Lung volume reduction surgery in patients with low diffusion capacity

Lung volume reduction surgery (LVRS) has been shown to reduce dyspnoea and provide symptomatic improvement for a sub-set of patients with severe emphysema. The National Emphysema Treatment Trial (NETT) demonstrated prognostic benefit in those with heterogenous disease, upper lobe predominance, and low baseline exercise capacity (1). This trial also identified patients at high risk of early mortality over the baseline risk of usual care. These patients had a forced expiratory volume in one second (FEV₁) of <20% predicted and either homogenous disease or diffusion capacity (DLCO) <20% predicted. The perceived high risk of LVRS has reduced physician willingness for referral, despite its proven benefits (2).