Surgery for severe COPD. Lung volume reduction and lung transplantation.

A management strategy for patients with severe emphysema is shown in figure 2 on page 199. Although the reported physiologic improvements after LVRS are significantly less than those seen after lung transplantation, LVRS has the potential to improve functional performance in a larger number of patients because of wider availability. Moreover, it accomplishes these goals without the attendant risks associated with transplantation and immunosuppression. The efficacy of LVRS over standard medical therapy in influencing survival and favorably affecting physiologic variables at rest and during exercise remains to be elucidated in NETT. Lung transplantation should be reserved for those patients deemed unsuitable or too ill for LVRS. It is to be hoped that future developments in organ preservation techniques and immunosuppressive regimens will expand the donor pool and decrease the incidence of posttransplantation bronchiolitis.