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. This evidence concerns the gene SERPINA1 and pulmonary sarcoidosis.