SERPINA1 and hyperinsulinemic hypoglycemia, familial, 4: Bullous lung disease is characterized by the development of bullae in otherwise normal lung parenchyma.21 Risk factors for the development of bullae include smoking history, pulmonary sarcoidosis, alpha-1 antitrypsin deficiency, alpha-1 anti-chymotrypsin deficiency, Marfan’s syndrome, Ehlers–Danlos syndrome, inhaled fiberglass exposure, and marijuana smoking.20,22 The underlying pathophysiology for bullae formation involves inflammatory damage to the bronchiole, leading to trapping of air.