Surgical and interventional procedures

For patients with very severe COPD who remain incapacitated by dyspnoea despite optimised therapy (including pulmonary rehabilitation), surgical or interventional procedures can be considered. Refer patients to a specialist centre for considerations of these highly specialised palliative approaches.

Lung transplantation can be considered for selected patients with end-stage COPD. It can improve survival, but is limited by donor availability, need for lifelong immunosuppression, and the development of chronic allograft dysfunction. Young patients with few comorbidities may be suitable for consideration of lung transplantation.

Lung volume reduction surgery or bronchoscopic lung volume reduction employing endobronchial valves are suitable for only a small group of highly selected patients. Although they can improve lung function, quality of life and exercise tolerance, they are also associated with significant morbidity and mortality.