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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

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. Pneumorax’s 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 are 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

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Andreoli, Thomas e., et al., editors, “Andreoli and Carpenter’s Cecil Essentials of Medicine,” 8th Edition, 2010, Saunders Elsevier, page 198-199, 215
  2. Kacmarek, Robert M., et al., editors, “Egan’s Fundamentals of Respiratory Care, 10th Edition, 2013, Elsevier Mosby, pages 186-202
  3. “Emphysema,” Physiopedia,,  accessed 10/24/18
  4. Felner, Kevin, Meg Schneider, COPD For Dummies,” 2008, NJ, Wiley Publishing, pages 10-12, 40
  5. Slebos, et al., “Air Trapping in Emphysema,” American Journal of Respiratory and Critical Care Mediicne, 2015, September 1,, accessed 2/14/19
  6. “Giant Bullae: What Are Giant Bullae?” Health Encyclopedia, University of Rochester Medical Center,, accessed 2/14/19
  7. “Bullectomy,” Medscapes, 2013, November 22,, accessed 2/14/19
  8. Meyers, BF, GA Patterson, “Chronic obstructive pulmonary disease • 10: Bullectomy, lung volume reduction surgery, and transplantation for patients with chronic obstructive pulmonary disease,” British Medical Journal, Originally from Thorax, 2003,, accessed 2/14/19


  • GAlexa
    6 months ago

    As I’m relatively new to COPD, many of the ideas I’m reading about might be old hat to you. Have there been many people helped with the Bullectomy procedure? How long does one stay in the hospital after surgery? And, if you had this done, or if you know someone that had this surgery done, how are they doing a year after, etc.?

  • Leon Lebowitz, BA, RRT moderator
    6 months ago

    Hi GAlexa, and thanks for joining in the conversation. Are you being considered or evaluated for surgery to treat your condition? Not everyone is a candidate for surgical procedures to treat COPD. And everyone also responds and recovers differently postoperatively. You may want to discuss this with your pulmonologist and/or the surgeon. Please do check back and let us know how you’re doing. All the best, Leon (site moderator)

  • Edward W.
    6 months ago

    Is this pretty much the same as LVRS?

  • Leon Lebowitz, BA, RRT moderator
    6 months ago

    Hi Edward W and thanks for your inquiry. The procedures are similar but not exactly the same. Are you being considered for this type of surgery? Leon (site moderator)

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