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Helping the lungs work more efficiently.
- COPD treatment can improve breathing, reduce flare-ups, and help you stay active.
- For selected people with severe emphysema, reducing trapped air can make breathing easier.
- Lung volume reduction surgery (LVRS) is one option. Careful testing helps determine whether surgery, endobronchial valves, or continued medical treatment is the best fit.
Understanding the condition
What are COPD and emphysema?
Chronic obstructive pulmonary disease (COPD) makes it harder to move air out of the lungs. Many people have a combination of emphysema and chronic bronchitis. Symptoms can include shortness of breath, cough, mucus, wheezing, and difficulty with everyday activity.[9]
Emphysema
The walls of the tiny air sacs are damaged, and the lungs lose some of their natural spring. Air becomes trapped, and there is less healthy surface available to move oxygen into the blood.
Chronic bronchitis
The airways are inflamed and produce excess mucus, causing a persistent cough and making airflow more difficult. Lung volume reduction targets emphysema, rather than chronic bronchitis alone.
Smoking is the most common cause, but COPD can also occur in people who have never smoked. Other contributors include long-term exposure to dust or fumes and an inherited condition called alpha-1 antitrypsin deficiency. Ask whether you have been tested for this condition.[5][9]
Spirometry, a breathing test, helps confirm COPD. A CT scan shows the amount and pattern of emphysema, but does not replace breathing tests.[5]
The foundation of care
Treating COPD before considering a procedure
Treatment is tailored to your symptoms, breathing tests, and history of flare-ups. These measures remain important even if you later have lung volume reduction.[1][9]
- Stop smoking and avoid irritants
- Stopping smoking can slow further lung damage at any stage. Counseling and medication can help. Avoid secondhand smoke and other exposures that worsen breathing.
- Inhalers and other medicines
- Bronchodilators relax the airways. Some people also benefit from an inhaled steroid or other medicines to prevent flare-ups. Correct inhaler technique is essential.
- Pulmonary rehabilitation
- A supervised program combines exercise, breathing techniques, education, and support. It can improve stamina and quality of life, including in people with severe COPD.
- Prevent and plan for flare-ups
- Stay current with recommended vaccines and have a plan for worsening symptoms. Antibiotics and short courses of steroids are used in selected flare-ups, rather than routinely for everyone.
- Oxygen and breathing support
- Oxygen is prescribed when oxygen levels are low enough to warrant it. Some patients with excess carbon dioxide benefit from a breathing-support mask, often at night. Never smoke near oxygen.
- Nutrition and activity
- Maintaining strength, adequate nutrition, and regular activity within your abilities helps support breathing and recovery.
Your pulmonary clinician can review additional medications when symptoms or flare-ups persist despite standard treatment.[9]
Why less lung can mean easier breathing
How does lung volume reduction help?
With advanced emphysema, the most damaged areas may stay overinflated with trapped air. This is called hyperinflation. It crowds the better-functioning lung and flattens the diaphragm, the main muscle used for breathing.[8]
The goal is better function from the remaining lung. Neither treatment replaces damaged air sacs or cures COPD.[2][3][8]
Matching the treatment to the patient
Who may benefit from LVRS?
An evaluation may be worthwhile when severe emphysema continues to limit daily life despite optimized medication and pulmonary rehabilitation. Potential candidates generally have substantial air trapping, identifiable areas of severe damage, and enough preserved lung and overall strength to benefit from surgery. Stopping smoking is essential.[2][8]
The pattern of emphysema matters
The strongest evidence of a survival benefit is in carefully selected patients with emphysema mainly in the upper lungs and low exercise capacity after rehabilitation. Other selected patients may improve their breathing, activity, and quality of life without a proven survival benefit.[4][8]
Very poor lung function, severely impaired oxygen transfer, certain patterns of widespread emphysema, significant heart disease, pulmonary hypertension, or frailty can make surgery too risky or unlikely to help. A diagnosis of “severe COPD” by itself does not establish whether LVRS is appropriate.[8]
Building an individual plan
What does the evaluation involve?
A pulmonary specialist and thoracic surgeon review your symptoms, treatment, imaging, and goals together. Tests help estimate both the likely benefit and the risk of a procedure.[2][8]
| Assessment | What it helps determine |
|---|---|
| Breathing tests | Spirometry measures airflow; lung volumes measure trapped air; the diffusion test (DLCO) assesses how well gas moves from the lungs into the blood. |
| Chest CT | The severity and distribution of emphysema, areas of better-preserved lung, and other findings that may affect treatment. |
| Walking or exercise testing | Your exercise capacity, oxygen needs with activity, and response to rehabilitation. |
| Heart and oxygen assessment | Heart function, pressure in the lung circulation, and oxygen and carbon dioxide levels. Testing is individualized. |
| Additional testing for valves | Whether air can enter the target lobe from neighboring lung through alternate pathways, called collateral ventilation. CT and sometimes measurements during bronchoscopy assess this.[6] |
Bring your medication list, breathing-test results, and information about prior CT scans and pulmonary rehabilitation. The First Visit guide can help you prepare.
The operation
What happens during LVRS?
LVRS is performed under general anesthesia. The surgeon removes selected areas of severely damaged lung with stapling instruments, preserving as much useful lung tissue as possible.[2][8]
A minimally invasive approach uses small chest incisions, a camera, and specialized instruments. The surgical approach and whether one or both lungs are treated depend on the pattern of disease and your overall condition. Treatment of the two sides may sometimes be staged.[8]
Chest tubes remove air and fluid while the lung heals. The team monitors breathing, manages pain, and helps you begin walking and breathing exercises after surgery.[8]
Comparing the options
LVRS and endobronchial valves
After medication and pulmonary rehabilitation have been optimized, Dr. Servais generally favors LVRS as the initial lung volume reduction procedure for appropriate surgical candidates. Endobronchial valves offer an alternative for selected patients. The recommendation depends on the pattern of emphysema, overall health, and individual goals.
LVRS has an established record of improving breathing and activity, with a demonstrated survival benefit in selected patients. Valve treatment does not need to be tried before considering surgery.[4][7][8]
| Feature | LVRS | Endobronchial valves |
|---|---|---|
| Role in treatment | An established treatment with long-term evidence, including a survival benefit in selected patients. | An alternative for selected patients whose anatomy, procedural risk, and goals favor a bronchoscopic approach. |
| How it works | Removes selected areas of severely damaged lung. | One-way valves let air leave a target lobe while blocking air from re-entering through its airways. |
| How it is done | An operation through chest incisions, often using a minimally invasive approach. | A bronchoscope passes through the mouth into the airways under anesthesia; no chest incisions are needed. |
| What determines suitability? | The emphysema pattern, air trapping, preserved lung function, and ability to tolerate surgery. | A suitable target lobe with little or no collateral ventilation, along with appropriate lung function and overall health. |
| Recovery | Hospital recovery with chest tubes, followed by a gradual increase in activity and rehabilitation. | Usually at least three nights in hospital for monitoring. Recovery can be shorter, but pneumothorax or other complications may prolong it. |
| Important risks | Persistent air leak, pneumonia, and breathing or heart complications. | Pneumothorax (air around the lung), infection, bleeding, and possible need to adjust or remove valves. |
| Longer-term considerations | Targeted lung tissue is permanently removed, and benefits may last several years. Ongoing COPD care remains essential. | Valves are removable and may need adjustment, replacement, or removal. Ongoing COPD care remains essential. |
Both options require careful selection and carry the possibility of serious complications.[2][3][4][6][8]
Surgery can also treat suitable areas when collateral ventilation makes valves ineffective. Bullectomy, removal of a very large air space that compresses healthier lung, and lung transplantation are different treatments considered for particular situations.[1][6][9]
Setting realistic expectations
Benefits, limitations, and risks
In appropriately selected patients, LVRS can reduce breathlessness and improve lung function, exercise capacity, and quality of life. Some people need less oxygen afterward, but this is not guaranteed. Benefits can last several years, although they may diminish as COPD progresses.[4][8]
Survival benefit is not the same for everyone. The National Emphysema Treatment Trial found improved survival in patients with upper-lung-predominant emphysema and low exercise capacity after rehabilitation. It also identified patients at high risk who should not undergo LVRS.[4][7][8]
A persistent air leak from the treated lung is a common complication and may require a chest tube for longer than expected, a longer hospital stay, or another procedure. Other possible complications include pneumonia, bleeding, infection, blood clots, heart rhythm problems, and respiratory failure requiring a breathing machine. Serious complications, including death, are possible. Dr. Servais will explain your individual risk and how the team works to reduce it.[2][8]
After treatment
Recovery and ongoing COPD care
- In the hospital
- Expect several days of monitoring after LVRS. The duration depends on breathing, mobility, chest-tube needs, and any complications. An air leak may prolong the stay.
- Pain and movement
- Pain treatment helps you breathe deeply, cough, and walk. Activity increases gradually; chest discomfort and fatigue improve as you heal.
- Returning to routine
- Recovery continues over the following weeks. Driving, lifting, exercise, and return to work depend on your progress and the operation performed. The team will give you specific instructions.
- Long-term care
- Continue prescribed inhalers, smoking avoidance, pulmonary rehabilitation, and follow-up. Oxygen needs are reassessed; do not change oxygen use on your own.
Improvement is gradual, and recovery varies. LVRS is an addition to ongoing COPD care.[2][8][9]
Learn more about chest tubes and air around the lung →Questions to bring to your consultation
- Have my medicines, inhaler technique, and rehabilitation been optimized?
- Does my CT show a pattern of emphysema that may respond to lung volume reduction?
- Would surgery, valves, or another approach offer the best balance of benefit and risk?
- What improvement is realistic for my breathing, daily activity, and oxygen needs?
- What should I expect for hospital stay, chest tubes, recovery at home, and rehabilitation?
Ask your clinician whether lung cancer screening is appropriate for your age, smoking history, and overall health. Screening and emphysema treatment address different needs.
Sources & further reading
Freely accessible patient resources appear first. The clinical references provide more detail about patient selection and the evidence for treatment.
Patient resources & clinical references
Patient resources
- National Heart, Lung, and Blood Institute: COPD Treatment.
- American Lung Association: Lung Volume Reduction Surgery.
- American Lung Association: Endobronchial Valve Treatment.
- National Heart, Lung, and Blood Institute: National Emphysema Treatment Trial (NETT).
- National Heart, Lung, and Blood Institute: COPD Diagnosis.
- Weill Cornell Medicine: Evaluating patients for bronchoscopic and surgical lung volume reduction.
Research and clinical background
- Fishman A, et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. New England Journal of Medicine. 2003;348:2059–2073.
- Martinez FJ. Lung volume reduction surgery in COPD. UpToDate. Updated August 13, 2026; literature reviewed through September 2026. Subscription may be required.
- Han MK. Patient education: Chronic obstructive pulmonary disease (COPD) treatments (Beyond the Basics). UpToDate. Updated July 23, 2025; literature reviewed through September 2026. Subscription may be required.
Updated October 26, 2026. This guide supports a discussion with your care team. Treatment choices depend on your symptoms, test results, overall health, and goals.