Patterns of disturbed lung function in patients with emphysematous bullae.

In a previous publication (Ogilvie, 1959) an account was given of the functional disturbance in emphysematous patients without radiologically visible bullae. The purpose of this second paper is to describe the patterns of pulmonary dysfunction in 14 patients with pulmonary bullae and to compare these with the patterns observed in emphysematous patients without bullae. These patients were unselected in that they represented 14 consecutive referrals to the pulmonary function laboratory at the London Hospital. The methods used for measurement of lung function were those described previously (Ogilvie, 1959). Baldwin, Harden, Greene, Cournand, and Richards (1950) described 16 patients with large pulmonary air cysts or bullae and divided them into three groups according to the disturbance in pulmonary function. This classification was based upon the freedom of communication between the large cyst and the bronchial tree and the functional state of the remainder of the lungs. In 14 of these 16 patients, the large cysts or bullae occupied at least the whole of one hemithorax. The authors themselves observed that it may be impossible to judge whether ventilatory insufficiency is due to mechanical interference from a tension cyst or to severe generalized changes in the lungs. In the present series of 14 patients with pulmonary bullae, large bullae occupied more than one-third of the hemithorax in only two, and in two others there were diffuse " honeycomb " changes without large bullae. In five patients, pulmonary function studies were repeated after the larger bullae had been removed. It was therefore hoped that, by studying patients in whom considerable volumes of pulmonary tissue were not compressed or destroyed by giant tension cysts, more exact information might be obtained regarding the functional disturbance in the lungs as a whole. RESULTS