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When to Consider Surgery for COPD

Medically Reviewed by Neha Pathak, MD on December 17, 2020

Surgery can be a treatment for chronic obstructive pulmonary disease (COPD) if it’s severe and has caused damage in certain parts of your lungs.

If you and your doctor decide this is the right course for you, you’ll be asked to commit to a healthy lifestyle, and you’ll probably need regular checkups, blood tests, and daily medication to stay healthy.

Are You a Good Candidate?

Surgery may be an option for you if:

  • You have COPD symptoms like emphysema (shortness of breath) or chronic bronchitis (severe cough).
  • Your symptoms have affected your quality of life.
  • You have flare-ups more often than in the past, and you have to go into the hospital because of COPD flares.

As with all types of surgery, there’s a chance of health problems with surgery for COPD, including bleeding, infection, heart attack, or stroke. Your doctor will want to make sure you are:

  • Strong and healthy enough to get through the surgery and recovery. That decision will be based on things like your body weight, your physical condition, and any other health problems you have that could make complications more likely.
  • Not a smoker. If you’ve smoked in the past 6 months, you may not qualify for certain types of surgery.
  • Willing to go through pulmonary rehab (PR). These are sessions where you take tests to see how well your lungs are working, meet with nutritionists and therapists, exercise with a trainer, learn how to breathe better and save energy, and talk with a psychologist about the emotional effects of lung surgery. PR may also include group therapy sessions with others who have advanced COPD.
  • The right age. If you’re 75 or older, you may not qualify.
  • Likely to be healthy enough to exercise after you finish PR.

If surgery isn’t a good option for you because of your overall health or another reason, other treatments can help you have a better quality of life with advanced COPD. For example, you may benefit from pulmonary rehab even if you don’t have surgery.

Types of COPD Surgery

Several types of surgery can treat advanced COPD if other treatments aren’t enough:

Bullectomy. This is surgery to remove large damaged air sacs, called bullae (or blebs), that can form inside your lungs. If they’re removed, you may be able to breathe more easily. But most people don’t have bullae that are big enough for this operation.

You’ll be under general anesthesia for this operation. The most common complication is an air leak. As with other surgeries, there’s also the risk of infection and post-surgery pain. As you recover, you’ll need to do pulmonary rehabilitation. If you smoke, it’s very important to quit.

Lung volume reduction surgery (LVRS). This is used to treat people who have emphysema in the upper lobes of their lungs. Diseased tissue can make an open space in that area, and air can get stuck there. That makes one lung too large, and it fills up with too much air when you breathe in (called hyperinflation). LVRS takes out about a third of the diseased tissue in the upper lobe area of your lung. Even though it makes your lung smaller, it may help the healthy parts of your lungs work better.

You’ll be under general anesthesia for this surgery. Your surgeon will take out the part of the upper lobe of your lung(s) that’s been damaged by the disease. They may also have to take out some of the healthy air sacs around the damaged part.

Recovery from LVRS surgery includes being in the hospital for 5-10 days right after the operation and going to pulmonary rehabilitation.

Endobronchial valves. A newer -- but still rare -- way to treat hyperinflation is to put a tiny, one-way air valve in the diseased lobe. The valve lets air out but not in. Within a few hours, all the air is pushed out.

To qualify for this type of surgery, you must have damage only in one area of your lung, not all over. Your treated lung can’t get any air from the lobe or lung that borders it. It must be airtight, or the surgery won’t work. You’ll have to get an imaging scan and other tests to be sure valve surgery will work for you. If not, you may still be able to get LVRS.

If you are a good candidate and decide to get these valves, the doctor will use a thin, flexible tube called a bronchoscope to position the valves in your affected lung. The valves are about the size of a pencil’s eraser. You’ll either be sedated or under general anesthesia during the procedure and you may stay in the hospital for a short time afterward.

Lung transplant. If your advanced COPD has so severely damaged your lung that it no longer works well, you may qualify for an organ transplant. This is major surgery to remove your diseased lung and replace it with a donated lung.

This is thought of as a last resort for advanced COPD treatment. Your doctor may recommend it if you have very severe COPD that’s getting worse even with treatment and you have at least one of the following:

  • You’ve had to go into the hospital to treat hypercapnia -- too much carbon dioxide in your blood from poor breathing.
  • You have pulmonary hypertension or an enlarged heart even though you’re on oxygen therapy.
  • You have emphysema throughout your lung.

You’ll also need to be healthy enough to qualify for a transplant. If you meet the requirements, you’ll go on the wait list of the National Organ Procurement and Transplantation Network. When a donated lung becomes available, you’ll have the lung transplant surgery done in a hospital while you’re under general anesthesia. Your surgeon will cut your chest open, replace the diseased lung with the donated one, reconnect the blood vessels going to that lung, and close up your chest.

The recovery will start in the hospital’s intensive care unit. You’ll then move to another part of the hospital for up to 3 weeks. You may need to do pulmonary rehabilitation, and you’ll need to take medication for the rest of your life so your body doesn’t reject your transplanted lung. Those medications make you more likely to get infections and over time raise your risk of cancer, diabetes, osteoporosis, and kidney problems. But they’re a key part of helping your lung transplant succeed. You’ll have a lot of check-ups to make sure your donated lung stays healthy and that your body accepts it.

WebMD Medical Reference

Sources

SOURCES:

Umur S. Hatipoglu, MD, pulmonologist, Cleveland Clinic.

Jason Turowski, MD, pulmonologist, Cleveland Clinic.

American Lung Association: “Surgery for COPD.”

Cleveland Clinic: “Lung Volume Reduction Surgery (LVRS).”

National Heart, Lung, and Blood Institute: “Pulmonary Rehabilitation.”

American Lung Association: “Lung Volume Reduction Surgery.”

Global Initiative for Chronic Obstructive Lung Disease (GOLD): “Pocket Guide to COPD Diagnosis, Management, and Prevention. A Guide for Health Care Professionals, 2019 Report.”

Medscape: “Bullectomy.”

UpToDate: “Bullectomy for giant bullae,” “Lung volume reduction surgery in COPD.”

American Thoracic Society: “Surgery for Chronic Obstructive Pulmonary Disease.”

Cleveland Clinic: “Lung Volume Reduction Surgery (LVRS): Recovery and Outlook.”

Franciscan Health: “PulmonX Zephyr Valve, a Treatment Option for COPD and Emphysema.”

National Heart, Lung, and Blood Institute: “Lung Transplant.”

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