What Is Bullectomy?

There are some neat treatment options for severe COPD. One such option is a bullectomy. So, what is this? Who qualifies for it? Here’s what to know.

Background on COPD and emphysema

A basic description of COPD is needed to understand bullectomy. I describe emphysema in my post, “What Is Emphysema.” I actually want to expand a bit on that post here.

Air travels down air passages. At the end of these passages are small balloon-like units called alveoli. These units are made of elastic tissue. Like balloons, they expand when you inhale. Also, like balloons, they recoil to their natural shape when you exhale. This recoiling also helps to splint airways leading to them. This helps keep airways open and patent. This helps to keep breathing normal and easy.^1-4

So, with emphysema, alveolar walls become inflamed. Gradually, over time, they become stiff. So, they expand when you inhale. But, they fail to recoil to their natural shape when you exhale. This causes air to become trapped inside alveoli.⁵

What are bulla?

Over time, these stiff alveolar walls bust. When this happens to enough alveoli, this creates air spaces inside your lungs. These air spaces are called bulla. Sometimes, these bulla can become large. They can take up lots of space where good lungs, good alveoli, might expand. So, this can cause you to become short of breath. As these air spaces get large enough, they can make you feel very short of breath.⁶

What is the pleural sac?

Also, there is a sac that wraps around your lungs. This is called the pleural sac. Between this sac and your lungs is a narrow space. This space is called the pleural space. Under certain conditions, large bulla may burst. Air then makes its way into this pleural space. This causes a condition called a collapsed lung. Another term for this is a pneumothorax.

This doesn’t always happen, but it’s a risk of having large bulla. PPneumothoraces can be very painful. They can also cause you to become very short of breath. They are treatable, however, A tube is inserted into your pleural sac to let the air out. This tube is called a chest tube.

This is a risk if you have very severe COPD. More specifically, it’s a risk for those suffering from very severe emphysema. It’s also a risk for those with alpha-1 antitrypsin deficiency, what is also often referred to as genetic COPD.

So, what is a bullectomy?

It’s an invasive procedure. You are put under anesthesia. You are taken into surgery. A surgeon then goes into your chest and removes your bulla. This almost immediately creates more room for good alveoli to expand. It can make breathing better, sometimes significantly better.⁷

Those who qualify for the procedure must be diagnosed with severe COPD. They must also have severe dyspnea even on good COPD days. They must have a confirmed bulla. Usually, an x-ray or cat scan can confirm this. The bulla must be large and take up as much as 30% of your lung space. This large of a bulla is called a “Giant Bulla.”^6-7

Other indications

Another indication is a history of pneumothorax. If you keep needing chest tubes you are a candidate for this procedure.⁷ Bullectomy may also fill with fluid. So, they can become infected. Repeated lung infections is also an indication. However, this is a rare symptom of bulla. Another rare symptom, but certainly an indication for bullectomy, is hemoptysis (spitting up blood).^7-8

Bullectomy is a generally safe procedure

The first bullectomy was performed before the 1950s. For those who meet qualifications, the surgery is generally considered safe. The procedure allows good lungs to fully expand. Therefore, it often results in an improvement in lung function. This has the potential to make breathing easier.⁸