Hereditary lung blebs won’t multiply, take over

Question: I am an active 68-year-old man in good health. I am thin, but not very tall. I am 5 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 t hatt h erewereabouta dozen blebs scattered around my lungs, with the densest concentration on the lower left s ide.Ihad two breathing tests, one in a sealed chamber and the other just blowing into am achine. Both showed that I have “normal lung function for my age” (I’ve 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 t hatcan 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’veh ad these all my life, whyare they starting to give me problems now?

— D.I.

Answer: Spontaneous pneumothorax is an unusual condition, and classically occurs in tall and thin young men. I agree with your pulmonary specialist that these arelikelytohavebeen there your whole life.

They don’t 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 isjustal arge 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 commu- nicated to the airway, and t hereisnolongerapressure gradient to expand thel ungs. 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 recurre ncesofthisc ondition. These procedures can include removing the remaining blebs, and instillation into the chest cavit yo fama terial that causes the lung to adhere tightly to its lining.

Dr. Roach writes:

In a recent column on osteoporosis, I inadvertently used the wrong brand name when referring to ab isphosphonate, risedronate. The correct brand name is Actonel. Evista is ame dication related to estrogen, but which reduces risk of breast cancer. It does not have the ris ksoffro zen bone the way that longterm bisphosphonates do. Iapp reciate the letters alerting me to this, and apologize to the people (and their doctors) who called up in a panic.