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LVRS Candidate Selection — RACP Adult Medicine MCQ

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HardRespiratoryLVRS Candidate SelectionRACP Adult Medicine

A 60-year-old man with severe COPD (FEV₁ 22%) is being considered for lung volume reduction surgery (LVRS). He has upper-lobe predominant emphysema on CT. He has poor exercise capacity (6MWD 180 m). Cardiopulmonary exercise testing shows low exercise capacity. He has completed pulmonary rehabilitation. What additional criterion would make him a GOOD candidate for LVRS?

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Correct answer: D — Upper-lobe predominant emphysema + low exercise capacity

NETT trial identified the ideal LVRS candidate: upper-lobe predominant emphysema + low exercise capacity after rehabilitation. This subgroup had the best survival benefit from LVRS. Poor candidates (increased mortality): FEV₁ <20% with DLCO <20% OR homogeneous emphysema (these patients did WORSE with surgery). Endobronchial valve therapy (BLVR — Zephyr valves) is an alternative to surgical LVRS for selected patients with heterogeneous emphysema and intact interlobar fissures.

Reference: COPD-X 2024; NETT Trial; LIBERATE/IMPACT Trials