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    COPD: Lung Volume Reduction Surgery

    COPD: Lung Volume Reduction Surgery

    Topic Overview

    In lung volume reduction surgery (LVRS), a large area of damaged lung is removed to allow the remaining lung tissue to expand when you breathe in. This surgery is done only for people with severe chronic obstructive pulmonary disease (COPD) or with certain types of emphysema. 1

    The National Emphysema Treatment Trial has examined the results of LVRS. The results of this study report that people not considered good candidates for this surgery include people who have: 2

    • Severely impaired lung function as measured by breathing tests or a uniform pattern of emphysema throughout the lungs.
    • Largely non-upper lung emphysema and who are able to exercise for a longer time than other people with COPD.
    • Certain other serious medical problems.

    For other people LVRS, compared to medical treatment, may provide an increased ability to exercise and may result in fewer symptoms. LVRS also can reduce the number of COPD exacerbations for some people. 3 But it does not improve the survival rate compared to medical treatment, except for people who have emphysema mainly in the upper portion of the lungs and who are not able to exercise well even after pulmonary rehabilitation. 4

    Although selecting candidates for LVRS is subjective, criteria identifying good candidates for LVRS include people: 5

    • Who have severe emphysema that does not respond to medical therapy.
    • Who are younger than 75 to 80 years old.
    • Who have not smoked for at least 4 months.
    • Who have reasonable expectations of surgery results.
    • Who have areas of the lung that can be targeted.
    • Who have severe difficulty breathing, as determined by breathing tests.

    Decision to have the surgery

    The decision to have this surgery is not an easy one. Not all patients who have emphysema or COPD will benefit from this surgery. Detailed testing is needed to find out if a person is likely to be helped by LVRS. Talk with your doctor about all of the treatment options available for COPD.

    References

    Citations

    1. Global Initiative for Chronic Obstructive Lung Disease (2011). Global Strategy for the Diagnosis, Management, and Prevention of COPD. Available online: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2011_Feb21.pdf.
    2. National Emphysema Treatment Trial Research Group (2003). A randomized trial comparing lung-volume reduction surgery with medical therapy for severe emphysema. New England Journal of Medicine, 348: 2059?2073.
    3. Washko GR, et al. (2008). The effect of lung volume reduction surgery on chronic obstructive pulmonary disease exacerbations. American Journal of Respiratory and Critical Care Medicine, 177(2): 164?169.
    4. Naunheim KS, et al. (2006). Long-term follow-up of patients receiving lung-volume-reduction surgery versus medical therapy for severe emphysema by the National Emphysema Treatment Trial Research Group. Annals of Thoracic Surgery, 82(2): 431?443.
    5. Ciccone AM, et al. (2003). Long-term outcome of bilateral volume reduction in 250 consecutive patients with emphysema. Journal of Thoracic and Cardiovascular Surgery, 125(3): 513?525.

    Credits

    By Healthwise Staff
    Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
    Specialist Medical Reviewer Ken Y. Yoneda, MD - Pulmonology
    Last Revised February 19, 2013

    Last Revised: February 19, 2013

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