six in my family all smokers, had a boyfriend who smoked, had plenty of exposure.
Be kind to yourself, and quit smoking. Please.
I was diagnosed with BE when I was 25 years old when my lung collapsed I am now 37 years old the doctors acted like I was an acceptence to the disease because of my young age until I found this site I cannnot believe all the people around my age with this disease I have quit smoking the doctors have told me lung transplants are my only option my lungs are beyond repair ... but I am too scared to get it done this disease has really effected my life I cant do much even pushing a lawn mower gets me to where I cannot breathe
I was diagnosed with giant bullous emphysema in both lungs in 1990 at 37 years old. It was at a pre-employment physical and I hadn't noticed any symptoms. The bullae compressed the rest of my lungs so they had little blood flow. I quit smoking immediately but it progressed until I had severe shortness of breath walking uphill. I think the lung volume reduction surgery had just been developed and the bullae were removed in 1993. Within one week my breathing seemed normal and I considered it a miracle. My doctors at the time of diagnosis couldn't give me the time I might have left and I was scared. It has now been 22 years since diagnosis. Though I'm no marathon runner I can walk long distances and ride my bicycle everywhere.
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