Lung volume reduction for emphysema comes of age

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality, affecting around 4% of the global population1 and over 1.3 million people in the UK. The main symptoms are breathlessness, which limits everyday activities and is caused by airflow obstruction and lung hyperinflation, and cough with sputum. Despite conventional pharmacological approaches and addressing what the National Institute for Health and Care Excellence has defined as the “five fundamentals of COPD care”—smoking cessation, vaccination, pulmonary rehabilitation, self-management, and managing multimorbidity2—many people with the condition remain highly symptomatic.34

COPD encompasses a range of conditions, including chronic bronchitis, emphysema, and pulmonary vascular disease, some or all of which can occur to a variable extent in any one patient. Pharmacotherapy guidance is relatively undifferentiated, beyond a need to identify which patients are likely to benefit from inhaled corticosteroids.2 Although inhaled drugs can improve symptoms, a climate of therapeutic nihilism has prevailed because of the lack of treatments that alter the natural …