ABSTRACT
Static and dynamic hyperinflation are key physiologic abnormalities in patients with advanced emphysema that contribute to dyspnoea, reduction in exercise performance, poor quality of life and even decreased survival. Many hyperinflated patients continue experiencing disabling dyspnoea despite maximal medical therapy, including smoking cessation, bronchodilators, oxygen supplementation and pulmonary rehabilitation. Carefully selected patients may benefit from either surgical or bronchoscopic techniques to reduce lung volumes. The National Emphysema Treatment Trial (NETT) demonstrated that lung volume reduction surgery (LVRS) improves lung function, dyspnoea, exercise performance, quality of life and survival in patients with upper lobe-predominant emphysema and low exercise performance. Those with upper lobe-predominant emphysema and high exercise performance experience the same benefits of LVRS except for the survival advantage. Bronchoscopic approaches to lung volume reduction (LVR) now are available. Endobronchial valves effectively reduce lung volumes and improve lung function, quality of life, and exercise performance in patients without collateral ventilation between the targeted and ipsilateral non-treated lobe. The two most frequent complications associated with EBV insertion include pneumothorax and COPD exacerbation. For patients with collateral ventilation, LVR coils or bronchoscopic thermal vapour ablation can be considered, but these techniques are not currently available in all areas of the world. This chapter reviews the available literature for both surgical and bronchoscopic approaches to lung volume reduction.
