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

36 comments:

  1. 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.

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  2. 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.

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  3. 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.

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  4. 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.

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  5. 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".

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  6. 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

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  7. 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.

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  8. 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

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  9. 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.

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  10. 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?

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    1. I had surgery in November. I never smoked. Female 40 yrs old. Extremely active athlete. The doctors do not know how how or why this happened. They theorize I had a small congenital growth on top of my lung that just recently infected and started filling with air which pushed my lung down like a sponge. They easily removed the bullae which was attached in only two small spots to the lung. I was in a lot of pain the 3 weeks after surgery while my lung expanded especially when coughing! It expanded completely again to fill the entire cavity!!!!! I am back to playing semi-pro soccer!

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  11. 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.

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  12. 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?

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  13. 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.

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  14. 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

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  15. 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.

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  16. 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.

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  17. im 35 years old with moderate bullous diesease just started chantix i hope it works

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  18. 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!

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  19. 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.

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  20. 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.

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  21. 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.

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  22. 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.

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  23. 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

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  24. 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

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  25. 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.

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  26. 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?

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  27. 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.

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  28. 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

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  29. 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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  30. I can't believe this is already happening to me when Im not even 26 years old yet, but Im so glad I found this site. I went in for a routine OBGYN visit last summer after having not been to the doctor in maybe two years, and she said she noticed I had extremely shallow breathing and asked if I ever had shortness of breath, which I said yes, like all the time, I get winded just walking up a single flight of stairs and have since I was maybe nineteen. I just figured it was because I had been a fairly heavy smoker compared to some other women my age, since Ive basically been smoking every day since I was like twelve and was already practically chain-smoking between a pack and a half a day to sometimes two packs a day when I was seventeen and have been that bad or worse since then. Im sure it didnt help that on top of that I had had bad asthma as a little girl. I feel so stupid for ruining my lungs like this; I just can't believe I already have bullous emphysema. Its so not fair.

    But no matter how hard I try I just can't quit smoking! It has me really scared that I'm not going to be able to respond to the treatment if I can't get control of my nicotine addiction, but Im so scared and stressed out about this that its almost like cigarettes are my only friends. I don't know if my doctor was just trying to scare me into quitting or not, but he told me that if I keep smoking the way I do now, that I might not make it see my 30th birthday if things keep progressing the way they are now. I don't think I have it in me to quit smoking right now, and I just don't think its fair that this has happened to me when Im still only 25.

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    1. It will only be fair when YOU make the decision to stop. Whatever moves you, you have to decide. Think about all the people who you affect when smoking whether it's your niece, your brother, your grandmother, your dog, the person next to you in the checkout line. All these lives are affected badly by the smoke you have on you constantly. I was at school function for my his daughter When the man next to me had to go outside, so I moved to let him go by. When he came back, it was evident that he only went out for a smoke. He wreaked!!!!...I could barely hold my breath sitting next to him but all other seats were taken. This was during his kid's senior awards ceremony. I was mad at him and then felt sorry that he actually felt he had to miss some of it just to smoke a cig!!!! What is going to make You stop!? Cigs ARE NOT your friends! Don't make excuses! Find a true friend; maybe they've been there all along TRYING to help you, but you haven't given them a chance...I don't know...but YOU have to do it. You will never have pristine lungs again, but you can make a huge difference in the rest of your life and in others. Form a group in your area for a confidant with like-minded goals! YOU CAN. You are better than you think!

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  31. I am 55. diagnosed this year with diabetes and emphysema. when I was in the hospital I was on level 12 for oxygen for five full days. it is beyond belief I did this to myself happily with cigarettes. I quit smoking the day I was admitted to the hospital. I am so sad what I did to myself.

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  32. My mom was diagnosed with Bullous Emphesyma and shes only 44years old. She smoked about two packs a day most of her life since she was a a teenager, but she eventually tried cutting back to only a pack a day last fall. Shes really sad about what her smoking has done to her, but she can't help it.

    It makes me feel bad when I smoke around her too, but its not like I can quit. My mom let me start smoking when I was not quite 11 years old and I loved it. I was hooked for life. Within a year I was smoking half a pack a day and by 13 I was smoking a pack a day. I think by the time I was 15 I was smoking almost two packs a day just like my mom. I thought she was so cool because she let me smoke and bought me cigarettes and my friends were jealous.

    She even let me keep smoking two packs a day when I got pregnant when I was 16. Again I thought she was so cool because she was the only one who never fussed at me for smoking so much while pregnant. Looking back on it, thats kinda embarassing I guess.

    But even watching how much my mother has been suffering with emphysema hasn't stopped me from continuing to smoke two and a half packs a day. Sometimes I even smoke three packs a day if Im not careful. Its awful I know, but I guess my constant smoking has already damaged my lungs so much that sometimes I don't even notice the fact that I get pretty winded just walking up a single flight of stairs, although I can barely make it up two flights of stairs without huffing and puffing and having to stop to catch my breath. Pretty bad for a twenty seven year old woman who should otherwise be healthy.

    Now my little girl is 10 years old and just the other day I caught her sneaking cigarettes again at her grandmas house. I didnt know if my mother had given her the cigarettes or not, or where she got them from this time, but its probably the seventh time this summer Ive caught her smoking again. But when I fussed at my daughter about smoking at grandmas, she just said it wasnt fair that I got to smoke all I wanted and she wasn't allowed to. I had this awful feeling in the pit of my stomach and I knew it was already too late for my daughter and that she'd become addicted to smoking just like me and my mother. It made me so upset I just started crying uncontrolably because I knew there was nothing I could do my poor little daughter was going to one day end up just like her grandmother, who's only 45 and already has emphysema.

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  33. When I was diagnosed with BE last year at age 31, it seemed impossible. It felt like I must be the only woman in her early thirties who had chain smoked so much I'd already given myself emphysema.

    Two packs a day really didnt seem like too much to me, even though others told me I was already smoking too much by the time I turned sixteen.

    I don't know how I'm supposed to quit now, and I don't think I'd ever thought I'd be able to quit smoking. But even if I can quit smoking and my emphysema just continues to get worse the more I smoke, at least I wont be alone.

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  34. I'm a 37 year old male. I was diagnosed with BE in October of 2012, after I suffered a pneumothorax.. I smoked for over 20 years up to 2 and a half packs a day. I quit on December 27 of 2010 after suffering from a partial lung collapse, which I mistook for a heart attack. I walked around like this for about a year and 10 months, not wanting to go to the Doctor out of fear. Then my lung completely collapsed, which forced me into the hospital in 3 days. When I arrived, they told me my lung was the size of a walnut. Anyway, I was hospitalized for 9 days with chest tubes. They did the surgery, and told me that it's a disease that they don't know too much about. Yet no one ever gave me a timeframe for living. In fact, the Dr's all indicated that I could live till I'm an old man. Things could go either way, and it really is something that you just have to monitor. Also, it turns out that my father and uncle have both had issues with this as well, so there is a genetic component to my case. I've been exercising, and feel alot better. Best thing you can do is quit smoking. If I can, anyone can.

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