Home > Journals > Minerva Pneumologica > Past Issues > Minerva Pneumologica 2009 March;48(1) > Minerva Pneumologica 2009 March;48(1):51-9





A Journal on Diseases of the Respiratory System

Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index




Minerva Pneumologica 2009 March;48(1):51-9

language: English

Indications for surgical intervention in COPD

Van Berkel V., Meyers B. F.

Division of Cardiothoracic Surgery, Washington University, St. Louis, MO, USA


Chronic obstructive pulmonary disease (COPD) is a progressive disease with substantial associated morbidity and mortality. While numerous surgical modalities have been tried as solutions to this debilitating disease, only three – bullectomy, lung volume reduction surgery (LVRS), and transplantation – have been demonstrated to have any benefit towards either survival or improvement in quality of life. These interventions are viable options in a select group of patients with severe, incapacitating emphysema. Only those patients that have failed to progress despite optimized medical therapy and a rigorous pulmonary rehabilitation regiment should be considered for operative planning. Pulmonary function tests, chest radiography, computed tomography, and nuclear ventilation-perfusion scans then further delineate those patients who are most likely to benefit from the operation, as well as determining which intervention is most likely to have a good outcome. The surgical options available to the patient depend upon the spectrum of the distribution of their disease – isolated bullae can be treated with bullectomy, heterogeneous emphysema lends itself to LVRS, while homogenous disease is best treated by lung transplantation. The ideal indicators for LVRS also include hyperinflation, a FEV1 greater that 20%, and a normal PaCO2. In contrast, patients with a low FEV1, hypercapnia, and associated pulmonary hypertension are directed towards transplantation. Using these criteria, there are few patients that are serious candidates for surgical intervention.

top of page

Publication History

Cite this article as

Corresponding author e-mail