Surgical and bronchoscopic treatment for COPD

Lung volume reduction surgery (LVRS) has been proved as the safe, effective, and durable treatment which improves life-span, exercise tolerance, QOL, and dyspnea in patients with severe COPD selected appropriately by distribution of emphysema (upper lobe vs non-upper lobe) and exercise capacity(low vs high) through the National Emphysema Treatment Trial (NETT) as well as previous or concurrent reports of clinical studies. However, this procedure has not always been offered to those patients who might benefit from it these years because of significant morbidity and mortality during perioperative period and in part because of misleading in early results of the trial. On the other hand, nonsurgical procedures, such as endobronchial valve to intend collapse of the emphysematous lung, extra-anatomical airway bypass to eliminate excessive residual lung volume, and remodeling of emphysematous lung with biological adhesives or vapor ablation have been proposed as alternative treatments for emphysema recently. However, efficacy and duration of these bronchoscopic lung volume reduction procedures are less than those of LVRS, and issues to be clarified remain. LVRS should be re-considered as a promising and practical tool for patients with emphysema confronting severe dyspnea during daily activities.