Surgical Treatment for Chronic Obstructive Pulmonary Disease (COPD)

Surgery is among the treatment options for chronic bronchitis and other forms of chronic obstructive pulmonary disease (COPD). In general, surgery is not a common therapeutic approach for chronic lung disease, and it is not always beneficial in COPD. But if your COPD is characterized by features that could be corrected surgically and medications haven't offered adequate relief, there are several interventional procedures that may be effective.

Surgery for COPD might not be completely curative and it has not been shown to prolong life expectancy. The intended outcome is a reduction of symptoms and an improved quality of life.

Surgical Evaluation

Prior to deciding whether or not surgery would be right for you, your medical team will do extensive testing of your pulmonary function. Keep in mind that anesthesia (which is necessary for these surgical procedures) can be particularly risky if you have COPD.

Your pre-surgical testing can be used to help determine whether you could potentially benefit from lung surgery and whether you can tolerate such a procedure.

Your pre-surgical evaluation may include:

• Chest X-ray
• Chest computed tomography (CT)
• Pulmonary function tests
• Arterial blood gas
• Ventilation/perfusion (VQ) scan
• Angiography of the lungs
• Cardiopulmonary exercise test (CPET)

Using these tests, your medical team can identify the areas of your lungs that are affected by COPD and assess much your pulmonary function has been affected by the condition.

If surgery is still on the table at that point, the following options will be considered.

Bullectomy

Bullae are enlarged (greater than 1 cm) air spaces within the lungs that can develop in COPD. Giant bullae cause substantial compression on the underlying healthy lung tissue, reducing blood flow and oxygen to the lungs. This exacerbates dyspnea (shortness of breath).

A bullectomy is a surgical procedure in which the bullae are removed. The purpose of a bullectomy is to allow healthy alveoli (air sacs) in the lungs to expand, making breathing easier.

You might benefit from a bullectomy if you experience:

• Severe dyspnea
• Hemoptysis (coughing up blood)
• Repeated bullae infections

Factors that may contraindicate having a bullectomy include:

• The presence of multiple small bullae
• Advanced emphysema in the non-bullous adjacent lung
• Hypercapnia (a high carbon dioxide level)
• Cor pulmonale (right-sided heart failure)
• A forced expiratory volume in one second (FEV1) less than 40% of the predicted value or 500 ml

Keep in mind that a bullectomy can cause complications, including prolonged air leaks, lung infections, respiratory failure, and even death.

Lung Volume Reduction Surgery (LVRS)

COPD can cause the lungs to become enlarged, a condition described as lung hyperinflation. LVRS surgery may help improve your breathing ability and lung capacity by removing a portion of the diseased lung tissue so that healthy lung tissue has space to expand and work more efficiently.

This procedure can be beneficial when severe COPD affects the upper lobes of the lungs, but it may be harmful when COPD affects other areas of the lungs.

To be considered for LVRS, the following criteria are required:

• Not smoking for four months prior to and throughout the evaluation process
• Not having had a previous LVRS
• Not having had a previous coronary artery bypass surgery or a serious heart condition

Endobronchial Valve Volume Reduction

You can also have lung volume reduction with placement of valves into your bronchi. This procedure involves bronchoscopic placement of one-way valves into severely diseased airways in the lungs. These valves collapse the areas of the lung where they are placed, making more space for healthy, functioning lung tissue.

While this procedure is less invasive than bullectomy and LVRS, it still has some risks and it requires anesthesia.

Lung Transplantation

A lung transplant for the treatment of COPD is a major surgical procedure. A previous bullectomy, LVRS, or endobronchial valve volume reduction procedure is not a contraindication for lung transplantation. In fact, these procedures can actually help serve as a bridge to lung transplantation for some people who have COPD.

A lung transplant may be considered for people who have severe disease involvement throughout the lungs, along with impaired lung function.

You will need to have a strong support system as you recover after a lung transplant.

A Word From Verywell

You will need to have pulmonary rehabilitation to optimize your lung function before and after your procedure.

Recovery from surgery for COPD can take weeks or months, and your outcome will be better if you take good care of your lungs and your overall health for the rest of your life. Taking care of your lungs involves avoiding infections, maintaining moderate exercise, and not smoking.