Indications and contraindications for lung volume reduction surgery
| Indications | Relative contraindications |
| Clinical | |
| Age <75 yrs | Age >75 yrs |
| Disability despite maximal medical treatment including pulmonary rehabilitation | Comorbid illness with 5‐yr mortality >50% |
| Exsmoker (>3 months) | Severe obesity or cachexia |
| Surgical constraint | |
| α1‐Antitrypsin deficiency | |
| Physiological | |
| FEV1 <35% pred | FEV1 >40% pred |
| RV/TLC >60% | RV <150% pred |
| TL,CO <20–40% pred | TLC <100% pred |
| 6MWD >300 m | Increased inspiratory resistance |
| TL,CO <20% pred | |
| Pa,CO2 >55 mmHg | |
| 6MWD <300 m | |
| MPAP >35 mmHg | |
| Imaging | |
| Severe heterogeneous emphysema on CT with upper lobe predominance | Minimal emphysemaSevere homogeneous emphysema |
FEV1: forced expiratory volume in one second
RV: residual volume
TLC: total lung capacity
TL,CO: transfer factor of the lung for carbon monoxide
6MWD: 6‐min walking distance
Pa,CO2: arterial carbon dioxide tension
MPAP: mean pulmonary artery pressure
CT: computed tomography
pred: percentage of the predicted value
(1 mmHg=0.133 kPa)