Detail (Long)
If no large bulla, consider ELVR or LVRS in select pts.<br>
◦ LVRS improves survival in severe dz w/ upper-lobe emphysema + low post-rehab exercise capacity [A]; however, LVRS shows higher mortality vs. medical mgmt in pts w/ FEV<sub>1</sub> ≤20% predicted w/ either homogeneous dz on HRCT or DLCO ≤20% predicted.<br>
◦ ELVR (e.g., EBV [A], LVRC [B], VA [B]) ↓ end-exp lung volume and ↑ exercise tolerance, health status, and lung fxn at 6-12mo in select pts.
◦ LVRS improves survival in severe dz w/ upper-lobe emphysema + low post-rehab exercise capacity [A]; however, LVRS shows higher mortality vs. medical mgmt in pts w/ FEV<sub>1</sub> ≤20% predicted w/ either homogeneous dz on HRCT or DLCO ≤20% predicted.<br>
◦ ELVR (e.g., EBV [A], LVRC [B], VA [B]) ↓ end-exp lung volume and ↑ exercise tolerance, health status, and lung fxn at 6-12mo in select pts.