Selection of Candidates for Lung Volume Reduction Surgery

Abstract

Chronic obstructive pulmonary disease (COPD) is now the fourth leading cause of death in this country and the only major disease continuing to increase in prevalence and mortality (1). There are more than 20 million people in the United States with COPD (2,3). Most of these have the asthmatic or chronic bronchitic forms of the disease, but more than two million are believed to suffer from the predominantly emphysematous type. Although asthma and chronic bronchitis tend to be medically treatable, medically controllable diseases, there is no good medical therapy for emphysema (4). Disability is the exception in asthma and chronic bronchitis. It is the rule in progressive emphysema. Finally, in studies comparing mortality risks, 10-yr mortality is far higher in emphysema than in the asthmatic or chronic bronchitic groups (5). Because medical therapy has been so limited in emphysema, surgical options have been sought for over 100 yr. Over those years, many procedures have been attempted; most initially appeared promising, only to be abandoned because of ineffectiveness, morbidity, or mortality risks (6–9). See Chapter 7 for a more detailed review of this interesting history.