Lung volume reduction surgery for emphysema

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease wit h a variable pathophysiologic basis(114) manifest by varying degrees of chr onic airflow obstruction and hyperinflation. The incidence in the United St ates is estimated to be at least 14 million and the prevalence is rising.(5 7, 80, 137) At least two million individuals suffer from (predominantly) em physema, which is characterized by anatomic air space enlargement.(33) The economic burden of COPD is huge and increases with more severe disease.(74) Furthermore, a marked impairment in quality of life is noted in these pati ents as the disease progresses.(43) Over the past 50 years, many advances h ave been made in the management of COPD. The American Thoracic Society rece ntly published a detailed, evidence-based analysis of medical management th at provides a stepped-care algorithm of bronchodilators and suggests a poss ible role for anti-inflammatory agents.(2) Furthermore, a recent comprehens ive review of pulmonary rehabilitation confirmed objective and subjective i mprovements with varying rehabilitation formats in patients with COPD.(1) D espite these advances, many patients continue to experience incapacitating breathlessness and exercise Limitation. Over the past 90 years, numerous su rgical approaches have been devised to ameliorate symptoms in these patient s.