Why do some people develop pulmonary bullae in their twenties?

Causes of pulmonary bullae in people in their twenties include congenital lung developmental abnormalities, long-term smoking or exposure to secondhand smoke, recurrent pulmonary infections, airway hyperresponsiveness or poorly controlled asthma, and complications from chest trauma or prior lung surgery. These factors may lead to structural damage in the lungs. If symptoms such as chest tightness, chest pain, or shortness of breath occur, prompt medical evaluation is recommended.

1. Congenital lung developmental abnormalities: Some individuals are born with weak alveolar walls and underdeveloped elastic fibers in the lungs. This makes alveoli prone to expansion and coalescence under respiratory pressure, leading to the formation of bullae. This condition often occurs without clear triggers and is relatively common among young people.

2. Long-term smoking or secondhand smoke exposure: Harmful substances in tobacco smoke can damage the airway and alveolar epithelium, impairing alveolar elasticity. This results in enlargement and fusion of alveolar spaces, increasing the risk of developing pulmonary bullae in young smokers or those frequently exposed to secondhand smoke.

3. Recurrent pulmonary infections: Lung infections such as pneumonia or tuberculosis can compromise the integrity of alveolar walls. After inflammatory healing, fibrotic changes may reduce alveolar elasticity, and repeated infections increase the likelihood of bulla formation.

4. Airway hyperresponsiveness or poorly controlled asthma: Airway spasms and airflow obstruction can elevate intra-alveolar pressure. In individuals with chronic uncontrolled asthma or airway hyperresponsiveness, alveoli are prone to over-distension, rupture, and eventual fusion into bullae.

5. Chest trauma or postoperative complications from lung surgery: Blunt or penetrating chest injuries, as well as lung surgeries, may damage alveolar walls and lung tissue. During healing, scar tissue may form and exert traction on surrounding areas, causing localized alveolar dilation that can progress into bullae.

Asymptomatic individuals should undergo regular follow-up imaging to monitor disease progression and avoid strenuous exercise and lung infections. Symptomatic patients may benefit from minimally invasive thoracoscopic surgery to remove the affected tissue. Daily management includes quitting smoking, avoiding irritants, maintaining a regular lifestyle to strengthen overall health, ensuring airway patency, and minimizing the risk of bulla rupture.