Lung volume reduction in chronic obstructive pulmonary disease

Abstract

Pathognomonic features of advanced emphysema include a markedly reduced alveolar surface area due to the formation of blebs and
bullae and significantly reduced elastic recoil. The aim of lung volume reduction, which can be achieved by either surgery or endoscopic
techniques, is volume loss of the targeted, diseased region(s) and redirecting airflow to less affected regions.
Lung volume reduction surgery (LVRS) entails reducing the lung volume by wedge excision of emphysematous tissue. LVRS carries
significant morbidity and mortality, but can offer survival benefit and increased exercise capacity in selected patients with predominantly
upper-lobe emphysema and low exercise capacity.
Endoscopic lung volume reduction (ELVR) refers to bronchoscopically inducing volume loss to improve pulmonary mechanics and
compliance, thereby reducing the work of breathing. Globally, this technique is increasingly used as treatment for advanced emphysema
with the objective of obtaining similar functional advantages to surgical lung volume reduction, while decreasing risks and costs. Current
evidence suggests that patients with either homogeneous or heterogeneous disease may benefit from ELVR.
It remains paramount that a systematic approach is followed and selection criteria are met, given the high costs and potential
complications related to both LVRS and ELVR.