Surgical Therapy for Chronic Obstructive Pulmonary Disease: Conventional Bullectomy and Lung Volume Reduction Surgery in the Absence of Giant Bullae

COPD is a category of heterogeneous diseases with varying pathophysiologic basis and varying degrees of airflow obstruction and hyperinflation. Standard therapy has consisted of medical management and individualized exercise training. Multiple surgical attempts have ensued over the years to treat disabling dyspnea in these patients. These techniques have included attempts to improve thoracic mobility, decrease thoracic distention, stabilize dynamic airway collapse and achieve thoracic denervation. The most widely applied and potentially useful techniques have been surgical attempts to decrease pulmonary hyperinflation. Initial techinques removed giant bullous lesions with short and long-term relief of symptoms and improved physiology in carefully selected patients. Recently, similar lung volume reduction surgical techniques have been applied to patients with bullous disease but without discrete, giant bullae. Although the data are limited, early results in selected patients seem promising. This discussion compares the short-term and long-term results of classic giant bullectomy with lung volume reduction in the absence of giant bullae. Data are also reviewed which contrast selection criteria advocated for surgical consideration in both clinical scenarios.