Dear Dr. Roach: I am an active 68-year-old man in good health. I am thin, but not very tall. I am five feet, 10 inches tall and weigh about 170 pounds.
In the past five years, I have had three recurrences of spontaneous pneumothorax (collapsed lung); the first happened when I was in my 20s. None was very serious, and they all reinflated without medical intervention. A CT scan showed that there were about a dozen blebs scattered around my lungs, with the densest concentration on the lower left side. I had two breathing tests, one in a sealed chamber and the other just blowing into a machine. Both showed that I have 鈥渘ormal lung function for my age鈥� (I鈥檝e never smoked). I do a lot of hiking and bicycling, and work out at a gym. I never seem to have difficulty breathing with exertion.
The pulmonary specialist said that I probably have had these blebs all my life, and they may be hereditary (two first cousins have had this, too). He also told me that if the collapsed lungs become more frequent, there are a couple of surgical procedures that can help. Otherwise, he said not to worry about this. However, I still have some concerns: Will the blebs multiply and eventually destroy my lungs? If I鈥檝e had these all my life, why are they starting to give me problems now? What is the difference between blebs and emphysema?
D.I.
Spontaneous pneumothorax is an unusual condition, and classically occurs in tall and thin young men. I agree with your pulmonary specialist that these are likely to have been there your whole life. They don鈥檛 multiply. Since you have never smoked, you are not at higher risk for development of lung disease such as COPD (chronic bronchitis and emphysema). Symptoms of a ruptured bleb (which is just a large cystic structure inside the lung) include sharp chest pain and shortness of breath. The lung can deflate, since the negative pressure created by the diaphragm and chest wall is communicated to the airway, and there is no longer a pressure gradient to expand the lungs. Normally, the lungs heal themselves, and there is no need for intervention.
Most of the recommendations I have read suggest considering surgery for people who have recurrences of this condition. These procedures can include removing the remaining blebs, and instillation into the chest cavity of a material that causes the lung to adhere tightly to its lining, preventing further recurrences.
Dr. Roach writes: In a recent column on osteoporosis, I inadvertently used the wrong brand name when referring to a bisphosphonate, risedronate. The correct brand name is Actonel. Evista is a medication related to estrogen, but which reduces risk of breast cancer. It does not have the risks of frozen bone the way that long-term bisphosphonates do. I appreciate the letters alerting me to this, and apologize to the people (and their doctors) who called up in a panic. I find it easier to use generic names and simply misremembered the brand name.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
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