Surgery for COPD

Surgery may be a treatment option for some people with chronic obstructive pulmonary disease (COPD). Surgery can help the lungs work better and improve quality of life. But surgery is not right for everyone with COPD. Some people will not benefit from it, and some people are not good candidates for surgery.^1-4

There are 4 main types of surgery that may be used to treat COPD:^1,2,5

• Bullectomy
• Lung volume reduction surgery (LVRS)
• Lung transplant

Who might be a good candidate for surgery?

Doctors use many different tests to find out whether surgery is a good option for each person. A whole team of doctors might be involved in helping a person with COPD decide whether surgery is the right treatment choice.^1-3

The term COPD refers to 2 conditions: chronic bronchitis and emphysema. Most people have symptoms of both conditions, which is why they are lumped under the same name. But bullectomy and LVRS surgeries treat only the lung damage caused by emphysema. So, people with chronic bronchitis are not good candidates for these surgeries.^1-3

Different surgeries have different criteria that make someone a good candidate. Some of the basic criteria are:^1-3

• You must be strong enough for surgery.
• You cannot be a current smoker.
• You must have participated in a pulmonary rehabilitation program, which is a special educational and exercise program for people with COPD.

What is a bullectomy?

Healthy lungs have millions of tiny air sacs in them. These are called alveoli. Emphysema damages the walls of the alveoli. When the alveoli walls are damaged, they start to form fewer large air spaces instead of many tiny ones. These large air spaces are called bullae.^1,5

Bullae can become large enough that they crowd out the healthier portions of the lungs. They also create less area in the lungs where oxygen can enter the bloodstream. A bullectomy is a procedure in which doctors surgically remove 1 or more of the bullae.^1,5

Removing the bullae helps the remaining parts of the lungs function better. The size and location of the bullae in a person's lungs determines whether this kind of surgery is a good option for them.^1,5

What is lung volume reduction surgery?

Lung volume reduction surgery (LVRS) may be another surgery option to address the lung damage caused by emphysema. This procedure involves removing small portions of damaged lung tissue, typically the parts that are overinflated and not working well.^2-5

By reducing the volume of the lungs, LVRS aims to improve lung function and relieve symptoms. Doing so can help the healthier parts of the lungs to work better.^2-5

Removing or collapsing damaged lung sections can also reduce pressure on the diaphragm. The diaphragm is the main muscle that controls breathing. When pressure on the diaphragm is reduced, it can move more efficiently and make breathing easier.^1,4-7

In the past, LVRS was done through a major open surgery. The surgeon would make a large incision (cut) in the chest so they could access the lungs through the skin and rib cage. Today, advancements in technology have led to minimally invasive options. These increasingly common surgery options have faster recovery times and fewer risks.^3,4,7

A thoracoscopy can be done using smaller tools, cameras, and tiny incisions in the skin around the chest. A bronchoscopic lung volume reduction (BLVR) involves tiny, flexible cameras and tools inserted through the nose or mouth to access the lungs.^3,4,7

In BLVR, no tissue is actually removed. Instead, the surgeon places a one-way valve that leads to the area of damaged lung. The valve only lets air out, but not in. Over time, the damaged area does not receive air flow and collapses on itself. This part of the lung then functions like lung tissue that has been removed.^4,7-9

What is a lung transplant?

In cases of end-stage COPD, where the lungs are severely damaged and no longer respond to other treatments, a lung transplant may be considered. A lung transplant can greatly improve lung function and quality of life for eligible candidates.^3,10

During a lung transplant, 1 or both of a person's lungs are removed and replaced with healthy lungs from a donor. This can make it much easier for the person to breathe and be active. However, a lung transplant is a major surgery that carries many risks. It requires a long and intensive stay in the hospital and at a rehabilitation center after the operation.^3,10

People who receive a lung transplant must also take immune system-suppressing drugs (immunosuppressants) for the rest of their life. These drugs help prevent the body from rejecting the new lungs. But immunosuppressants have side effects and risks. People must carefully consider whether a lung transplant and its aftercare is the right option for them.^10,11

The number of people waiting for lung transplants is much higher than the number of available lungs from donors. This means that once a person decides to go forward with a lung transplant, they may have to wait a long time for a suitable lung. This waiting period can be very stressful.⁹