Bullous emphysema is characterized by permanent enlargement of airspaces distal to the terminal bronchiole accompanied by destruction of alveolar walls. Several aetiologies have been described, namely deficiency of alpha1 -antitrypsin and the consumption of tobacco. With the exception of the deficiency of alpha1 -antitrypsin, some cases of bullous emphysema in the young adult continue without known aetiology. Some cases of bullous emphysema have been described, emphasising the relationship between the disease and drug consumption. The association possibly creates the conditions for the development of large lung bullae, with particular exuberance for the superior lobes. The authors describe two clinical cases of young patients, with history of consumption of smoked substance abuse and bullous emphysema.