Pulmonary emphysema is a chronic and lifelong disease of the lungs. Primarily, the alveoli (small and tiny air sacs) in the lungs are affected. Sometimes, they can be narrowed by the walls between them becoming thickened. Sometimes, these walls can be entirely destroyed, leading to larger yet fewer alveoli. Sometimes, they can become too stretched, and others, they can lose their elasticity entirely. Many different types of damage to the alveoli in the lungs can contribute to pulmonary emphysema which, along with chronic bronchitis make up chronic obstructive pulmonary disease (COPD) one of the most common causes of death in the United States. The disease is divided into four stages, with the fourth and final stage being the most advanced, and where bullous emphysema exists.
In advanced cases of emphysema, bullae may appear. These are simply very large air sacs in the lungs that are considered a complication of the disease. These large pockets of air can severely impact breathing because they take up space in the chest that the lungs need in order to function properly. Pressure and crowding can occur as a result, which has led bullous emphysema to be given its nickname, “vanishing lung syndrome”.
Essentially, the bullous emphysema is caused no differently than other stages of the disease and types are. Smoking is the single biggest contributing factor. Marijuana use is also suspected as being related to the development of bullous emphysema. However other less common causes such as regular exposure to pollutants, consistent inhalation of dust and other contaminants, frequent and recurrent infections of the respiratory system and others may also exist. Indirectly, bullous emphysema is more likely to occur when these sources of disease are left to persist. Thus, someone who continues to smoke after emphysema onset, for example, is more likely to develop this form of the condition.
This relationship between source removal is also essential to emphysema prognosis in general, not just the reduction of risk of developing bullae. Emphysema is graded in stages based on severity of lung function decrease. Each stage reflects a poorer and poorer ability to breathe. In the final stage of emphysema, when bullae are more likely to appear, the prognosis is often not good. However, at each stage of emphysema, quitting smoking and reducing or eliminating any other underlying causes while increasing overall health in other ways like dieting and exercise can greatly slow the progression of the disease.
Because there is an additional physical component to bullous emphysema, additional symptoms exclusive of traditional emphysema symptoms may exist. These include feelings of tightness or pressure in the chest as well as chest pain. Many times, this does not occur until the bullae have become large, and often no other symptoms present when they remain small. One bullous emphysema symptom that can be alarming is coughing up blood, or sputum that is tinged or stained with blood. If the bullae become infected, they can bleed, and this is often evidenced in the upcoming sputum.
Although when bullae are small, emphysema treatment does not vary much from traditional treatments for the condition, when bullae are large, there are some different options for care that may be considered. Surgical removal of the bullae may be indicated in cases where they are severely impacting breathing. Additionally, if they are becoming infected regularly or a pneumothorax (collapsed lung) has presented, surgical removal of the large bullae may be required. Aside from this difference, bullous emphysema treatment focuses on removing the source of the disease through smoking cessation and reduction of environmental or occupational hazards. Additionally, oxygen, bronchodilators, steroid medication and agents designed to reduce the thickness of mucus (common COPD medications) may also be indicated. These are used in the treatment of bullous emphysema in order to help reduce the severity of COPD signs and symptoms like shortness of breath by opening up airways and reducing inflammation or otherwise making breathing easier.
In advanced stages of emphysema, breathing is often very severely impacted, with lungs functioning around a quarter of what they are intended to. Bullae exacerbate this by further reducing the amount of real estate that the lungs have available to make breathing possible. It’s a chronic condition that may require invasive treatment to preserve remaining quality of life. Quitting smoking is the single best way to reduce the risk of developing the disease, and it can also help to slow the progression of it as well.