Your Guide to Bullous Emphysema (BE) and Its Treatment

Smoking is the primary cause of bullous emphysema (BE), but this painful breathing condition can develop in anyone.

BE is a condition that affects your lungs. It can make it difficult or painful to breathe, so it requires treatment by a doctor. It’s one of several types of emphysema, which is classified as a chronic pulmonary obstructive disease (COPD).

BE is a chronic condition, meaning it’s not curable, but your doctor can prescribe medications, make lifestyle recommendations, and possibly remove bullae surgically to improve symptoms and slow the condition.

Causes of bullous emphysema (BE)

Emphysema occurs when the part of your lungs that creates gas exchange becomes permanently inflamed. This section of the lungs is called the alveolar walls. This is where your body converts the oxygen that you breathe in into carbon dioxide that you breathe out.

When this part of the lungs is swollen, your body can’t absorb oxygen as easily, and breathing becomes more difficult.

The two main causes of BE are smoking tobacco and having an alpha-1 antitrypsin deficiency . This is a genetic condition that interferes with the production of alpha-1 antitrypsin, which is a protein that protects the lungs and liver from irritants.

Other environmental factors could also cause BE, including:

• inhaling environmental irritants like fiberglass, air pollutants, dust, sand, and chemical fumes
• smoking cannabis
• using cocaine

Additionally, some genetic conditions could lead to BE. These include sarcoidosis and connective tissue disorders such as Marfan and Ehlers-Danlos syndromes.

BE most frequently occurs in males who smoke or who have smoked, but anyone can develop the condition. One case study examined BE in a 42-year-old woman from Sierra Leone. They had exposure to secondhand smoke, though, as well as environmental pollution and people with respiratory illnesses.

Symptoms of bullous emphysema (BE)

With BE, the walls of the lung expand when pockets of air, or bullae, form. These pockets are larger than a centimeter and sometimes can even be classified as giant if they take up 30% of one side of the lung.

Symptoms of BE may include:

• a productive cough
• painful breathing
• difficulty breathing
• shortness of breath
• chest pain
• tiredness

You may need a CT scan to diagnose BE. This imaging tool is more accurate than an X-ray for BE. A CT scan can indicate the number, size, and placement of bullae in the lungs. A CT scan is also more sensitive than an X-ray, which may not be able to capture the bullae as accurately.

It’s important that a doctor diagnoses BE properly because it can present similarly to a collapsed lung. A collapsed lung requires different treatment than BE and can be life threatening.

Treatment options for bullous emphysema (BE)

Your doctor may treat BE in several ways. They should address your symptoms to make you more comfortable and make your breathing easier. Treatments can also slow the condition so it doesn’t get worse.

The first line of treatment may be to open your airways. A doctor can do this with:

• bronchodilator medications like albuterol or ipratropium
• supplemental oxygen
• antibiotics or steroids (if you’ve developed a lung infection)

Your doctor may also recommend surgery to remove large bullae, but this isn’t always required to manage the condition. You may need surgery for other lung conditions that relate to BE or emphysema, such as an infection or a collapsed lung.

If possible, you should also avoid exposure to environmental irritants and stop smoking to lessen the symptoms and slow the progression of BE.

Are bullous emphysema (BE) treatments covered by insurance?

Your insurance may cover your BE treatments as long as your doctor deems them “medically necessary.” It’s a good idea to talk with your insurance provider to confirm what it covers so you’ll know what to expect during treatment, as there may be additional copays.

BE is classified in the ICD-10 with the code for emphysema: J43.0. This code can help you look up the coverage for BE within your insurance documentation.

Is bullous emphysema (BE) serious?

BE is a chronic condition, meaning it’s incurable. But you can slow it and manage your symptoms with medications, oxygen supplementation, lifestyle adaptations like quitting smoking or avoiding pollutants, and even surgery, if needed.

These treatments may improve your overall quality of life, but they won’t cure the condition.

Takeaway

Talk with your doctor if you think you have symptoms of BE. These may include difficulty or painful breathing along with other symptoms, like a cough, fatigue, and pain.

You may be more likely to have BE if you smoke, but anyone can develop this condition. Environmental pollutants and genetics can contribute to the development of BE.

Your doctor can diagnose and treat BE to help you manage your symptoms and improve your daily life.