What Causes Bubbles in the Lungs? How Should I Address It?

The significance of lung health is self-evident, as this vital respiratory organ plays a crucial role in maintaining our respiratory system. Any issues with the lung can have significant impacts on respiratory function. However, due to the lungs' location within the body, many problems can be difficult to directly assess, necessitating the use of various diagnostic tools to understand their condition. Some individuals may undergo lung exams and discover the presence of bubbles, leading to questions about their cause and management. Let's explore these issues further.

Pulmonary bullae, also known as lung blebs, are a form of localized emphysema. They occur when the alveoli become highly distended, with their walls rupturing and fusing together. This condition is typically caused by valvular obstruction in the small bronchi. Asymptomatic pulmonary bullae generally require no treatment, but in patients with chronic bronchitis or emphysema, the primary focus should be on managing the underlying disease. In cases of secondary infection, antibiotics may be prescribed. Large pulmonary bullae that occupy 70% to 100% of one side of the chest cavity and cause symptomatic issues, without other lung pathologies, may be surgically removed to decompress the affected lung tissue. Advanced surgical techniques, such as thoracoscopic minimally invasive surgery, allow for the removal of these bullae without the need for rib or sternum resection, resulting in minimal trauma, concealed scars, and excellent outcomes.

Asymptomatic pulmonary bullae generally do not require treatment. However, in patients with chronic bronchitis or emphysema, managing the underlying condition is essential. If an infection occurs, antibiotics may be prescribed. In cases where the bullae are large, occupying 70% to 100% of one side of the chest cavity, and causing symptoms such as respiratory distress, infection, or bleeding, surgical intervention may be indicated. Surgical removal of the bullae can decompress the affected lung tissue, increasing respiratory surface area, eliminating intrapulmonary shunting, improving arterial oxygen partial pressure, reducing airway resistance, and enhancing ventilation. This can lead to improvements in symptoms such as chest tightness and shortness of breath. The surgical principle aims to remove the bullae while preserving healthy lung tissue as much as possible. In cases of bilateral pulmonary bullae requiring surgery, the more severe side should be addressed first, with the possibility of addressing the other side six months later if necessary. Spontaneous pneumothorax caused by ruptured pulmonary bullae can often be treated non-surgically through methods such as chest puncture or closed thoracic drainage. However, recurrent spontaneous pneumothorax may require surgical intervention.

The symptoms of approximately two-thirds of patients improve significantly after surgery. Better outcomes are typically observed in cases where the bullae are well-defined, significantly enlarged, and occupy at least 30% of the chest cavity. In contrast, smaller, multiple pulmonary bullae may have relatively poorer postoperative outcomes. The removal of small pulmonary blebs (subpleural bullae) generally has minimal impact on lung function. Patients with intraparenchymal pulmonary bullae without emphysema can maintain long-term improvements after surgery. However, in patients with intraparenchymal bullae accompanied by emphysema, the symptoms of breathlessness may gradually return to preoperative levels within five years postoperatively. The primary reason for the inability to maintain the therapeutic effect is the gradual progression of emphysema. The improvement rate in these patients is approximately 50% at five years and 20% at ten years.

It is crucial to maintain lung health and seek prompt medical attention for any respiratory concerns. Regular check-ups and following the advice of healthcare professionals can help prevent and manage lung-related issues, including pulmonary bullae.