Lung volume reduction surgery
A quick fire revision post for the Final FRCA examinations.
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This topic was examined in the September 2025 CRQ paper.
What is the indication for lung volume reduction surgery?
- Severe heterogeneous emphysema
- With severe dyspnoea
- Despite maximum medical therapy and pulmonary rehabilitation
That's it.
What other methods of lung volume reduction exist?
- Endobronchial valves - duckbill and umbrella types exist
- Biological sealants
- Thermal bronchial ablation
- Bronchial blockers
These all generate atelectasis in the target area, aiming to achieve the benefits of LVRS without the risks of major surgery.
Describe the pathophysiology of COPD
- Chronic inflammation leads to destruction of lung parenchyma and vasculature
- This, combined with mucus hypersecretion and ciliary failure, causes central and peripheral airflow dysfunction
- The result is chronic and usually progressive expiratory flow limitation that is not fully reversible
- Eventually leads to development of emphysematous bullae that hinder gas exchange
What are the aims of lung reduction surgery?
- Improve exercise tolerance and relieve dyspnoea
- In patients with severe emphysema
- Who have poor symptom control despite maximal medical therapy
Simple enough.