New treatment modalities for end-stage emphysema

The concept of nonresectional LVRS appears to be highly promising. Several strategies and approaches are currently available; however, the investigations to date are still just studies, and there remain many unanswered questions. No doubt new modifications and improvements in design will occur and these devices will continue to evolve. Appropriate patient selection is, as always, the key to good outcome. The studies so far have included only patients who have heterogenous disease; whether or not the procedures can be helpful for patients who have homogenous distribution of emphysema remains to be seen. Radioactive isotope scans are currently being used in an attempt to identify patients who have significant collateral flow, and these scans might eventually be useful in selecting patients who are unlikely to benefit from this approach. The preliminary data remain encouraging and suggest that a larger study with long-term follow-up care is warranted.