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Lung Volume Reduction — RACP Adult Medicine MCQ

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HardRespiratoryLung Volume ReductionRACP Adult Medicine

A 68-year-old man with severe emphysema (FEV1 22% predicted) and hyperinflation (RV/TLC 0.65) has debilitating breathlessness despite maximal inhaler therapy and pulmonary rehabilitation. CT shows heterogeneous upper-lobe-predominant emphysema. What intervention may improve lung function and exercise capacity?

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Correct answer: C — Lung volume reduction surgery or bronchoscopic lung volume reduction

Lung volume reduction surgery (LVRS) or bronchoscopic lung volume reduction (BLVR – endobronchial valves, coils) improves exercise capacity, dyspnoea, and quality of life in selected emphysema patients. Best candidates have heterogeneous upper-lobe-predominant emphysema, hyperinflation (RV >175% predicted), low exercise capacity, and FEV1 15–45% predicted (NETT trial). BLVR with endobronchial valves requires absence of collateral ventilation (assessed by Chartis catheter). The LIBERATE and IMPACT trials support BLVR in appropriately selected patients.

Reference: eTG – 2025 – Respiratory; TSANZ – 2024 – LVRS/BLVR Position Statement