Abstract
Chronic obstructive pulmonary disease (COPD) is a common and morbid progressive disease
where treatment is focused on improving dyspnea, reducing exacerbations, attenuating
comorbidities, and improving quality of life. Surgical therapy can be beneficial to
a carefully selected subset of individuals and is the subject of this review. The
National Emphysema Treatment Trial (NETT) has not only demonstrated the efficacy of
lung volume reduction surgery (LVRS) but has also provided many lessons regarding
advanced emphysema. NETT demonstrated that LVRS improves exercise performance, quality
of life, and pulmonary function in those with upper lobe predominant emphysema in
the setting of advanced disease. Those with upper lobe predominant emphysema and low
exercise tolerance also had a survival advantage compared with maximal medical therapy.
Careful patient selection is paramount to success, as there clearly are patients in
whom LVRS increases mortality. Giant bullae are rare, but bullectomy has been demonstrated
to improve dyspnea and lung function in cases where the bulla occupies at least one-third
of the hemithorax and compresses some adjacent lung tissue. For patients with chronic
respiratory failure due to COPD who have not improved despite maximal surgical and
medical therapy, lung transplantation remains an option in those without significant
comorbid conditions.
Keywords
emphysema - lung volume reduction surgery - lung transplantation - bullectomy - COPD
