Heelkundige of bronchoscopische behandeling van ernstig COPD? Stand van zaken

Certain surgical techniques may improve pulmonary function, exercise capacity and quality of life in selected patients suffering from severe end-stage emphysema, who remain symptomatic despite maximal pharmacological and non-pharmacological treatment. Bullectomy can be offered to patients with a giant bulla; lung volume reduction surgery can be proposed to patients with severe but not catastrophic, heterogeneous emphysema; and lung transplantation may constitute an option in relatively young patients with end-stage, homogeneous emphysema associated with hypoxemia, hypercapnia and pulmonary hypertension. As lung volume reduction surgery is associated with significant morbidity and mortality, less invasive alternative treatments are currently being investigated. Recently, various bronchoscopic techniques have been developed. Intrabronchial placement of one-way valves in patients with heterogeneous emphysema, as well as the creation of extra-anatomical airways by means of bronchial perforation followed by placement of drug-eluting stents seem the most promising.