Lung Volume Reduction Surgery

If you have severe chronic obstructive pulmonary disease (COPD) that has progressed to the point where it can no longer be managed with inhaled medications, you may be a candidate for lung volume reduction surgery (LVRS).

COPD disorders include both chronic bronchitis and emphysema, when the air sacs in the lung are unable to effectively contribute to breathing and gas exchange. Some people who have the emphysema type of COPD or other lung diseases that cause emphysema can benefit from LVRS.
 
Many people with severe emphysema, however, are not candidates for LVRS, according to the American Lung Association. The following criteria must ideally be met:

• You must be strong enough to have the surgery and not use tobacco
• You must be willing and able to participate in pulmonary rehabilitation
• Your emphysema must be localized and there must be adequate healthy lung tissue

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Three types of lung surgery may improve breathing and quality of life in patients with severe emphysema:

• LVRS typically removes the most diseased lung tissues of the upper one-third of one or both lungs
• Bronchoscopic lung volume reduction surgery places valves in the airways leading to the diseased parts of the lung (isolated part of the lung collapses)
• Bullectomy removes one or more large air sacs from damaged lung tissue

Candidates for LVRS cannot have significant heart failure because the heart must be strong enough to pump blood effectively through a surgically reduced lung. The lung tissue that remains after the surgery must be healthy enough to sustain you with your anticipated level of breathing and activity. If you are not a candidate for LVRS, lung transplantation may be a last resort.
 
If you have no major health problems other than lung disease and your breathing problems are so severe that the benefits of surgery outweigh the risks, you may be a candidate for one of these major surgical procedures. Most patients with COPD, however, are not good candidates because of the risk of serious complications, according to the American Thoracic Society.
 
Bronchoscopic insertion of a valve to collapse part of your lung and bullectomy are less invasive procedures, but not appropriate for most patients whose tissue damage is spread throughout the lungs and not localized.