Smoking causes 'Bulla' disease of lung? : Be careful

Dr KK Pandey *

Tobacco products which are widely in use in the State :: Pix - TSE

In our region, the 'bulla' disease or in other words 'emphysema' is prevalent in a large population. With the rapid rise in number of smokers in recent years, the percentage of bulla disease of lung too is rising. Many young males and females, due to their smoking habits are falling victim to bulla disease of lung and gradually losing the vital functions of their lungs.

Due to increasing tendency of smoking among ladies day by day, the number of females falling victim to bulla disease is steadily rising. You would have observed quite frequently, that smokers generally complain of breathing difficulty. Sometimes, the breathing difficulty become so frequent that the daily routine of the sufferer gets disturbed and eventually he is unable to earn his livelihood.

You would have heard or seen that these sufferers, majority of who are chronic smokers, keep trying all sorts of medicines and homemade preparations but in the end, they do not get any let-up in coughing and breathlessness. If a chronic smoker suffers from breathing difficulty and he has already tried all kinds of medicines with no positive result, in such a scenario, the possibility of bulla disease of lung cannot be ruled out and such patients should immediately consult a thoracic or a chest surgeon and seek his advice.

What is this bulla disease of lung?

When any part of a lung loses its normal anatomical architecture or the lung tissue which normally participate in exchange of oxygen, gets destroyed due to some reasons — that destroyed part of lung assumes the shape of a balloon, whose wall are very thinned-out. This thin-walled and balloon-shaped part of lung is called Bulla in medical terms.

This bullous part of lung on one hand is unable to participate in the process of oxygen and carbon dioxide gas exchange, and on the other it exerts an excessive and unnecessary pressure upon the adjacent remaining lung and by doing this the bulla seriously impedes the functioning of lung. Due to decreased and improper functioning of lung, the percentage of oxygen in blood begins dropping. This drop in blood oxygen level happens to be the most important cause of breathlessness.

What does this bulla ultimately lead to?

If a chronic smoker has bullous disease of lung too, there happens to be a significant drop in his work efficiency due to decreased oxygen content. As a result on one hand, a sufferer of bullous disease becomes totally unfit to earn his livelihood and becomes eventually a burden on society and on the other, such patients may develop a lot of complications due to delayed diagnosis of bulla disease of lung.

When excessive coughng occurs, already weakened wall of bulla gives way due to sudden rise of internal pressure during coughing. When bulla bursts, a lot of air leaks out from branches of windpipe and collects inside the chest around the lung, which gets compressed leading to gross hampering of its function. If timely measures are not taken urgently to evacuate the air from the chest, the patient of bulla disease is destined to die. This dangerous condition is called in medical terms a 'pneumothorax'

What will happen , if a 'bulla' is not treated ?

The second important complications a patient of bulla disease faces, is the problem of massive bleeding inside the bulla. Due to this bleeding, patient starts passing out blood through mouth during coughing. This condition if not treated properly and timely will cost a patient very dearly and he may lose his life due to catastrophic bleeding.

The third problem, which may arise in a patient of bulla disease, is the complication of infection. This ballooned - out portion of lung catches infection very fast and there is always an increased possibility of pus collection. Always remember, in an untreated case of bulla disease, there is a grave risk of developing cancer of lung.

About 10% of patients suffering from bulla disease are always at risk of developing a lung cancer. The other reason is that due to presence of bulla, there occur changes in the adjacent healthy part of remaining lung, which is unable to participate completely in the process of gaseous exchange of oxygen and carbon dioxide. This leads to accumulation of cancer producing material in the lung.

How to identify a bulla disease of lung?

If you are a chronic smoker and at the same time you suffer from breathing difficulty too, it simply indicates you are very close to developing a bullous disease of your lung. If either you have breathing difficulty at your work place, or you are unable to complete your daily routine chores, or you suffer from recurrent episodes of chronic cough and infection of pneumonia, or you have started coughing out blood , in all these conditions, the possibility of bulla disease cannot be ruled out.

A smoker if suffering from any of these problems, should get his chest x-ray done and immediately consult a thoracic surgeon instead of a general surgeon.

Where to go, after bulla disease has been diagnosed?

If it has been proved that you are really suffering from bulla disease, always go to a hospital where the facility of a full time thoracic or a chest surgeon is there. For the cor- rect evaluation of seriousness of bulla disease, a number of latest investigations like multislide contrast CT scan of chest, angiography, pulmonary arteriography and ventilation perfusion scan are required.

Before entering a hospital make sure that the facility of these latest investigations is available or not. Before starting the treatment, it is very essential to enquire whether lung surgery is done routinely in that hospital or not. It has been seen that the surgeons more involved with heart surgery, does not have enough experience of lung surgery. Therefore, before deciding about the choice of surgeon this fact should be kept in mind.

Various modes of treatment of Bulla disease

If the bulla of lung has burst due to excessive internal pressure and the sufferer has developed breathing difficulty, in this situation it is very important to get the collected air removed through a chest tube by a thoracic or chest surgeon, otherwise patient may die. If patient has started passing blood during coughing, it is important to reach hospital in time, otherwise a patient may face a lot of dangerous complications.

After bulla disease has been diagnosed, such patient should not sit idle, instead he should consult immediately a thoracic surgeon. The surgery in bulla disease, involves removal of non- functioning balloon portion of lung. This operation in medical term is called 'bullectomy'. This surgery has three advantages.

Firstly, one can pre-empt an impending rupture of bulla in future and thus can save the life of such patient. Secondly, benefit from operation is that it can prevent any catastrophic bleeding episode in future.

Thirdly, operation can eradicate and nip in time the possibility of developing lungcancer in future. As you know in 10% of patients of bulla disease of lung, there is always a risk of developing cancer of lung.

Bulla and cancer of lung

When a bulla disease co-exists with the cancer of lung, only removal of bulla then from the lung does not suffice, but whole cancerous lung has to be removed. This operation in medical term is called 'lobectomy' or pneumonectomy'. All these types of major operations lose their value and any operation becomes a waste if a chronic smoker does not stop completely any use of cigarette of bidi.

According to one survey, if only a patient of bulla disease simply observe a complete abstinence from smoking, he can control to a great extent the complications arising out of bulla disease and simultaneously a tremendous improvement in work efficiency of remaining lung surprisingly has been noticed.

For planning of the surgery of bulla disease, the assessment of heart function, lung function and general physical condition is mandatory.

Generally, in an uncomplicated bulla disease there is no age bar for surgery of bulla disease unto 60, but if a complication of bulla disease occurs, no age is an exception for surgery.