Emphysema is a slow killer. Severe emphysema even alienates family members as the patients relegate themselves to the length of their oxygen tubing and suffer through an acquired mutism from conversational dyspnea. Patients and families slowly realize the limitations caused by the irreversible loss of pulmonary reserve.

Despite the hours spent counseling tobacco cessation, encouraging the use of inhalers with proper technique, ensuring compliance with durable medical equipment, and enrolling in pulmonary rehabilitation, more than once have we observed these methods fall short of the expected outcome. As healthcare professionals, we have watched as patients progressed from one to three inhaler combinations, to requiring oxygen, to getting on lung transplant lists.

In appropriate patients, both surgical and bronchoscopic lung volume reduction (BLVR) can have significant morbidity benefits. BLVR is an excellent minimally invasive option for patients who fit within specific criteria, and physicians play a critical role in recognizing potential candidates and facilitating timely evaluation. Patients who experience severe airflow limitation (FEV1 ≤50%) and hyperinflation (TLC ≥100; RV ≥150) meet initial screening criteria to be seen by an experienced interventional pulmonologist who can discuss BLVR.

Most BLVR procedures in the US are performed using endobronchial valves (EBVs), which are placed in the airways of the selected lobes to block airflow to the most diseased areas, allowing healthier lung tissue to function more efficiently.

As healthcare professionals, it’s important to understand the broader impact of severe COPD on our patients’ everyday lives. Asking questions about their lifestyle and how the disease affects their daily activities, personal goals, etc., can provide valuable insights into their quality of life. For instance, questions like, “Are your symptoms preventing you from enjoying hobbies or activities you used to love?” and “Have you had to miss out on family gatherings or social events due to shortness of breath?” can help identify areas where interventions like BLVR might make a significant difference.

While the rate of development and implementation of new medical technology is always slower than the progression of the disease, it is imperative to know that there is now something more we can do for patients who suffer from severe emphysema or COPD.