Regression of giant bullous emphysema

Spontaneous resolution of bulla associated with infection or tumor is occasionally observed. However, resolution of progressively enlarging giant bullous emphysema (GBE) after medical therapy has not been reported. A 51-year-old man smoker with GBE on the right lung was referred to Samsung Medical Center for the consideration of bullectomy. A review of his medical records revealed that right-side bullous emphysema had been detected 4 years previously and it had progressively enlarged with a concomitant deterioration of lung function. Although he had a history of chronic asthma, he had never been treated on a regular basis. After combination therapy, including regular tiopropium, a salmeterol/flucatisone inhaler, a salbutamol inhaler as needed, and oral theophylline therapy, right side bulla showed marked regression. This regression of bulla was associated with an improved forced expiratory volume in one second and normalization of residual volume. This case serves as a reminder to clinicians that medical treatment for underlying diseases should precede surgical consideration in patients with GBE.