Only a small number of patients with chronic obstructive pulmonary emphysema can look forward to help and relief from surgery.
Resection or surgical obliteration of large emphysematous bullae affords relief in a high percentage of patients. There must, however, be strict criteria for the choosing of surgical candidates. A large stationary bulla of at least one-third the size of the hemithorax, or an expanding bulla accompanied by increasing dyspnea are the most common symptoms of surgical candidates.
Preoperative regimen includes seven days of expectorant therapy and intermittent positive pressure breathing treatments. The most important and informative preoperative procedure is a pulmonary angiograph.
Joannides M. Chronic Obstructive Emphysema: The Thoracic Surgeon's Position. JAMA. 1965;192(5):365–367. doi:10.1001/jama.1965.03080180023004
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