Chronic obstructive pulmonary disease (COPD) is the most extensively studied and researched disease in pulmonology and a cause of significant morbidity, mortality, and financial burden on patient’s family and country’s economy. Its management continues to be a challenge to both the physician and the patient’s family. So far, it is preventable and treatable but not curable. Emphysema, a phenotype of COPD, is the most debilitating condition associated with progressive exercise intolerance and severe dyspnea. Despite decades of research, medical treatments available so far have helped improve quality of life and slowed down the decline in respiratory function but did not significantly improve the survival benefits. Though surgical lung volume reduction (LVR) procedures have shown some promise in context to functional gains and survival but, only in a carefully selected group of patients, bronchoscopic LVR procedures are yet to explore their full potential and limitations. This paper retrospectively studied the developments so far, medical and surgical, with special emphasis on the bronchoscopic procedures of lung volume reduction, and tried to comparatively analyze the risks and benefits of each one of them through various trials and studies done to date. 1. Chronic Obstructive Pulmonary Disease: Available Treatments and Interventions Chronic obstructive pulmonary disease is now a widely recognized major health problem with an increasing trend throughout the globe. As per the future projections it is likely to become the third leading cause of death [1] by year 2030 and fifth leading cause of DALY (Disability Adjusted Life Years) lost worldwide by year 2020 [2]. A more recent study predicts it to be the fourth leading cause of death by 2030 [3]. Our understanding of the disease so far has led us to believe that COPD behaves like a condition with premature aging of the lungs and that it is more of a systemic inflammatory disease with lungs as its primary target. This is evident from the fact that the natural course of COPD is characterized by a persistent fall in pulmonary function (FEV1) two-to-three times faster than seen in normal aging nonsmoking population [4] resulting in disabling symptoms, reduced exercise capacity, poor health related quality of life (HRQoL), chronic respiratory failure, and premature death. Inflammation remains a cornerstone in development and pathogenesis of COPD and its comorbidities [5, 6] and studies have shown various specific and nonspecific inflammatory markers increased in lungs and systemic circulation in patients with
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