[When the throug is reached].

Area of Science:

• Pulmonology
• Thoracic Surgery
• Medical Case Reports

Context:

• Severe chronic obstructive pulmonary disease (COPD) significantly impacts quality of life, limiting daily activities.
• Standard medical therapies, including oxygen, are often insufficient for end-stage COPD.
• Lung transplantation and lung-volume-reduction surgery (LVRS) are established options for select patients.

Purpose:

• To report a case of unilateral LVRS in a patient with end-stage COPD who did not meet standard criteria.
• To illustrate the potential for therapeutic decisions outside established evidence in critical situations.
• To highlight the importance of clinical reasoning and experience in managing complex respiratory diseases.

Summary:

• A patient with far-advanced COPD, severely debilitated and unresponsive to maximal therapy, underwent unilateral LVRS.
• The decision was based on clinical judgment rather than strict adherence to evidence-based criteria for LVRS.
• The patient experienced substantial subjective and objective improvement post-surgery with an uncomplicated recovery.

Impact:

• This case suggests that carefully considered LVRS may benefit carefully selected patients with end-stage COPD, even in the absence of definitive scientific evidence.
• It underscores the potential value of individualized therapeutic approaches in critical care settings.
• Highlights the need for further research into expanded indications for LVRS in severe COPD.