OVERVIEW

What is pulmonary bulla?

Pulmonary bulla, also known as pulmonary air sac, bullous emphysema, acquired pulmonary cyst, or pneumatocele, is sometimes inaccurately referred to as "pulmonary bubble" by the general public.

It occurs when increased pressure within the alveoli, due to congenital or various acquired factors, causes the alveolar walls to rupture, leading to the fusion of multiple alveoli into a large air-filled cavity. It is a chronic condition, but if a bulla ruptures and causes pneumothorax, it can manifest acutely with severe breathing difficulties.

Depending on the type of pulmonary bulla, symptoms may be absent or include chest tightness, chest pain, shortness of breath, and difficulty breathing. If secondary infection occurs, symptoms like cough, phlegm, and fever may appear, potentially worsening existing symptoms. Treatment ranges from conservative observation to surgical intervention based on severity. Prognosis depends on underlying conditions—more or severe comorbidities may lead to poorer outcomes, while fewer or milder ones result in better prognosis.

Generally, asymptomatic or mild cases do not significantly impact quality of life. However, severe symptoms, recurrent spontaneous pneumothorax, or repeated infections can severely affect daily living, and surgical treatment should be considered as early as possible.

Is pulmonary bulla common? How many people have it?

Pulmonary bulla is relatively common clinically, and many cases are asymptomatic and discovered incidentally during medical examinations.

Are pulmonary bulla and pulmonary bleb the same condition?

With emphysema or increased alveolar pressure, alveolar walls may rupture and fuse. Pulmonary blebs involve the fusion of a few alveoli but are smaller than 1 cm, thus not meeting the diagnostic criteria for pulmonary bulla, which exceeds 1 cm. Blebs usually cause no or mild symptoms and are not typically diagnosed clinically.

In rare cases, pulmonary blebs may merge into larger air spaces or bullae.

What are the types of pulmonary bulla?

Different classification methods yield different types:

• By cause:
  • Congenital pulmonary bulla (idiopathic): Possibly genetic, more common in children.
  • Acquired pulmonary bulla (secondary): Often due to underlying lung diseases like chronic bronchitis, emphysema, COPD, or tuberculosis, more common in adults and the elderly.
• By pathological morphology:
  • Type I: Narrow-necked bulla.
  • Type II: Broad-based superficial bulla.
  • Type III: Broad-based deep bulla.
• By number:
  • Single bulla.
  • Multiple bullae.

Which department should I visit for pulmonary bulla?

Patients with pulmonary bulla can consult the respiratory medicine, thoracic surgery, or cardiothoracic surgery department.

SYMPTOMS

What are the common manifestations of pulmonary bullae?

• Single, small simple pulmonary bullae may have no symptoms, and most patients are incidentally discovered during physical examinations (chest X-rays or CT scans).
• Common manifestations of multiple or large pulmonary bullae:
  • Chest tightness: Patients may feel pressure in the chest, shortness of breath, or difficulty breathing.
  • Shortness of breath: Patients may experience breathlessness during respiration or feel unable to complete a sentence in one breath while speaking.
  • Difficulty breathing: Patients may feel labored breathing or a sense of insufficient air intake.
• Common manifestations of spontaneous pneumothorax after bulla rupture:
  • Sudden dyspnea: Patients may experience abrupt rapid breathing or gasping for air.
  • Worsening difficulty breathing: Patients may feel increased effort in breathing.
  • Cough.
  • May be accompanied by chest pain.
• Common manifestations of secondary infection of pulmonary bullae:
  • Cough.
  • Expectoration: Sputum may be expelled after coughing, with varying color and consistency depending on the infectious pathogen.
  • Fever.
  • Aggravation of existing symptoms: Difficulty breathing, chest tightness, and shortness of breath may worsen after secondary infection.

Where do pulmonary bullae commonly occur in the lungs?

Pulmonary bullae can be classified into three types based on pathological morphology, each with different predilection sites:

• Type I: Narrow-necked bullae. Most commonly occur in the middle lobe or lingula, but also frequently seen in the upper lobes.
• Type II: Broad-based superficial bullae. Can appear in any part of the lungs.
• Type III: Broad-based deep bullae. Can occur in any lung lobe.

How does pulmonary bullae disease progress?

The onset of pulmonary bullae disease is often subtle, and many cases are discovered incidentally during physical examinations or as secondary conditions to chronic lung diseases such as emphysema or chronic bronchitis. The progression is slow but persistent, resembling a long downhill slope, with a course often spanning over a decade.

What are the complications of pulmonary bullae disease?

Common complications of pulmonary bullae include spontaneous pneumothorax and secondary infections.

CAUSES

What are the common causes of pulmonary bullae?

• Congenital pulmonary bullae: May be related to genetic inheritance;
• Acquired pulmonary bullae: Mostly secondary to underlying lung diseases, such as chronic bronchitis, emphysema, chronic obstructive pulmonary disease (COPD), and tuberculosis.

Who is prone to pulmonary bullae?

• Congenital pulmonary bullae: More common in children;
• Acquired pulmonary bullae: More common in adults and elderly patients, often accompanied by chronic lung diseases such as chronic bronchitis, emphysema, COPD, and tuberculosis.

Are pulmonary bullae contagious?

Pulmonary bullae are not an infectious disease and therefore are not contagious.

Are pulmonary bullae hereditary?

Congenital pulmonary bullae may be related to genetic inheritance, but the specific genetic mechanism is currently unclear.

DIAGNOSIS

How is pulmonary bullae diagnosed?

When diagnosing pulmonary bullae, doctors primarily rely on the patient's symptoms (such as chest tightness, shortness of breath, difficulty breathing, etc.), chest X-ray examinations, and chest CT scans.

What tests are needed for pulmonary bullae?

Generally, a chest X-ray or CT scan is required. Both are used to determine the presence of pulmonary bullae, complications like pneumothorax or infection, and to differentiate the condition from other lung diseases to avoid misdiagnosis.

What precautions should be taken during X-ray and CT scans for pulmonary bullae?

There are no special precautions for chest X-rays or CT scans. Patients only need to follow the doctor's instructions for inhaling and exhaling during the examination.

Which diseases are easily confused with pulmonary bullae?

Since many lung diseases share similar clinical symptoms and even imaging findings, pulmonary bullae may be confused with localized pneumothorax, congenital cystic bronchiectasis, or multiple pneumatoceles. Doctors need to differentiate them through chest X-rays, CT scans, and other tests.

TREATMENT

How to treat pulmonary bullae?

The treatment of pulmonary bullae mainly includes conservative drug therapy and surgery. Conservative drug therapy is suitable for patients with mild symptoms (not affecting their quality of life). Currently, there is no specific drug for treating pulmonary bullae.

Therefore, only symptomatic treatment can be provided. During treatment, the patient's symptoms and the number and size of the bullae should be monitored, with regular chest X-rays or CT scans. Surgery is suitable for patients with severe symptoms (significantly affecting their quality of life) who meet surgical criteria, those with recurrent secondary infections, and those with spontaneous pneumothorax.

Can pulmonary bullae heal on their own?

Pulmonary bullae generally do not heal on their own and may even worsen over time. Asymptomatic cases may not require special treatment. Patients with mild symptoms may need drug therapy, while those with severe symptoms may even require surgery.

Does pulmonary bullae require hospitalization?

Patients with severe symptoms meeting surgical criteria, those with recurrent secondary infections, and those with spontaneous pneumothorax require hospitalization for surgery. Patients with severe underlying conditions such as chronic bronchitis or emphysema also need hospitalization for conservative treatment. Those with severe secondary infections from pulmonary bullae also require hospitalization for conservative treatment.

Asymptomatic patients do not need treatment, while those with mild symptoms can manage drug therapy at home.

What are the common risks of surgical treatment for pulmonary bullae?

Currently, surgery for pulmonary bullae is relatively mature and carries relatively low risks.

The main risk for patients and their families to be aware of is postoperative lung infection. Therefore, patients should be encouraged to perform lung exercises and quit smoking before surgery. After surgery, caregivers should provide proper and scientific nursing under the guidance of medical staff.

How long does recovery take after surgical treatment for pulmonary bullae?

• Open-chest surgery for pulmonary bullae: The surgery usually takes about 1 hour. Patients can typically be discharged about 9 days after surgery and resume normal work and life after 1–2 months of rest.
• Thoracoscopic surgery for pulmonary bullae: The surgery usually takes about 1.5 hours. Patients can typically be discharged about 6 days after surgery and resume normal work and life after 1–2 months of rest.

Can pulmonary bullae be cured completely?

Pulmonary bullae can be cured through surgery, but it cannot guarantee a permanent solution, as there is still a possibility of recurrence.

DIET & LIFESTYLE

What should patients with pulmonary bullae pay attention to in their diet?

Since pulmonary bullae are not a diet-related condition, patients do not need to follow any specific dietary restrictions. Maintaining a normal, healthy, and balanced diet while avoiding being underweight is sufficient.

What should patients with pulmonary bullae pay attention to in daily life?

Patients should prioritize rest and avoid strenuous physical activities such as heavy lifting, weightlifting, or diving, which require breath-holding. Those who smoke should quit. Additionally, they should take precautions to prevent colds and severe coughing.

What are the post-surgical precautions and care for pulmonary bullae?

After surgery, a chest drainage tube will be placed. Patients should ensure the tube does not dislodge and monitor the volume and characteristics of the drained fluid and gas daily. They should also avoid severe coughing or heavy lifting. If phlegm is difficult to expel, family members can assist with back patting or administer nebulizer therapy.

Do pulmonary bullae require follow-up examinations? How?

Since pulmonary bullae may enlarge or recur, all patients—whether post-surgery or not—require regular follow-ups. Typically, a chest X-ray or CT scan should be performed every 3 months to monitor changes. If the bullae remain stable over multiple check-ups, the interval may be extended to 6 months or 1 year. However, if rapid growth is observed, follow-ups should be more frequent. Immediate medical attention is necessary if symptoms suddenly worsen.

Can patients with pulmonary bullae fly, engage in intense exercise, or travel to high-altitude areas?

Air travel and high-altitude trips involve changes in air pressure, which can adversely affect the lungs. Therefore, patients with pulmonary bullae are advised against flying or traveling to high-altitude regions.

Intense exercise should also be strictly avoided, as it increases lung pressure and may lead to bullae rupture.

PREVENTION

Can pulmonary bullae be prevented? How to prevent it?

Congenital pulmonary bullae are caused by genetics and genes, so they usually cannot be prevented. However, pulmonary bullae are more likely to occur in tall, thin young people. Therefore, it is recommended to maintain a normal, balanced diet and a healthy body weight, avoiding being underweight.

Acquired pulmonary bullae are usually secondary to chronic underlying diseases such as chronic bronchitis and emphysema. Therefore, actively treating and managing these underlying conditions is key to preventing pulmonary bullae.

How to prevent recurrence of pulmonary bullae?

The prevention methods are the same as above.

How can patients with pulmonary bullae prevent other diseases caused by this condition?

The common complications of pulmonary bullae are spontaneous pneumothorax and secondary infections. To prevent these complications, patients should rest adequately in daily life and avoid heavy physical labor, lifting heavy objects, weightlifting, deep diving, or other activities that require breath-holding.

Patients can engage in low-intensity aerobic exercises (such as jogging). Those who smoke should quit and take precautions to avoid colds and severe coughing. Patients with underlying conditions like chronic bronchitis or emphysema should actively manage and control these diseases.