Emphysema affects millions of people in the United States; the underlying pathophysiology is destruction of lung parenchyma resulting in hyperinflation. To date mainstay of treatment is medical care however currently there are 2 surgical treatment strategies approved by the FDA to reduce lung hyperinflation. First being lung volume reduction surgery (LVRS) which carries significant higher risk of mortality within 90 days of the procedure versus bronchoscopic lung volume reduction surgery (BLVR). BLVR has reduced peri-operative morbidity without compromising the long-term effect of improvement in post-bronchodilator forced expiratory volume 1 second (FEV1) and patient-reported outcomes. The added benefit of BLVR being a minimally invasive bronchoscopic procedure is that older adults who have end-stage emphysema who otherwise would not be appropriate surgical candidates for LVRS or transplant have an alternative treatment option.
This is a review paper focusing on Zephyr endobronchial valves (EBV). Specifically, will focus on: clinical outcomes involving the major trials that led to FDA approval, patient & lobar selection criteria, valve/deployment catheter features, detailed description of procedure, discussing the Chartis Pulmonary Assessment System and StratX report, management of complications and finally discussing next steps in protocolizing post-EBV placement care.
The expert opinion section focuses on outcomes from the LIBERATE Trial and 1-yr . Further 5-year follow-up post Zephyr EBV placement along with protocolization post-EBV placement are needed to minimize adverse events and/or be able to treat accordingly especially with high risk of pneumothorax (PTX).

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