Sunday, April 09, 2006
Surgical options for COPD
What the hospitalist and PCP need to know is when to refer. The principal options are lung volume reduction surgery (LVRS) and transplantation. Although LVRS remains somewhat controversial the National Emphysema Treatment Trial has helped define the best candidates. These include patients with heterogeneous involvement with emphysema, particular upper lobe disease, DLCO > 20% and FEV1 > 20%. These are general principles, and final selection is very nuanced. Patients with more advanced disease might better be considered for transplantation. Although age cutoffs for transplantation are not absolute, patients older than 65 are not usually considered. The topic is reviewed here in Clinical Pulmonary Medicine.