Surgery

Surgical options for treatment of severe COPD include lung volume reduction and transplantation. Lung volume reduction by resection of nonfunctioning emphysematous areas improves exercise tolerance and decreases 2-year mortality in patients with severe, predominantly upper-lung emphysema who have low baseline exercise capacity after pulmonary rehabilitation.

The best candidates for lung volume reduction are those with an FEV₁ 20-40% of predicted, poor gas transfer in the lungs [a DLCO >20% of predicted], significantly impaired exercise capacity, heterogeneous pulmonary disease on CT with an upper-lobe predominance, poor carbon dioxide levels [PaCO₂ >50 mmHg], and absence of severe pulmonary hypertension and coronary artery disease.

Occasionally, patients have extremely large bullae that compress the functional lung. These patients can be helped by surgical resection of these bullae, with resulting relief of symptoms and improved pulmonary function.

Candidates for lung transplantation are patients <60 year with an FEV₁ <25% predicted after bronchodilator therapy or with severe pulmonary hypertension. The goal of lung transplantation is to improve quality of life, because survival time is rarely increased. The 5-year survival after transplantation for emphysema is 45-60%. Lifelong immunosuppression is required, with the attendant risk of opportunistic infections.

Reference

1. Global Initiative for chronic obstructive lung disease: Global strategy for the diagnosis, management, and prevention of COPD. 2010. www.goldcopd.org