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COPD Treatment: 3 Types Of Surgeries Patients With Severe Symptoms Can Consider

by — Last updated: 2019-09-28 in Respiratory tract disorders and diseases

When all lifestyle and medication options have been exhausted and a COPD patient's quality of life has severely declined, surgery may be an option. What should you know?

Rescue inhalers and long-acting bronchodilators. Steroids. Oxygen therapy. A comprehensive pulmonary rehabilitation program that includes exercise, education, and nutritional advice. Antibiotics, an annual flu shot, and pneumococcal vaccination. A true wealth of treatments is available during every stage of chronic obstructive pulmonary disease — but some patients still won't get sufficient relief. 

If this includes you, you may just be a candidate for one of the surgeries that can help COPD sufferers in the more advanced stages. These operations are a bullectomy, lung volume reduction surgery, and a lung transplant. Beware, though, as surgery only helps a small number of patients and comes with serious risks as well as significant benefits. What do you need to know?

Who may benefit from COPD surgery?

Surgical options for COPD are only explored when all other options have been explored and have failed to yield satisfactory results, but even in those cases, not every person will be a candidate for every surgery, or even any surgery. Before you're seriously considered, your medical team will need to determine whether the potential benefits of surgery outweigh the risks.  

Regardless of the kind of surgery, to be a candidate, minimal requirements are that:

  • You are healthy enough to undergo the surgery, which (obviously) includes receiving general anesthesia.
  • You have to be attending a pulmonary rehabilitation program, and must have shown that you are capable of adhering to medications and medical advice.
  • You can't be a smoker. 

It is also, always, important for patients to understand the potential risks as well as the potential benefits — you must be able to give informed consent. 

COPD: When might bullectomy be an option?

Patients with emphysema can develop "air pockets" called bullae, which can develop into giant bullae and take up significant portions of your lungs. This leads to reduced blood flow and a lack of oxygen — and then severe shortness of breath and discomfort. Your remaining healthy air sacs, in turn, lack space and cannot function well either. A bullectomy — an operation to remove these enlarged air sacs — may be a solution. 

While your medical team will need to carefully consider whether you are a candidate for a bullectomy, but those who may end up with this operation will usually suffer from intense shortness of breath, cough up blood (hemoptysis), and have suffered recurrent infections of the bullae, which need to be especially large for you to be considered. Evaluations that will help determine if you are a candidate will include a chest x-ray and CT, lung function tests, a ventilation/perfusion (VQ) scan, and sometimes a lung angiography.

The surgery comes with risks:

  • Research shows that somewhere between zero and 22 percent of patients undergoing a bullectomy will die on the operating table or shortly after surgery. 
  • Respiratory failure is another risk. 
  • Lung infections can be a complication of the surgery.
  • Prolonged air leaks

COPD: Who may benefit from a lung volume reduction surgery?

Yes, this surgery reduces the volume of your lungs. You may wonder why this would be helpful to someone who already can't breathe properly. Lung volume reduction surgery can help some people with emphysema or a combination of emphysema and chronic bronchitis whose lung tissues and air sacs have become severely damaged, to the point where portions of the lungs become significantly enlarged and air is trapped, further obstructing breathing. 

The surgery removes part  — around a third —  of this damaged lung tissue in one upper lung or sometimes both, to allow the remaining portion of the lungs to work better. When it goes well and is conducted in the right candidate, lung volume reduction surgery can result in significantly improved breathing and a better quality of life. 

However:

  • Only people with severe or end-stage COPD are usually considered.
  • Only about one or two percent of COPD patients will ultimately be candidates, and only people with emphysma can benefit.
  • People with additional lung diseases like asthma, bronchiectasis, or pulmonary fibrosis may not be good candidates.
  • Only people who are healthy enough to undergo the surgery will be candidates. This means that the portion of your lungs that would remain needs to be healthy enough, and your heart needs to be strong enough as well.

Lung function tests and tests to determine the exact state of your emphysema will be carried out to determine if this surgery is suitable for you. Again, you need to be a (current, and from hereon out) non-smoker, participate in pulmonary rehab, and have shown that you can adhere to medication. You should not have other medical conditions that make the surgery risky, and you should be aware that lung volume reduction can cause complications and may be fatal. 

COPD: Who may be a candidate for a lung transplant?

A lung transplant, in which you receive one new lung, or even two, from a donor, is a last-resort surgery and the only hope of relief for some patients. Because the surgery ultimately depends on the availability of a donor, your medical team will consider whether you are a candidate for a wait list. 

Ideal candidates:

  • Will have end-stage COPD that can no longer reasonably be managed in other ways, but otherwise have no serious health problems.
  • This may include patients with an FEV1 of 20 percent or below, hypercapnia (sevely elavated carbon dioxide levels), and pulmonary hypertension.
  • Be younger than 65 years old, with older patients only being considered in some cases. 
  • Are not smokers, participate in pulmonary rehab, and have shown that they can stick to their medications and lifestyle recommendations. 
In short, because lung transplants come with extremely serious risks including death, people are considered when undergoing the surgery is less risky than not undergoing it. After an organ transplant, patients will need to take immunosuppressants — which can have serious side effects — for the rest of their lives.

  • Photo courtesy of SteadyHealth

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