Widening the selection criteria for lung volume reduction surgery

Extract Lung emphysema is a chronic disease that strongly impairs the patient's quality of life (QoL) and survival. In well-selected patients with severe emphysema, who are breathless despite maximal medical care, lung volume reduction (LVR) can improve lung function and exercise capacity to alleviate symptoms and potentially delay or prevent lung transplantation [1, 2]. The main goal of LVR is to reduce hyperinflation by targeting the excess residual volume (RV), increasing dynamic lung volumes and breathing reserve capacity [2]. Patients should be selected by a specialised multidisciplinary team following thorough functional and morphological assessment [3]. The general accepted selection criteria for lung volume reduction surgery (LVRS) originate from expert recommendations in the NETT-trial and include forced expiratory volume in one second (FEV₁) 20–45%predicted (%pred), total lung capacity (TLC) >100%pred, RV >150%pred, diffusing capacity for carbon monoxide (DLCO) ≥20%pred, six-minutes walking distance (6MWD) 140–450 meters, absence of coronary artery disease or moderate to severe pulmonary hypertension (mean PAP <35 mmHg) [4].