Reduced lung function and bullae resulting from illicit drug use.

Emphysema is a progressive, disabling disease. Emphysematous bullae form as a result of local areas of alveolar weakness and parenchymal remodeling. They grow as a result of preferential inflation during inspiration and elastic recoil of the surrounding lung tissue. Isolated apical bullae can be a consequence of illicit drug use, as was suspected in this patient. In the case of cocaine and marijuana smoking, direct drug toxicity or drug-induced vasoconstriction presumably contributes to bullae development. LVRS is often used to treat patients with bullae and severe underlying emphysema, although these patients are difficult to assess and their disease course is hard to predict. LVRS is associated with a higher morbidity and mortality. The best candidates for surgery have enlarged, well-localized bullae and minimal underlying lung disease. Early postoperative results include relief of shortness of breath, improved lung function, increased energy level and physical mobility, and improved ability to function during daily activities. LVRS may decrease the need for supplemental oxygen as soon as a few weeks after surgery, and benefits may be sustained for years. The best results are seen in patients with large bullae that cause the greatest compression of almost normal underlying lung. However, clinical and symptomatic improvement may be greater than actual spirometric measurements.