Economic considerations and future directions for lung volume reduction surgery

Chronic obstructive pulmonary disease is a major cause of morbidity and mortality throughout the world. Standard management includes avoidance of causative factors such as smoking, and pharmacological therapy with combinations of inhaled and/or oral bronchodilators and corticosteroids. Lung transplantation is an established but infrequent option due to donor shortages. The nonevidence-based application of lung volume reduction surgery as palliation for patients with severe emphysema culminated in the US federally approved multicenter National Emphysema Treatment Trial published in 2003. This article reviews recent guidelines concerning chronic obstructive pulmonary disease management as outlined in the 2002 Global Initiative for Obstructive Lung Disease Workshop Report, focuses on published data regarding the cost-effectiveness of lung volume reduction surgery and outlines some less invasive techniques that are on the horizon.